SSS & EC BENEFITS

Presented by:
SMD Benefits Administration Department

Service Quality Fundamentals and Core Processes Training

 COVERAGE: MEDICAL BENEFITS
SSS EC
Sickness
Sickness

Medical & Related Services

Maternity

Rehabilitation Services
Disability
Disability
01 SICKNESS BENEFIT
Daily cash allowance paid for
the number of days a
member is unable to work
due to sickness or injury.

Sickness
Benefit
 Qualifying Conditions
In accordance with Sec. 14 of the SS Law, a member is
entitled to avail of sickness benefit if:
 Confined either in the hospital or at home for at least
four (4) days ;
 Paid at least three (3) monthly contributions within the
12-month period immediately before the semester of
sickness or injury;
 Has notified the employer , if employed or the SSS, if
SE/VM/separated from employment regarding his
sickness or injury; and
 Has used up all company sick leave with pay for the
current year. [For employed members]
Policy on Flexibility
Based on Commission Res. No. 639, s-1970

Rule:
When the start of the sickness confinement
period falls on the semester wherein the
member will not qualify for sickness benefit,
the confinement period shall be shortened in
such a way that the first day of confinement
shall be adjusted forward to the next semester
wherein he would qualify for the remaining
period of confinement.

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7
Example - Flexibility
Date of 1st employment - Dec. 1, 2016
Posted contributions - Dec. 2016 to May 2017 (6 months)
Approved Confinement - 06/01 /2017 to 07/30/ 2017 = 60 days

Computation based on approved confinement:

Semester of contingency - 01/2017 – 06/2017
12-month period - 01/2016 – 12/2016
Member is not qualified because there is only 1 contribution (Dec. 2016) within
the 12-month period prior to the semester of sickness.

Applying the rule on Flexibility:

Start of compensable confinement will be July 1, 2017
Next Sem. of contingency - 4/2017 – 09/2017
12-month period - 4/2016 – 03/2017
Adjusted compensable confinement period - July 1 to 30, 2017 = 30 days

Member is qualified because there are 4 contributions (Dec. 2016 to March 2017) within
the 12-month period prior to the semester of sickness.
 Rules on Sickness Notification
SE/VM/Member separated from
Employed Member employment

EE to ER - within 5 calendar days Member to SSS - within 5 calendar

after the start of confinement. days after the start of confinement

ER to SSS - within 5 calendar days Note: OFWs are given 30-day grace
after receipt of notification from period beyond the 5-day
employee prescriptive period in filing sickness
claims. This only apply to cases not
requiring hospital confinement (SSC
Res. No. 524-s.2015 dated July 8, 2015;
Office Order No. 2015-042 ).
Failure to observe the rule on notification shall be a ground for the
reduction or denial of the sickness claim application.
 Amount of Benefit
The amount of sickness benefit per day is equivalent to
90% of the member’s average daily salary credit.

Maximum Period of Entitlement

 120 days in one calendar year
 Daily sickness benefit shall not be paid for more
than 240 days on account of the same illness

Note: If the sickness persists after 240 days the

member may be entitled to disability benefit
 Manner of Payment

• The employer shall advance the benefit every regular

FOR payday. The amount advanced by the employer will
EMPLOYED be reimbursed 100% by the SSS either thru check or
MEMBERS thru employer’s depository bank (Sickness &
Maternity Benefit Payment Thru The Bank Program)

FOR SE/VM • SSS will pay directly to the member either thru
AND check or thru member’s depository bank (Sickness &
SEPARATED Maternity Benefit Payment Thru The Bank Program)
MEMBER Mandatory effective Oct. 6, 2016

SMEC disbursement for January 1, 2017 to December 31, 2017

 Thru the Bank - 95.78%
 Thru Check - 4.22%
 When To File the SBRA

 FOR HOME CONFINEMENT - Within one (1)

year from the start of illness.

 FOR HOSPITAL CONFINEMENT - Within one (1)

year from the last day of confinement.
EXAMPLE:

Home Confinement

Approved Confinement - 03/01/2016 – 03/30/ 2016 = 30 days

(1 yr. period from start of confinement – March 1, 2016 to February 28, 2017)

Sickness benefit reimbursement filed by ER on March 5, 2017

Existing: Claim is for denial - filed beyond 1 year period from the start of illness

Note:
Claim should not be denied based on Section 14 (c) of the SS Law

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 SS LAW (RA 8282)
SEC. 14. Sickness Benefit. (C)

“That the SSS shall reimburse the employer or pay

the unemployed member only for confinement
within the one-year period immediately preceding
the date the claim for benefit or reimbursement is
received by the SSS, except confinement in a
hospital in which case the claim for benefit or
reimbursement must be filed within one (1) year
from the last day of confinement.”

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EXAMPLE:

Home Confinement
Approved Confinement - 03/01/2016 – 03/30/ 2016 = 30 days
Sickness benefit reimbursement filed by ER on March 5, 2017
(1 yr. period immediately preceding the claim is filed – Mar. 5, 2016 to Mar. 4, 2017)
Reimbursable period: March 5, 2016 to March 30, 2016 = 26 days

Hospital Confinement
Approved Confinement - 03/01/2016 – 03/30/ 2016 = 30 days
Last day of hospital confinement - March 5, 2016
Sickness benefit reimbursement filed by ER on March 10, 2017
(1 yr. period from the last day of confinement – March 5, 2016 to March 4, 2017)
Claim is for denial - filed beyond 1 year period from the last day of confinement
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What if the last day of filing of sickness notification or
filing for sickness benefit reimbursement falls on a
Saturday, Sunday or holiday?

SSC Res. No. 778-s.2016 dated 09 Nov. 2016 (Office Order No.
2017-001 dated 03 Jan. 2017), approved the policy that
whenever the last day to: (i) notify the employer or SSS of an
employee’s/member’s sickness or injury, or (ii) file a claim for
reimbursement for sickness benefit falls on a Saturday, Sunday or
holiday, the sickness notification or claim for reimbursement may
be filed on the immediately succeeding working day without the
penalty of delay.
POLICIES (Office Order No. 2017-001 dated 03 Jan. 2017)

1. Holiday shall mean legal, regular or special non-working day

declared by the national government or local government.
2. The 5-calendar day notification period of the employee to the
employer and the employer to SSS, respectively, may be done on
the next working day if the last day of filing the sickness
notification falls on a Saturday, Sunday or holiday.
3. The determination of the compensable period under par. (c)
Section 14 of SS Law, shall exclude the Saturday, Sunday or holiday
where the deadline falls as in the following cases.
a. 10-calendar day period immediately before the date of
notification to the SSS by the employer
b. One-year period immediately before the date the claim for
benefit or reimbursement is received by the SSS; and
c. One-year period from the last day of confinement in a hospital.
4. Should the member or the employer fails to notify or file the
reimbursement claim on the immediately succeeding or next
working day, the usual procedure shall be applied in the
evaluation based on the actual date the notification or
reimbursement was received by SSS.
5. The sickness benefit application of members who are OFWs shall
continue to be governed by the policies approved under Office
Order No. 2015-042 that gives them a 30-day grace period beyond
the existing five-day prescriptive period in the initial filing of
sickness benefit application for cases that do not require hospital
confinement.

For hospital confinement, if the deadline of the one-year

prescriptive period will also fall on Saturday, Sunday or holiday, the
rule as stated in this Office Order shall also be applied.
CLAIMS THAT SHOULD BE DENIED AT THE BRANCH LEVEL

• Delay in Notification – ER to SSS

Example:
Approved confinement (No. of days) : 4 days
Delay in Notification – ER to SSS : 4 days

• Claims filed beyond the prescriptive period

NOTE:
All sickness claims denied by the branch with an appeal for
reconsideration from the claimant, shall be endorsed to the
respective Local BenRC for final evaluation and decision (Office
Order No. 2017-013 dated 02 March 2017)
 Where To File

 ANY SSS BRANCH THAT IS MOST

CONVENIENT TO MEMBER.
 Documents Required
 FOR EMPLOYED MEMBERS

1. Sickness Benefit Reimbursement Application (SBRA)

2. Approved Sickness Notification or Certificate of
Medical Approval issued by the Medical Evaluation
Section
3. Copy of page of Employer’s Logbook (manual
logbook or electronic filing) for approved EC claim
4. Filers SS card or other valid IDs
 Documents Required
FOR SELF-EMPLOYED/VOLUNTARY MEMBER &
MEMBER SEPARATED FROM EMPLOYMENT

1. Sickness Benefit Application

2. Copy/ies of page/s of Employer Logbook (manual
logbook or electronic filing) for EC claims
3. Filers Valid Identification Cards/Documents
ADDITIONAL DOCUMENTS FOR:
MEMBER SEPARATED FROM EMPLOYMENT
SELF-EMPLOYED AND VOLUNTARY MEMBER (Previously employed)

 If confinement period applied for is within the period of

employment or prior to date of separation
CERTIFICATE OF SEPARATION FROM EMPLOYMENT WITH EFFECTIVE DATE OF
SEPARATION AND THAT NO ADVANCE PAYMENT WAS GRANTED (SIGNED BY THE
AUTHORIZED COMPANY REPRESENTATIVE REFLECTED IN L-501 OF EMPLOYER)

 If confinement period applied for is after the date of separation (for

member separated from employment)
CERTIFICATE OF SEPARATION FROM EMPLOYMENT WITH EFFECTIVE DATE OF
SEPARATION (SIGNED BY THE AUTHORIZED COMPANY REPRESENTATIVE REFLECTED
IN L-501 OF EMPLOYER)

 If company is on strike
• NOTICE OF STRIKE DULY ACKNOWLEDGED BY THE DOLE
• DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER THAT
NO ADVANCE PAYMENT WAS GRANTED

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Continuation -
 If there is a case pending before a court regarding
separation of member
• CERTIFICATION FROM DOLE
• DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH
EFFECTIVE DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT WAS
GRANTED

 If company has been dissolved or has ceased operation

DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH
EFFECTIVE DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT WAS GRANTED

 If separated from employment due to AWOL or with strained

relations with the employer
DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH
REASON AND EFFECTIVE DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT
WAS GRANTED

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AFFIDAVIT OF UNDERTAKING FOR SICKNESS AND MATERNITY
BENEFITS OF SE/VM/MEMBER SEPARATED FROM EMPLOYMENT

a. Duly notarized Affidavit of Undertaking by members replaces

the Certificate of Separation and non-advance payment of
benefit for members who can no longer secure certificate of
separation and non-advancement from their previous
employer.

b. The Affidavit of Undertaking shall at all times be properly

accomplished and duly notarized. Thus, field investigation
shall no longer be made by the Branches and the Large
Account Departments.
AFFIDAVIT OF UNDERTAKING FOR SICKNESS AND MATERNITY
BENEFITS OF SE/VM/MEMBER SEPARATED FROM EMPLOYMENT

c. The Member Service Representative (MSR) of the Member

Services Section/Senior Clerk of the Medical Evaluation
Section (MES) shall elevate, for approval, to his/her Branch
Head/MES Head the duly notarized affidavit with other
reasons why the member cannot secure a certificate of
separation and non-advancement, aside from those listed in
the affidavit form
 Computation Of Sickness Benefit

 Exclude the semester of contingency;

 Select the six highest monthly salary credits (MSC)

within the 12-month period immediately before
the semester of contingency to arrive at the total
monthly salary credit (TMSC);
 Divide the TMSC by 180 to get the average daily
salary credit (ADSC);

 Multiply the ADSC by 90 % to get the daily sickness

allowance (DSA); then
 Multiply the DSA by the number of approved days
to get the amount of sickness benefit.
Quarter – refers to 3 consecutive months ending in the
month of March, June, Sept. and December

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

• January • April • July • October

• February • May • August • November
• March • June • September • December
Semester - Two consecutive quarters ending in the Quarter of Contingency

2016 2017
1st Quarter 1st Quarter
• January • January
• February • February
• March • March Jan-June:
2nd Quarter Semester
2nd Quarter
• April • April
• May • May
Oct 2016 to
• June Mar 2017: • June Apr-Sept:
3rd Quarter Semester Semester
3rd Quarter
• July • July
• August • August
• September • September
4th Quarter 4th Quarter July-Dec:
• October • October Semester
• November • November
• December • December
 Sickness Benefit Computation
Confinement Period Dec 1-30, 2017 30 days
Current Company Sick Leave with pay Dec 1-5, 2017 5 days

MONTHLY SALARY CREDIT

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2017 16,000 16,000 0.00 0.00 0.00 0.00 16,000 16,000 16,000 16,000 16,000 16,000

2016 16,000 16,000 16,000 16,000 16,000 16,000 0.00 0.00 0.00 16,000 16,000 16,000

Exclude the semester of

• July 2017 to Dec 2017
contingency

12 month period before

• July 2016 to June 2017
semester of contingency
 Sickness Benefit Computation
2016 Oct 16,000
Member has only 5 qualifying
2016 Nov 16,000
contributions within the 12 month
2016 Dec 16,000
period immediately before the
2017 Jan 16,000
semester of contingency
2017 Feb 16,000
Total Monthly Salary Credits 80,000
Divided by (constant) 180
Average Daily Salary Credit 444.44
Multiplied by 90% 90%
Daily Sickness Allowance 400.00
Multiplied by approved number of days
25
30 days confinement less 5 days company sick leave w/ pay
Amount Of Sickness Benefit P 10,000.00
 Case Problem
Approved Confinement (Home) - 02/01 – 05/31/ 2017 = 120 days
Company sick leave w/ pay - Exhausted
Total Monthly Salary Credit - P60,000
Sickness reimbursement filed by ER on Feb. 28, 2018

Is the ER still qualified for the sickness reimbursement?

If yes, compute the reimbursable amount due the
employer. If no, support your answer.
ANSWER
a) Yes, even if ER reimbursement was filed beyond one
year, only the period that was late shall be deducted.

b) Reimbursable amount due the employer

Sem. of contingency - 10/2016 – 03/2017
12 month period - 10/2015 – 09/2016
TMSC - 60,000
Divided by - 180
ADSC - 333.33
Multiplied by - 90%
DSA - 300.00
Multiplied by - 93 days
(Feb 28 to May 31, 2017 = 93 days)
Amount due - P 27,900.00
 Case Problem
Date of 1st employment - July 1, 2017
Approved Confinement - 12/10/2017 – 01/3/2018 = 25 days
Co. sick leave w/ pay - Exhausted
MSC (July 2017 to Dec 2017) – P10,000/month

Is the member qualified for sickness benefit? If yes,

compute the sickness benefit due the member. If no,
support your answer.
ANSWER
a) Yes, applying the “Flexibility in Sickness Benefit” the
member is qualified.

Start of compensable confinement will be January 1, 2018

Next Sem. of contingency - 10/2017 – 03/2018

12 month period - 10/2016 – 09/2017
TMSC - 30,000
Divided by - 180
ADSC - 166.67
Multiplied by - 90%
DSA - 150.00
Multiplied by - 3 days (Jan 1 to 3, 2018) = 3 days
Amount due - P 450.00
02 MATERNITY BENEFIT
Daily cash allowance
granted to a female
member who is unable to
work due to childbirth or
miscarriage.

Maternity
Benefit
 Qualifying Conditions
Section 14-A of the SS Law
 Has paid at least three (3) monthly contributions
within the 12-month period immediately before
the semester of member’s childbirth or
miscarriage; and

 Has notified her employer of her pregnancy and

the probable date of her childbirth, which notice
shall be transmitted to the SSS, or directly to the
SSS if she is separated from employment,
voluntary or self-employed member.
 Rules on Maternity Notification
Employed Member
• Immediately notify employer thru an accomplished Maternity
Notification Form
• ER notifies the SSS thru the submission of the Maternity
Notification Form immediately after the receipt from EE
(either Over- the-Counter or thru SSS Website)

SE/VM/Member Separated from Employment

• Notify the SSS thru the following channels:
 Over-the-Counter (OTC)
 SSS Website
 Self-Service Information Terminal (SSIT)
 Rules on Maternity Notification

Failure to notify the SSS of the pregnancy of the employee

shall not bar the employee from receiving the benefit.
Continuation - Rules on Maternity Notification
Office Order No. 85-P dated May 21, 2003 – Guidelines in the
Processing of Maternity Claims in the Absence of Maternity
Notification

For delivery or miscarriage in a place other than a hospital:

1. Normal Delivery -

Branch shall confirm the fact of birth from at least 2 of the ff.
sources:
• Lying-in Clinics
• Local Civil Registrar
• Employer
• Townspeople
Continuation - Rules on Maternity Notification
Verification of fact of birth from at least 2 sources maybe dispensed
with if the claim is supported by a written certification of an SSS
Officer or employee occupying at least a Team Head position (Level
5) or its equivalent, that he has personal knowledge of the actual
child birth of the member concerned, indicating the basis of his
information.

2. Miscarriage

The Medical Officer evaluates the claim based on the submitted

medical records
 Maternity Benefit
 100% of the Average Daily Salary Credit (ADSC) multiplied by
60 days for normal delivery or miscarriage and 78 days for
caesarean section delivery.
Note:
SSC Resolution No. 256-s.2013 dated 05 April 2013
approved the following:
 Inclusion of Hydatidiform Mole (H Mole) as compensable
under maternity benefit - 60 days
 Adjustment of compensable number of days for ectopic pregnancy
 Ectopic pregnancy without operation - 60 days
 Ectopic pregnancy with operation - 78 days

 Paid only for the 1st four deliveries or miscarriages.

 Miscarriages included (effective May 24, 1997)
 Maternity Benefit
Circular No. 36-V dated February 20, 1998

Item 2:

b. Maternity benefit shall be paid for the first four

deliveries including miscarriages.

c. The fifth delivery shall no longer be paid even if no

availments were made on previous deliveries (beginning
13 March 1973.
 Payment of maternity benefit is a bar to the recovery
of sickness benefit for the same period for which
daily maternity benefit has been received.
Example of overlapping of confinement
Member has settled sickness benefit for the period
January 1 to 30 2017. She gave birth thru a
caesarean delivery on January 20, 2017.

• The amount of sickness benefit for the period

January 20 to 30, 2017 shall be deducted from
the proceeds of her maternity benefit.
Manner Of Payment & Reimbursement
• The full payment shall be advanced by
the employer within 30 days from the
filing of maternity leave application. The
FOR
amount advanced by the employer will
EMPLOYED
be reimbursed 100% by the SSS either
MEMBERS thru check or thru employer’s depository
bank (Sickness & Maternity Benefit
Payment Thru The Bank Program)

• SSS will pay directly to the member

FOR SE/VM
either thru check or thru member’s
AND
depository bank (Sickness & Maternity
SEPARATED
Benefit Payment Thru The Bank
MEMBER
Program)
When to File

• Claim application shall

be filed within ten (10)
years from the date of
delivery or miscarriage.
 Where to File

 ANY SSS BRANCH THAT IS MOST

CONVENIENT TO MEMBER.

Office Order # 2012-068 dated Oct. 23, 2012

 Documents Required
 Maternity Benefit Reimbursement Application (for
employed member)
 Maternity Benefit Application (for SE/VM/member
separated from employment)

 Maternity Notification (MN) duly received by SSS prior to

delivery/miscarriage/procedure or Maternity Notification
Submission Confirmation (If filed thru the SSS Website if
employed or SSIT for SE/VM)
Note: MN is not required if the member has been confined in a
hospital duly licensed by the DOH.
 Documents Required
OTHER DOCUMENTS:
 NORMAL DELIVERY

 Original or certified true copy (CTC) of child’s birth or fetal death

certificate duly registered with the LCR
 CAESAREAN DELIVERY
 Original or certified true copy (CTC) of child’s birth or fetal death
certificate duly registered with the LCR
 Any of the following documents issued by the hospital
INDICATING THE TYPE OF DELIVERY:
 Operating Room Record (ORR)
 Surgical Memorandum
 Discharge Summary Report
 Medical/Clinical Abstract
 Delivery Report
 Detailed Invoice showing caesarean delivery charges (for deliveries abroad only)
The Original Copy of Birth Certificate is acceptable the same
way as the Certified True Copy. However, the original copy of
the Birth Certificate should contain the Registry Number as well
as the signature of the Local Civil Registrar.
 Documents Required
 COMPLETE MISCARRIAGE -
 Any of the following:
 Pregnancy test before and after miscarriage
 Ultrasound report indicating proof of pregnancy
 Medical certificate issued by attending physician
on the circumstances of pregnancy
 INCOMPLETE MISCARRIAGE -
 Any of the following:
 Certified true copy of hospital/medical record/s
 Dilation & Curettage (D & C) Report
 Histopathological Report
 Pregnancy test before and after miscarriage
 Ultrasound report indicating proof of pregnancy
 Documents Required
 ECTOPIC PREGNANCY -
 Any of the following:
 Certified true copy of hospital/medical record/s
 Certified true copy of ORR
 Histopathological Report
 Pregnancy test before and after miscarriage

 HYDATIDIFORM MOLE -
 All of the following:
 D & C Report; and
 Histopathological Report
 Documents Required
Note:
• In case of discrepancy/disparity in the birth order as per document
submitted and what is in the data base, the member shall be
required to submit a Medical Certificate bearing the Obstetrical
History

• The Medical Specialist may require other documents necessary for

the evaluation of the claim (for miscarriage/ectopic/H-Mole cases)

• For deliveries/miscarriages/procedure that happened abroad,

documents issued by foreign country should be with English
translation and duly authenticated by the Philippine Embassy/
Consulate Office or duly notarized by notary public in host country.
OBSTETRICAL HISTORY FORM

• Refrain from issuing the Obstetrical History form because said

form is unofficial

• Only in cases of discrepancy/disparity in the birth order as per

document submitted and what is in our data base, that the
member is requested to submit a Medical Certificate bearing
the Obstetrical History.
ADDITIONAL DOCUMENTS FOR SE/VM (Previously employed)

 If contingency is within employment period or within six (6) months

from date of separation
CERTIFICATE OF SEPARATION FROM EMPLOYMENT WITH EFFECTIVE DATE OF SEPARATION
AND NO ADVANCE PAYMENT WAS GRANTED (SIGNED BY THE AUTHORIZED COMPANY
REPRESENTATIVE REFLECTED IN THE EMPLOYER SPECIMEN SIGNATURE CARD (SS FORM L-
501)

ADDTL DOCUMENTS FOR MEMBER SEPARATED FROM EMPLOYMENT (Tagged

as Covered EE)
 If contingency is within employment period
CERTIFICATE OF SEPARATION FROM EMPLOYMENT WITH EFFECTIVE DATE OF SEPARATION
AND NO ADVANCE PAYMENT WAS GRANTED (SIGNED BY THE EMPLOYER’S AUTHORIZED
SIGNATORY REFLECTED IN SS FORM L-501)

 If contingency is after date of separation

CERTIFICATE OF SEPARATION FROM EMPLOYMENT WITH EFFECTIVE DATE OF SEPARATION
(SIGNED BY THE EMPLOYER’S AUTHORIZED SIGNATORY REFLECTED IN SS FORM L-501)
Certificate of separation is not required under any of the ff. conditions:

 If company is on strike
• NOTICE OF STRIKE DULY ACKNOWLEDGED BY THE DOLE
• DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER THAT NO
ADVANCE PAYMENT WAS GRANTED
 If there is a case pending before a court regarding separation of member
• CERTIFICATION FROM DOLE
• DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH EFFECTIVE
DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT WAS GRANTED

 If company has been dissolved or has ceased operation

DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH EFFECTIVE
DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT WAS GRANTED

 If separated from employment due to AWOL or with strained relations

with the employer
DULY NOTARIZED AFFIDAVIT OF UNDERTAKING ISSUED BY THE MEMBER WITH REASON AND
EFFECTIVE DATE OF SEPARATION AND THAT NO ADVANCE PAYMENT WAS GRANTED
 Computation of Maternity Benefit
 Exclude the semester of delivery/miscarriage;
 Select the six highest monthly salary credits within the
12-month period immediately before the semester of
contingency to arrive at the total monthly salary credit
(TMSC);
 Divide the TMSC by 180 to get the average daily salary
credit (ADSC). This is the daily maternity allowance; and

 Multiply the daily maternity allowance by 60 or 78 days

as the case may be to get the total amount of maternity
benefit.
 Maternity Benefit Computation
TYPE OF DELIVERY DELIVERY DATE NO. OF DAYS
Normal Dec 1, 2017 60 days
Caesarean Dec 1, 2017 78 days
MONTHLY SALARY CREDIT
Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2017 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000

2016 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000

Exclude the semester of

• July 2017 to Dec 2017
contingency
12 month period before the
• July 2016 to June 2017
semester contingency
 Computation of Maternity Benefit
2017 Jan 16,000
2017 Feb 16,000
Sum of the 6 highest MSC from the 12
2017 Mar 16,000
month period before the semester of
2017 Apr 16,000
contingency 2017 May 16,000
2017 June 16,000
Total Monthly Salary Credits 96,000
Divided by 180
Average Daily Salary Credit 533.33
Multiplied by 100% 100%
Daily Maternity Allowance 533.33
Multiplied by number of days
Normal delivery 60
Caesarean delivery 78
Amount of Maternity Benefit
Normal delivery P 32,000.00
Caesarean delivery P 41,600.00
 Case Problem
Date of employed/covered - January 15, 1994
Total Monthly Salary Credit - 60,000
Date of delivery (normal) - March 1, 2017

Previous pregnancies:
Delivery Date Type of Delivery Check No. Check Date
June 30, 1992 Normal (not yet employed)
Aug. 5, 1995 Miscarriage 652469 Aug.30, 1995
Feb. 14, 2001 Normal 589043 Mar. 5, 2001
May 30, 2007 Miscarriage 456789 June 15, 2007

Is the member still qualified for maternity benefit? If yes,

compute the benefit, If no, support your answer.
 Answer

YES
Semester of contingency - Oct. 2016 - March 2017
12 month period - Oct. 2015 - Sept. 2016
TMSC - 60,000
Divided by - 180
Ave. Daily Salary Credit - 333.33
Multiplied by - 100%
Daily Maternity Allowance - 333.33
Multiplied by - 60 days
Amount due - P 20,000.00
 Case Problem
I am an adoptive mother to an 11 month year old girl. I
would like to ask for the procedure on how to claim Maternity
Benefit as an adoptive mother.

As per R.A. 8552 Implementing Rules and Regulations, I

will be given the same rights as a biological mother should the
child be above 7 years old. Would the Pre-Adoptive Placement
Authority (PAPA) document be enough to claim my
benefit from SSS? Can I avail of the full 60 days SSS maternity
benefit even if I have not been confined?
 Answer
Legal Opinion dated February 11, 2016

• It is the position of this Office that Section 12 of RA No. 8552

does not include the maternity benefit granted under Sec. 14-A
of the SS Law (RA 1161), as amended by RA 8282 (Social Security
Act of 1997).

• Based on the provision of the SS Law (Sec. 14-A), the maternity

benefit shall only be granted to female SSS members who have
given birth or had miscarriage. Considering that adoptive
mothers have not given birth, it is our position that the SSS
maternity benefits does not apply to them
 Answer
Legal Opinion dated February 11, 2016

• It is likewise our opinion that the SS Law was not effectively

amended by RA 8552. A careful perusal of the provisions of RA
8552 reveals that nothing therein mentions that maternity
benefit under the SSS neither did it mention the SS Law as one of
the laws being amended by said act. Any amendment to the SS
Law, being a special law, should be expressly made in the
succeeding laws pursuant to established rules and jurisprudence
on statutory construction.
 ISSUED ADVISORY RE:
03 SICKNESS AND MATERNITY
USE OF THE MAIDEN NAME OF MARRIED WOMEN

• Female members can file sickness or maternity benefits using

their maiden name for as long as the member’s name per
claim application is the same as that in our database.

• Change of member’s name is required if the name per claim

application is married name but the member’s record in our
database is still the maiden name.
USE OF THE MAIDEN NAME OF MARRIED WOMEN

Name per Name per SSS Name per Birth Actions to be taken
Claim Database Certificate
Application
1. Maiden Name Married Name Married Name Advise the member to
change/correct her
name in the claim
application
2. Married Name Maiden Name Married Name Request member to
update her SSS record
3. Married Name Maiden Name Maiden Name thru E-4
4. Maiden Name Maiden Name Married Name Accept claim
application for
5. Maiden Name Maiden Name Maiden Name processing
6. Married Name Married Name Married Name
SICKNESS AND MATERNITY BENEFITS PAYMENT THRU THE BANK
PROGRAM
Approval of the request for exemptions for the following cases shall
be up to the Branch Head only:
1. For Employer
• Location of employer is far from bank
• Location of employer is in a high risk area; and
• Employer with number of employees three (3) and below

2. For SE/VM/Member Separated from Employment

• Member’s address is beyond 30 kms to the nearest SSS-accredited
bank;
• Member’s address is in a high risk area;
• Amount of benefit is one thousand pesos (P1,000.00) and below
regardless of the member’s address; and
• Member is physically incapable of transacting business with the
bank
SMBPB PROGRAM FOR SE/VM/MEMBER SEPARATED FROM
EMPLOYMENT

Member Service Representatives and Senior Clerks of the

Member Services Section and Medical Evaluation Section,
Branch Offices are advised to confirm from the SSS members
that the numbers they indicated in the Maternity Benefit
Application or in the Sickness Benefit Application form is the
account number. The ATM card with card number AND validated
deposit slip or bank statement is encouraged to be requested
from the SE/VM/Separated member to ensure that the account
number is valid and to facilitate receipt of the benefit payment
by the member.
 AUTOMATED REPLACEMENT
OF CANCELLED CHEQUES FOR
04 SICKNESS AND MATERNITY
(SMEC) BENEFIT PAYMENTS
OFFICE ORDER NO. 2017-071

SUBJECT: AUTOMATED REPLACEMENT OF CANCELLED

CHEQUES FOR SICKNESS AND MATERNITY BENEFIT
PAYMENTS

DATE : DECEMBER 18, 2017

Policy
1. Replacement of cheque shall be performed provided the
following conditions are satisfied:

a. Cancellation of the cheque has been effected by

Branch Accounting Department (BRAD) and posted in
the SSS WINS Check Status Inquiry; and

b. With request from the payee together with a

photocopy of any one (1) of the primary ID
cards/documents or of any two (2) secondary ID cards/
documents, both with signature and at least one (1)
with photo.
Policy
2. Reason for replacement of cancelled cheques are as
follows:
a. Returned/non-receipt/lost cheque
b. Outstanding cheque beyond the validity period.
c. Cheque previously reported as “cashed” but corrected
by the depository bank after the submission of
statement by BRAD or LuzVisMin Division-General
Accounting Section (Div-GAS) to Commission On Audit
(COA).

3. Replacement of cancelled cheques shall be the

responsibility of the Processing Center that settled the
claim.
Policy

4. Proceeds of the replaced cheque shall be credited to the

member’s/employer’s designated bank account under the
Sickness and Maternity Benefits Payment thru the Bank
Program if at the time of approval of cheque
replacement the member/employer has an enrolled
account, otherwise replacement shall be made thru
cheque.
The Member Services Section, Branch shall:

1. Receive and screen letter request for cheque replacement with

photocopy/ies of valid IDs from employer/member which
request may be with or without the physical cheque subject of
replacement.

a. If with SSS cheque – stamped “cancelled” indicate reason for

cancellation in the cheque and forward together with the
transmittal list to BRAD for cancellation within two (2)
working days from date of receipt of request.
b. If without SSS cheque – verify status from the SSS WINS if
already tagged as cancelled. Print status and attach to the
request for replacement. Otherwise, make an official request
to BRAD for issuance of Certificate of Cheque Status.
The Member Services Section, Branch shall:

2. If payee is self-employed (SE)/Voluntary Member (VM)/

Member Separated from Employment, verify from the
Registration and Coverage System (RCS) thru the Online Inquiry
System if the address of payee in the database is the same as
the address indicated in the letter request. Otherwise, update
the payee’s address and contact information in the RCS first
following the usual process before transmitting the request for
replacement to concerned Processing Center (PC)
NOTE:
Address of SE/VM/Member separated from employment
in the RCS is mandatory because the Check Replacement
Module (CRM) will retrieve the payee’s address from the RCS.
The CRM will reject request for replacement if payee has no
address to be retrieved from the RCS. Likewise, the PC will
also reject the request if the address of payee in the letter
request is not the same as the address in the RCS.
The Member Services Section, Branch shall:

3. Forward the following to the Processing Center that settled

the claim:
• Letter request for check replacement
• Photocopy/ies of payee’s valid IDs
• Print-out of cheque status from the SSS WINS-Check
Status Inquiry or Certification of Cheque Status
HANDLING OF EXCEPTIONS ON THE RECEIVING OF
REQUEST FOR CHEQUE REPLACEMENT (RCR) WITH
SUPPORTING DOCUMENTS

1. Check is not yet cancelled per WINS - Check Status Inquiry

• Prepare memo to Branch Accounting Department
(BRAD) requesting for the status of the check.

2. No address / different address in RRCS

• Require the member to accomplish the MDCR form for
updating/correction of registered mailing address in
RRCS.
03 DISABILITY BENEFIT
Cash benefit granted to a
member who becomes
permanently disabled
either partially or totally.

Disability
Benefit
 Kinds of Disability

 PERMANENT TOTAL

 PERMANENT PARTIAL
 Kinds of Disability
 PERMANENT TOTAL
The ff. disabilities shall be deemed permanent total
 Complete loss of sight of both eyes
 Loss of two limbs at or above the ankle or wrist
 Permanent complete paralysis of two limbs
 Brain injury resulting to incurable imbecility or insanity
 Such cases as determined and approved by SSS
 PERMANENT PARTIAL
Injury resulting to any of the ff. shall be deemed Permanent
Partial Disability. The benefits shall be payable not longer than
the period designated in the hereunder schedule:
Complete & Permanent loss of use of Number of Months
One Thumb 10
One Index Finger 8
One Middle Finger 6
One Ring Finger 5
One Little Finger 3
One Big Toe 6
One Hand 39
One Arm 50
One Foot 31
One Leg 46
One Ear 10
Both Ears 20
Hearing of One Ear 10
Hearing of Both Ears 50
Sight of One Eye 25
 The amount of monthly pension
is based on :
 THE NUMBER AND THE AMOUNT OF MONTHLY
CONTRIBUTIONS PAID BY THE MEMBER PRIOR TO THE
SEMESTER OF CONTINGENCY;
 HIS CREDITED YEARS OF SERVICE; AND

 THE NUMBER OF QUALIFIED DEPENDENT CHILDREN, IF

ANY
Minimum Pension
• P1,000.00 - with less than 10 CYS
• P1,200.00 - with at least 10 CYS
• P2,400.00 - with at least 20 CYS
Basic Formula in the Computation of Monthly Pension
The higher of the following:
 P 300 + (20% x AMSC) + [2% x AMSC x (CYS - 10)]

 40% x AMSC, or

 MINIMUM PENSION

CYS = A + B + C
Where A = 1985 minus the calendar year of coverage
B = number of years with at least 6 monthly
contributions from 1985 to 2001
C = total number of monthly contributions paid
per year divided by 12 beginning January 2002
AVERAGE MONTHLY SALARY CREDIT (AMSC) IS:

The bigger of:

THE SUM OF THE LAST SIXTY (60) MSC PRIOR
TO THE SEMESTER OF DISABILITY
AMSC = _____________________________________
60
OR
THE SUM OF ALL THE MSC PAID PRIOR TO THE
SEMESTER OF DISABILITY
AMSC = _____________________________________
THE NUMBER OF MONTHS PAID FOR THE
SAME PERIOD
Basic Formula in the Computation of Lump sum Benefit
Total disability - lump sum
The higher of the following:
 Monthly Pension (MP) x number of monthly contributions
paid to the SSS, or
 12 x the MP

Partial disability - lump sum

The higher of the following:
 MP x number of monthly contributions paid x Percentage
of disability in relation to the whole body
 MP x 12 x Percentage of disability in relation to the whole body
 Components of Disability Benefit
 BASIC BENEFIT
• Monthly Pension - cash benefit paid to a disabled person with at
least 36 monthly contributions prior to the semester of contingency
• Lump sum - granted to those with less than 36 monthly
contributions prior to the semester of contingency
 SUPPLEMENTAL ALLOWANCE of P 500.00/month
 ADDITIONAL PENSION BENEFIT of P 1,000.00/month (effective 01/01/2017)
 13th MONTH PENSION - payable every December to total disability
pensioners; for partial disability pensioners, 13th month pension shall be
paid provided that pension duration is at least 12 months.
 DEPENDENTS PENSION (for total disability) - 10% of the member’s
monthly pension or P 250.00 whichever is higher.
 Qualifying Conditions for
Dependents’ pension :
 Dependent child conceived/legally adopted on or
before the date of the member’s permanent total
disability but not exceeding five (5) beginning with the
youngest and without substitution.

 THE DEPENDENT’S PENSION STOPS IF THE CHILD:

 Reaches 21 years old;
 Gets married;
 Gets employed; or
 Dies
 Disability Pension Is :
 Transferable upon death of pensioner
[If with primary beneficiaries]

 Guaranteed for five [5] years

[If there are no primary beneficiaries]
 Grounds for suspension of pension of
a total disability pensioner:
 Recovery from total disability

 Re-employment or resumption of self-employment

 Failure to present himself for physical examination
and interview at least once a year upon notice by
SSS.
DEEMED PAID CONTRIBUTIONS (Sec. 13-A (i) of RA 8282)

 REFERS TO CONTRIBUTIONS THAT ARE DEEMED PAID

FOR THE MONTHS DURING WHICH THE MEMBER
RECEIVED PARTIAL DISABILITY PENSION. SAID
CONTRIBUTIONS ARE BASED ON HIS LAST
CONTRIBUTIONS PRIOR TO HIS DISABILITY.

 DEEMED PAID CONTRIBUTIONS ARE USED IN THE

ADJUDICATION OF RETIREMENT, DEATH AND PERMANENT
TOTAL DISABILITY CLAIMS.
 When to file

INITIAL CLAIM • MUST BE FILED WITHIN 10 YEARS FROM

THE OCCURRENCE OF DISABILITY.

REQUEST FOR • MUST BE FILED WITHIN 10 YEARS FROM

RE-ADJUDICATION THE DATE OF THE INITIAL SETTLEMENT OF
THE CLAIM

Where to file
APPLICATION FOR DISABILITY BENEFITS CAN BE FILED AT
ANY SSS BRANCH OFFICE.
 Documents Required
 Disability Claim Application
 Medical Certificate
 SS card of the member or two (2) valid IDs both with
signature and at least one (1) with photo
 Any of the following:
 Copy of passbook
 Copy of ATM card & validated deposit slip
 Cash Card Enrollment Form
 Other documents as may be required by SSS
 Frequently Asked Questions
1. Can a member who was granted Permanent Total
Disability benefit and later on recovered from the
disability still qualified to avail the retirement benefit?
YES. A member who was granted Permanent Total
Disability benefit and later on recovered from the disability
may still qualify to avail the retirement benefit provided
that he/she meets all the qualifying conditions stated in
Office Order No. 2016-048 dated July 25, 2016.

System Requirement: Cancellation code should be “2420”

 Frequently Asked Questions
2. What will happen to a member who has received lump
sum benefit and is re-employed or has resumed self-
employment not earlier than one (1) year from the date
of his/her disability?
A member who has received a lump sum benefit and is re-
employed or has resumed self-employment not earlier than
one (1) year from the date of disability shall again be
subject to compulsory coverage and shall be considered a
new member, provided that he/she is not over 60 years of
age at the time of re-employment or resumption of self-
employment.
 EMPLOYEES’
06 COMPENSATION (EC)
 Employees’ Compensation Program

The Employees’ Compensation Program (ECP) is a government

program designed to provide compensation package to public
and private employees and/or their dependents in the event of
work-related sickness, injury or death
Compensable Contingencies
Any work-connected INJURY or SICKNESS, resulting to DISABILITY or DEATH
of a covered employee is compensable under the ECP.

Compensable Diseases
A sickness is considered compensable if the same is included in the ECC’s
List of Occupational Diseases and the conditions for its compensability are
met. If the conditions were not satisfied and/or the claimed ailment is not
included in the list, proof must be shown that the risk of contracting the
disease is increased by the working conditions.

Compensable Injuries
An injury is considered compensable when the same takes place within the
period of employment, at a place where the employee may reasonably be
in the performance of his duties, and while he is fulfilling those duties or
engaged in doing something incidental thereto, or where he is engaged in
the furtherance of the employer’s business.
An Accident may be considered to have risen out of and in the course
of employment when it happened:

 At the workplace;
 While performing official functions;
 Outside of the workplace, but performing an order/instruction
of the employer;
 When going to or coming home from work
 While ministering to personal comfort;
 While in a company shuttle bus; or
 During a company sponsored activity
LIMITATIONS/EXCLUSIONS

 Intoxication/drunkenness

 Willful intention to injure or kill himself or another

 Notorious Negligence
Benefits Under EC Program
A. Loss of Income Benefit
A cash benefit given to a worker to compensate for loss of income due to inability
to work:
1. Temporary Total Disability (TTD) or Sickness
2. Permanent Partial Disability (PPD)
3. Permanent Total Disability (PTD)
B. Medical Benefits
Reimbursement of the cost of:
1. Ward services during confinement in an accredited hospital;
2. Medicine for the illness or injury
3. Payment to providers of medical care, hospital care, surgical expenses
4. the cost of appliances and supplies
Continuation -
C. Rehabilitation Services
Provision of remedial treatment, vocational assessment and preparation
which is designed to meet the individual needs of each handicapped
employee to restore him to suitable employment and to help each person
with work-related disability (PWRD) to develop his/her mental, vocational
or social potential
Example:
• Physical restoration, Skills training, Psychiatric evaluation, Hearing
impairment evaluation, job referral

D. Carer’s Allowance
Provided to an employee who suffers from a permanent partial or
permanent total disability as a result of a work-related contingency arising
out of employment
EC Temporary Total Disability or
Sickness Benefits

An income cash benefit

equivalent to 90% of the
average daily salary credit
but not to exceed P 200.00/
day.
 Qualifying Conditions

 Sickness or injury is work- connected;

 Employee has been duly reported to SSS;

 SSS has been notified of such sickness or injury;

and

• Note: Member need not have to exhaust his leave

credits before he can avail sickness benefit under ECC.
When to File
Three (3) years prescriptive period from date of
contingency.

Maximum Number of Entitlement

240 days in one calendar year.
 Rules on Sickness Notification

Employee shall notify his employer within (5) days from the
occurrence of the contingency. Employer then report to SSS
within (5) days from entry of contingency in his logbook.

Notice from employee is not necessary if:

• The contingency is known to the employer or his
representative, or
• The contingency occurred at his workplace.
However, it is mandatory for employer to notify the SSS
within 5 calendar days in order for him to avail of the double
recovery, if qualified.
 DOUBLE RECOVERY PROGRAM
The payment of compensation under the EC program
does not bar the recovery of benefits under other
laws administered by the System or any other agency
of the government.

When an illness/injury is considered work-connected,

a member is entitled to both EC & SSS benefits
[sickness & disability] provided the qualifying
conditions for the availment of such benefits are met.
 DOUBLE RECOVERY PROGRAM
Criteria SSS EC
Min. # of days of At least 4 days Even 1 day conft. is
confinement compensable

Max. # of days 120 calendar 240 calendar

allowed days/year days/year

Company SL Exhaust all current Need not have to

company SL exhaust Co. SL

Qualifying W/ at least 3 cont. w/in 12 1st day of employment

Contributions mo. period prior to the is covered
semester of contingency

Prescriptive One (1) Year Three (3) years

period
Manner of Payment

The employer shall advance the

benefit every regular pay day. The
amount advanced by the employer is
reimbursed 100% by the SSS.
Computation of EC Sickness Benefit

FOR MORE THAN TWELVE (12) MONTHS COVERAGE

• Exclude the semester of sickness/contingency;
• Select the (6) six highest monthly salary credits within
the 12 month period immediately before the
semester of contingency to arrive at the total monthly
salary credits (TMSC);
• Divide the total monthly salary credit by 180 to get
the average daily salary credit (ADSC); and
• Multiply the ADSC by 90%, then further multiply it by
the approved number of days.
Continuation -
IF EC SICKNESS IS FOR MEMBERS WITH MORE THAN 12 MONTHS COVERAGE

Date employed/covered May 2004

Approved confinement December 1 – 30, 2017
Number of Days Approved 30 days
MONTHLY SALARY CREDIT
YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2017 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000

2016 9,000 9,000 9,000 9,000 9,000 9000 9,000 9000 9,000 9,000 9,000 9,000

Semester of contingency • July to December 2017

Six highest monthly salary credits
• Jan to June 2017
within the 12 months period
Continuation -
YEAR MONTH EC SS
2017 Jan 9,000 9,000
Sum of the 6 highest MSC
2017 Feb 9,000 9,000
from the 12 month period
2017 Mar 9,000 9,000
preceding the semester of
2017 Apr 9,000 9,000
contingency
2017 May 9,000 9,000
2017 June 9,000 9,000
Total Monthly Salary Credits (TMSC) 54,000 54,000
Divided by 180 180
Average Daily Salary Credit (ADSC) 300 300.00
Multiplied by 90% 90% 90%
Daily Sickness Allowance (DSA) 270.00 270.00
Maximum Daily Salary Allowance (DSA) 200.00 270.00
Multiplied by number of days 30 30
Amount of Benefit P 6,000.00 P 8,100.00
 Continuation -
IF EC SICKNESS IS FOR MEMBERS WITH LESS THAN 12 MONTHS COVERAGE

Date employed/covered May 2017

Approved confinement Sept. 1 – 15, 2017

Number of Days Approved 15 days

MONTHLY SALARY CREDIT

YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2017 0 0 0 0 6000 0 0 0
5,000 6,000 3,000 5,000
2016 0 0 0 0 0 0 0 0 0 0 0
0

Date of illness is less than 12 months from date of employment

No need for quartering, counting starts from the date hired up to
the date prior to the month of illness
Continuation -
MONTHLY SALARY CREDIT
YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2017 0 0 0 0 5,000 6,000 3,000 5,000 6,000 0 0 0
2016 0 0 0 0 0 0 0 0 0 0 0 0

YEAR MONTH EC
Sum of the MSC from
2015 May 5,000
month of coverage to
2015 Jun 6,000
month prior the 2015 Jul 3,000
contingency 2015 Aug 5,000
Total Sum 19,000
Divided by number of months 4
Average 4,750
Multiplied by 6 months (constant) 6
Total Monthly Salary Credit (TMSC) 28,500
Divided by 180
Average Daily Salary Credit (ADSC) 158.33
Multiplied by 90% 90%
Daily Sickness Allowance (DSA) 142.50
Multiplied by number of days 15
Amount of EC Sickness Benefit P 2,137.50
Continuation -

IF EC SICKNESS IS WITHIN THE MONTH OF COVERAGE

Date employed/covered December 1, 2017

Approved Confinement December 16 - 31, 2017

Number of Days Approved 16 days

Date of illness is within the month of employment

Add all the earnings from the first day of employment
up to the day immediately preceding the initial date
of contingency;

Convert the total earnings into salary credits.

Continuation -

IF EC SICKNESS IS WITHIN THE MONTH OF COVERAGE

Date employed/covered Dec 1, 2017

Approved Confinement Dec 16 - 31, 2017
Number of Days Approved 16 days

Earnings per day P 390.00

Multiply by # of days worked - Dec 1 - 15, 2017 15
Total Earnings P 5,850.00
Convert to Salary Credit 6,000
Multiply by Constant factor 6
Total Monthly Salary Credit (TMSC) 36,000
Divided by 180 180
Average Daily Salary Credit (ADSC) 200.00
Multiply by 90% 90%
Daily Sickness Allowance 180.00
Number of days approved - Dec 16 - 31, 2017 16
Amount of Benefit P 2,880.00
PROBLEM:

Date of 1st Employment : March 2, 2017

Confinement applied/approved: November 5 to 7, 2017
Co. sickleave with pay : Exhausted
Salary : P 8,500.00/ month
Compute the sickness benefit due to member under EC & SSS
COMPUTATION:
EC (Less than 12 months coverage) SSS
TMSC 68,000 x 6 = 51,000 Not Qualified.
8 (Mar to Oct 2015) Member’s confinement
51,000 = 283.33 x 90% is less than 4 days.
180 = 255.55
= 200 DSA x 3
= P 600.00
 Disability Benefit

Kinds of Disability

 PERMANENT TOTAL

 PERMANENT PARTIAL
 Components of Disability Benefit
 BASIC BENEFIT
• Monthly Pension - 115% of the SS Monthly Pension
Minimum Pension: P2,000.00

 SUPPLEMENTAL ALLOWANCE of P 575.00/month

 13th MONTH PENSION - payable every December to total disability

pensioners; for partial disability pensioners, 13th month pension shall be
paid provided that pension duration is at least 12 months.

 DEPENDENTS PENSION (for total disability) - 10% of the monthly

pension or P 250.00 whichever is higher for each minor child of a
permanent total disability pensioner not exceeding 5 beginning with the
youngest and without substitution
 Disability Pension Is :
 Transferable upon death of pensioner
[If with primary beneficiaries]

 Guaranteed for five [5] years

[If there are no primary beneficiaries]
04 DOCUMENTARY REQUIREMENTS
 Temporary Total Disability or
Sickness Benefit
 Sickness Benefit Reimbursement Application (SBRA)
Form
 Approved Sickness Notification or Certificate of Medical
Approval issued by the Medical Evaluation Section
 Copy of page of Employer’s Logbook (manual logbook
or electronic filing)
 Filers SS card or other valid IDs
 Disability Benefit

 Disability Claim Application

 Medical Certificate
 SS Employment Data Form
 SS card of the member or two (2) valid IDs both with
signature and at least one (1) with photo
 Any of the following:
 Copy of passbook
 Copy of ATM card & validated deposit slip
 Cash Card Enrollment Form
 Other documents as may be required by SSS
 EC Medical Reimbursement
 EC Medical Reimbursement Application Form 1
 EC Medical Reimbursement Application Form 2
 Filers valid identification cards/documents
SUPPORTING DOCUMENTS
 Photocopy of page in the company record or any proof containing the
description/information of the sickness/accident
 Accident Report, if applicable
 Other Documents:
 For work-related sickness/illness
• Pre-employment physical examination report; chest x-ray;
ECG, if available
• Certificate of Length of Service certified by employer; and
• Certified true copy of hospital abstract
Continuation -
 Other Documents:
 For work-related accident
• Employee’s destination and purpose of trip certified by employer; and
• Police report, if vehicular accident/medico-legal incident
 For Employer/Member Payee
• Original Official Receipts (OR) with BIR permit number of medical
expenses including professional fees.
• Original copy of charge slips/statement of accounts with itemized list
or breakdown of expenses
 For Hospital/Clinic Payee/Provider
• Original copy of charge slip/statement of accounts with itemized list
or breakdown of expenses

 For Doctor Payee

a) Clinical records showing the following:
• Services rendered
• Number and date/s of consultation/s or visit/s, if hospitalized
b) Operating Room Record, if applicable
 Rehabilitation Services

Documents Required:

 REQUEST FROM EC SECRETARIAT ON THE STUDENT

REHABILITEE’S TUITION FEES, TRANSPORTATION
ALLOWANCE, TRAINING MATERIALS, ETC.
04 Frequently Asked Questions
 Frequently Asked Questions

1. Should the sick leave credits be consumed first before

filing the EC claims?

No. There is no need to consume sick leave or other similar

benefits before EC temporary or permanent disability can
be filed.
 Frequently Asked Questions
2. When does the three year prescriptive period in the filing
of EC claim stop?
Under the EC Board Resolution No. 10-03-45 (March 17,
2010), when a claimant filed a claim for disability or death
benefits before the SSS or the GSIS, either under the SS Law
or the GSIS law, the claim for EC benefits for the same
incident should be considered as filed.

The filing of disability or death benefits either under the

SSS law or the GSIS law within three years from the time
the cause of action accrued would stop the running of the
prescriptive period.
 Frequently Asked Questions
3. Can an employee avail of simultaneous benefits under
the ECP and under another law for the same contingency?

It depends. For private sector employees, the payment of

benefits under the SSS does not bar the
employee/beneficiaries from receiving benefits under the
EC Program, provided that the disability or death is work-
related.

For public sector employees, EC benefits are subject to the

exclusiveness of benefits as provided under the GSIS law.
“Exclusiveness of benefits” provision under the GSIS Law in
relation to PD No. 626, as amended

According to Section 55 or R.A No. 8291 or the GSIS Law,

whenever there are other laws that provide similar benefits
for the same contingency covered by GSIS Law, the member
who qualifies for the EC benefits shall have the option to
choose which benefit between the GSIS and EC will be paid
to him.

However, if the chosen benefit is less than the benefits

provided by the GSIS, the GSIS will only pay for the difference
between the benefit chosen as paid by the EC and the value
of the GSIS benefit.
 Frequently Asked Questions
4. A member who is already receiving retirement pension is
filing for EC total disability claim with contingency date
after his retirement. Is the member still entitled to the EC
total disability benefit?

YES. The member is still entitled to EC total disability

benefit even if he is already receiving retirement pension
because SSS benefits are distinct and separate from the
benefits being granted by the Employees Compensation
Commission (ECC).
 Frequently Asked Questions
5. An EC total disability pensioner is filing for a dependent’s
pension for his/her child born after his/her date of
contingency. Is the child still entitled to dependent’s
pension?
YES. “The Employees’ Compensation Commission issued Board Resolution
No. 06-05-50 dated May 18, 2006 allowing payment of dependent’s
pension to minor children of EC total disability pensioners, whether
legitimate or illegitimate, who were born after the member’s
contingency. Provided, that the maximum number of children shall not
exceed five (5) beginning with the youngest and without substitution.
Provided, further, that where there are legitimate and
illegitimate/acknowledged natural children, the former shall be
preferred.”(Office Order No. 255-P)
End of presentation.
Thank you.