I.

RA 7875- NATIONAL HEALTH INSURANCE ACT as amended by RA 9241 and RA 10606

GUIDING PRINCIPLES

Section II, Article XIII of the 1987 Constitution of the Republic of the Philippines declares that the State
shall adopt an integrated and comprehensive approach to health development which shall endeavor to
make essential goods, health, and other social services available to all the people at affordable cost.
 Priority of the needs of the underprivileged, sick, elderly, disabled, women, and children shall be
recognized. Likewise, it shall be the policy of the State to provide free medical care to paupers.
 As an integral responsibility of Philippine government to recognize its citizens need for health services,
National Health Insurance Act of 1995 was enacted. The said insurance act has been amended multiple
times to meet and adapt with the ever-changing needs of society. Yearly, the Department of Budget and
Management releases the People’s Proposed Budget. Therein is a category “health”. The proposed
budget varies depending on the current situation and on what to expect on the succeeding year.
 For the year 2022, the proposed budget was 252.4 billion pesos. The proposal of budget and its further
allocation is only one of the many implications that our government has acknowledged our call for health
care services.
 Referring to the constitutional mandate – priority of the needs of the underprivileged, sick, elderly,
disabled, women, and children shall be recognized. This is equity, not equality. Access to care must be a
function of a person’s health needs rather than his ability to pay.
 Republic Act 10606 introduced sponsored members which covers indigent people and others that need
assistance. Currently, premium contributions for indigent members as identified by the DSWD shall be
fully subsidized by the national government. The amount necessary shall be included in the
appropriations for the DOH under the annual General Appropriations Act.
 Also, the premium contributions of orphans, abandoned and abused minors, out-of-school youths, street
children, PWDs, senior citizens and battered women under the care of the DSWD, or any of its accredited
institutions run by NGOs or any nonprofit private organizations, shall be paid by the DSWD and the funds
necessary for their inclusion in the Program shall be included in the annual budget of the DSWD. This
supports the main objective; to provide all citizens of the Philippines with the mechanism to gain financial
access to health services.

PHILIPPINE HEALTH INSURANCE CORPORATION

The  Philippine Health Insurance Corporation  (PhilHealth) was created in 1995 to implement  universal
health coverage  in the  Philippines. It is a tax-exempt, government-owned and controlled corporation
(GOCC) of the Philippines, and is attached to the Department of Health.
 Philippine Health Insurance Corporation is affiliated with International Social Security Association, ASEAN
Social Security Association, and Philippine Social Security Association. Its stated goal is to "ensure a
sustainable national health insurance program for all”. The said goal is aligned with the concept of
compulsory coverage enshrined in the National Health Insurance Program. Compulsory Coverage means
that all citizens of the Philippines shall be required to enroll in the National Health Insurance Program to
avoid adverse selection and social inequity - and that is the insurance should be universal, affordable,
acceptable, available, and accessible.
 Note: In relation with acceptability, availability, and accessibility of the insurance, we have what we call
Portability. Portability is the enablement of a member to avail of Program benefits in an area outside the
jurisdiction of his Local Health Insurance Office.

MEMBERS

A member is defined in the insurance act as any person whose premiums have been regularly paid to the
National Health Insurance Program.
 Other than regular paying members, we also have the sponsored members and lifetime members.
Sponsored members are those whose contribution is being paid by another individual, government
agency, or private entity according to the rules as may be prescribed by the Corporation. Example of
sponsored members are indigent people, orphans, and battered women. Sponsorship is not automatic.
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The DSWD is tasked to determine, through use of means test, whether applicants are qualified. If
deemed qualified, they will be full subsidized by the national government.
 On the other spectrum, a lifetime member is a former member who has reached the age of retirement
under the law and has paid at least one hundred twenty (120) monthly premium contributions. An eligible
lifetime member need not pay the monthly contributions to be entitled to the Program’s benefits after due
application.

DEPENDENTS

In general, a dependent is a person who relies on another.

 The legal dependents of a member under National Health Insurance Program are:
1) the legitimate spouse who is not a member;
2) the unmarried and unemployed legitimate, legitimated, illegitimate, acknowledged children as
appearing in the birth certificate; legally adopted or stepchildren below twenty-one (21) years of age;
3) children who are twenty-one (21) years old and above but suffering from congenital disability, either
physical or mental, or any disability acquired that renders them totally dependent on the member of our
support;
4) the parents who are sixty (60) years old or above whose monthly income is below an amount to be
determined by the Corporation in accordance with the guiding principles set forth in Article I of this Act;
5) And parents with permanent disability that render them totally dependent on the member for
subsistence.

ENROLLMENT

Enrollment is the process to be determined by the Corporation in order to enlist individuals as members
or dependents covered by the Program.
 A member whose premium contributions for at least three (3) months have been paid within six (6)
months prior to the first day of availment, including those of the dependents, shall be entitled to the
benefits of the Program: Provided, That such member can show that contributions have been made with
sufficient regularity: Provided, further, That the member is not currently subject to legal penalties as
provided for in Section 44 of this Act.
 The following need not pay the monthly contributions to be entitled to the Program’s benefits:
(a) Retirees and pensioners of the SSS and GSIS prior to the effectivity of this Act; and
(b) Lifetime members. XXX
 Indigent members used to be one of those who need not pay the monthly contributions to be entitled to
the Program’s benefits. However, through RA 10606, the legislative department deemed it necessary
categorize them separately form the others. Under Section 7 of National Health Insurance Act, the
following categories for enrollment are
a) Members in the formal economy;
b) Members in the informal economy;
c) Indigents;
(d) Sponsored members; and
(e) Lifetime members.
Nonetheless, indigents and sponsored member are almost alike for both can be subsidized by the
national government.

EXCLUDED PERSONAL HEALTH SERVICES

Section 11 of National Health Insurance Act, as amended, provides that the Corporation shall not cover
expenses for health services which the Corporation and the DOH consider cost ineffective through health
technology assessment.
 Before Republic Act 10606, the present amendment to National Health Insurance Act, there was a
specific list of what should be excluded in the personal health services. Some of it were alcohol abuse or
dependency treatment, cosmetic surgery, optometric services, and so on.
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 At present, the said list is abandoned. The Philippine Health Insurance Corporation is given authority to
indicate exclusions and limitations as it may deem reasonable in keeping with its protection objectives
and financial sustainability.

HEALTH CARE PROVIDER

A member can avail of the PhilHealth benefits only from accredited health care providers.
 Health Care Provider refers to:
(1)   a health care institution , which is duly licensed and accredited devoted primarily to the maintenance
and operation of facilities for health promotion, prevention, diagnosis, injury, disability, or deformity, drug addiction
or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building, or
place where there are installed beds, cribs, or bassinets for twenty-four hour use or longer by patients in the
treatment of diseases, injuries, deformities, or abnormal physical and mental states, maternity cases or sanitarial
care; or infirmaries, nurseries, dispensaries, rehabilitation centers and such other similar names by which they
may be designated; or
(2)   a health care professional, who is any doctor of medicine, nurse, midwife, dentist, or other health
care professional or practitioner duly licensed to practice in the Philippines and accredited by the Corporation; or
3)   a health maintenance organization, which is entity that provides, offers, or arranges for coverage of
designated health services needed by plan members for a fixed prepaid premium; or
(4)   a community-based health organization, which is an association of indigenous members of the
community organized for the purpose of improving the health status of that community through preventive,
promotive and curative health services.

QUASI-JUDICIAL POWER

A quasi-judicial power refers to the power vested in the commissions established by law, administrative
officers, or bodies to determine the rights of those who appear before it. It has been described as the
power or duty to investigate and to draw conclusions from such investigations.
 The following are the quasi-judicial power of the Philippine Health Insurance Corporation:
a) Subject to the respondent’s right to due process, to conduct investigations for the determination of a
question, controversy, complaint, or unresolved grievance brought to its attention, and render decisions, orders, or
resolutions thereon. It shall proceed to hear and determine the case even in the absence of any party who has
been properly served with notice to appear. It shall conduct its proceedings or any part thereof in public or in
executive session; adjourn its hearings to any time and place; refer technical matters or accounts to an expert and
to accept his reports as evidence; direct parties to be joined in or excluded from the proceedings; and give all
such directions as it may deem necessary or expedient in the determination of the dispute before it;
b) To summon the parties to a controversy, issue subpoenas requiring the attendance and testimony of
witnesses or the production of documents and other materials necessary to a just determination of the case under
investigation;
c) Subject to the respondent’s right to due process, to suspend temporarily, revoke permanently, or
restore the accreditation of a health care provider or the right to benefits of a member and/or impose fines. The
decision shall immediately be executory, even pending appeal, when the public interest so requires and as may
be provided for in the implementing rules and regulations. Suspension of accreditation shall not exceed six (6)
months. Suspension of the rights of members shall not exceed six (6) months. The revocation of a health care
provider’s accreditation shall operate to disqualify him from obtaining another accreditation in his own name,
under a different name, or through another person, whether natural or juridical. The Corporation shall not be
bound by the technical rules of evidence.

SUABILITY

The  Philippine Health Insurance Corporation  is a tax-exempt, government-owned and controlled

corporation (GOCC) of the Philippines, and is attached to the  Department of Health.
 As a rule, if the GOCC does not have a separate and distinct personality from the government, then the
state immunity will apply. In the case of National Health Insurance Act - Philippine Health Insurance
Coporation, its charter particularly provide that it can sue and be sued.
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THE NATIONAL HEALTH INSURANCE FUND

 The National Health insurance fund is consisted of:

a)    Contribution from Program members;
b)    other appropriations earmarked by the national and local governments purposely for the implementation of
the Program;
c)    Subsequent appropriations provided for under Sections 46 and 47 of this Act;
d)    Donations and grants-in-aid; and
e)    All accruals thereof.
·   RA 10606 removed “b) Current balances of the Health Insurance Funds of the SSS and GSIS collected
under the Philippine Medical Care Act of 1969, as amended, including arrearages of the Government
of the Philippines with the GSIS for the said Fund” from the enumeration

 The National Health Insurance fund is composed of:

a)    The Basic Benefit Fund
         This fund shall finance the availment of the basic minimum benefit package by eligible beneficiaries.
All liabilities associated with the extension of entitlement to the basic minimum benefit package to the
enrolled population shall be borne by the basic benefit fund.

b)    Supplementary Benefit Funds

Consisting of:
1)    supplementary benefit fund for SSS-Medicare members and beneficiaries
2)    supplementary benefit fund for GSIS- Medicare members and beneficiaries
Each supplementary benefit fund shall finance the extension and availment of additional benefits
not included in the basic minimum benefit package but approved by the Board.

 Supplementary benefit funds shall be maintained for not more than five (5) years, after which,
such funds shall be merged into the basic benefit fund.

 Applicable laws shall govern the use, disposition, investment, disbursement, administration and
management of the National Health Insurance Fund, including any subsidy, grant or donation received for
program operations. If there are no applicable laws, existing resolutions of the Board of Directors of the
Philippine Health Insurance Corporation shall be applied
Limitations:
a)  All funds under the management and control of the Philippine Health Insurance Corporation shall be
subject to all rules and regulations applicable to public funds
b)  The Philippine Health Insurance Corporation is authorized to charge to the various funds under its
control the costs of administering the Program. The total annual costs for these shall not exceed the sum
total of the following:
1)    Four percent (4%) of the total premium contributions collected during the immediately
preceding year;
2)    Four percent (4%) of the total reimbursements or total cost of health services paid by the
Philippine Health Insurance Corporation in the immediately preceding year; and
3)    Five percent (5%) of the investment earnings generated during the immediately preceding
year.
 The period for implementation of the cost ceiling provided under this section shall not be later than five (5)
years from the effectivity of RA No. 10606 during which period, the total annual cost shall not exceed the
sum total of the following:
i. Five percent (5%) of the total contributions;
ii. Five percent (5%) of the total reimbursements; and
iii. Five percent (5%) of the investment earnings generated during the immediately
preceding year.
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RESERVE FUNDS

 The portion set aside by Philippine Health Insurance Corporation of its accumulated revenues not needed
to meet the cost of the current year’s expenditures. It shall be invested in short-term investments to earn
an average annual income at prevailing rates of interest and shall be known as the “Investment Reserve
Fund”
 Whenever actual reserves exceed the required ceiling at the end of the Corporation’s fiscal year, the
excess of the Corporation’s reserve fund shall be used to increase the Program’s benefits, decrease the
member’s contributions, and augment the health facilities enhancement program of the DOH.

FINANCING

Contributions

 The Program shall cover the following members and their dependent/s
a.  Members in the Formal Economy – those with formal contracts and fixed terms of employment
including workers in the government and private sector, whose premium contribution payments are
equally shared by the employee and the employer.

Their monthly contributions shall not exceed five percent (5%) of their respective monthly salaries.
1.    Government Employee. Any increase in the premium contribution of the national government as
employer shall only become effective upon inclusion of said amount in the annual General Appropriations
Act.
2. Private Employee
3. All other workers rendering services, whether in government or private offices, such as job order
contractors, project-based contractors, and the like
4. Owners of Micro Enterprises
5. Owners of Small, Medium and Large Enterprises
6. Household Help
7. Family Drivers

b. Members in the Informal Economy – Contributions from members in the informal economy shall be
based primarily on household earnings and assets.
This sector would include but are not limited to the following:
1. Migrant Workers
2. Informal Sector - to this sector belong, among others, street hawkers, market vendors, pedicab and
tricycle drivers, small construction workers, and home-based industries and services.
3. Self-Earning Individuals
4. Filipinos with Dual Citizenship
5. Naturalized Filipino Citizens
6. Citizens of other countries working and/or residing in the Philippines
Citizens of other countries working in the Philippines may be allowed coverage in the Program provided
that their countries have existing reciprocity agreements with the Philippines, subject to additional
guidelines as may be prescribed by the Philippine Health Insurance Corporation.

c. Indigent – a person who has no visible means of income, or whose income is insufficient for family
subsistence, as identified by the DSWD based on specific criteria set for this purpose.
Contributions made on behalf of indigent members shall not exceed the minimum contributions for
employed members. Premium contributions for indigent members as identified by the DSWD through a
means test or any other appropriate statistical method shall be fully subsidized by the national
government.
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d. Sponsored Member – a member whose contribution is being paid by another individual, government
agency, or private entity according to the rules as may be prescribed by the Philippine Health Insurance
Corporation.
 i.  The premium contributions of orphans, abandoned and abused minors, out-of-school youths, street
children, PWDs, senior citizens and battered women under the care of the DSWD, or any of its
accredited institutions run by NGOs or any nonprofit private organizations, shall be paid by the
DSWD and the funds necessary for their inclusion in the Program shall be included in the annual
budget of the DSWD.
 ii. The needed premium contributions of all barangay health workers, nutrition scholars and other
barangay workers and volunteers shall be fully borne by the LGUs concerned.
iii. The annual premium contributions of househelpers shall be fully paid by their employers, in
accordance with the provisions of Republic Act No. 10361 or the ‘Kasambahay Law

. Lifetime Member – a member who has reached the age of retirement under the law and has paid at
least one hundred twenty (120) monthly premium contributions.
Lifetime members shall include but not limited to the following:
1. Retirees/ Pensioners from the Government Sector
2. Retirees/ Pensioners from the Private Sector
3. Uniformed Members of the AFP, PNP, BJMP and BFP
4. Members of PhilHealth who have reached the age of retirement as provided by law and have met the
required premium contributions of at least 120 months, regardless of their employer/s’ or sponsor’s
arrears in contributions and are not included in the Sponsored program nor declared as dependent by
their spouse or children.

 The annual required premium for the coverage of unenrolled women who are about to give birth shall be
fully borne by the national government and/or LGUs and/or legislative sponsor which shall be determined
through the means testing protocol recognized by the DSWD.
 Members engaged in multiple employment in the government and private sectors whose aggregate
monthly premium contribution exceeds the maximum rate in the prescribed premium contribution
schedule may request for adjustment of personal share subject to the guidelines to be issued by the
Philippine Health Insurance Corporation.
 A member separated from formal employment or whose coverage as a Sponsored member or as an
Indigent or as a migrant worker has ceased should pay the required premium as self-earning individuals
to ensure continuous entitlement to benefits.
 A member who has missed/unpaid premium contribution shall be allowed to pay retroactively as
prescribed by the Philippine Health Insurance Corporation.

HEALTH CARE PROVIDERS

Accreditation of Healthcare Providers

Philippine Health Insurance Corporation has the authority to grant Health Care Providers accreditation.
All health care providers operating for at least three (3) years may apply for accreditation
 exception: A health care provider not operated yet for at least three (3) years may still apply and qualify
for accreditation if it complies with all the other accreditation requirements of and further meets any of the
following conditions:
(a)   Its managing health care professional has had a working experience in another accredited health
care institution for at least three (3) years;
(b)   It operates as a tertiary facility or its equivalent;
(c)    It operates in a LGU where the accredited health care provider cannot adequately or fully service its
population; and
(d)   Other conditions as may be determined by the Corporation.

 The following health care institutions shall be exempted from the three (3) year operation requirement:
-Primary Care Benefit Providers with or without out-patient malaria package;
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-TB DOTS providers;

-Non-hospital maternity care package providers;

- Animal bite treatment providers; and,
- Such other health facilities as may be determined by the Corporation
A health care provider found guilty of any violation of this Act shall not be eligible to apply for the renewal
of accreditation.

Minimum Accreditation Requirements

a)   human resource, equipment and physical structure in conformity with the standards of the relevant facility,
as determined by the Department of Health;
b) acceptance of formal program of quality assurance and utilization review;
c)   acceptance of the payment mechanisms specified in the following section;
d) adoption of referral protocols and health resources sharing arrangements;
e)    recognition of the rights of patients; and
f)  acceptance of information system requirements and regular transfer of information.

Grounds for Denial/Non-Reinstatement of Accreditation

a. Non-compliance with any or all of the requirements of accreditation;
b. Revocation, non-renewal or non-issuance of license/ accreditation/ clearance to operate or practice of
the health care provider by the DOH, PRC or government regulatory office or institution;
c. Conviction due to fraudulent acts as determined by the Corporation until such time that the decision is
reversed by the Appellate Court or the penalty has been fully served;
d. Change in the ownership, management or any form of transfer either by lease, mortgage or any other
transfer of a health care institution without prior notice to the Corporation; or,
e. Such other grounds as the Corporation may determine

    No other fee or expense shall be charged to the indigent patient, subject to the guidelines issued by the
Corporation.
 The Corporation may deny or reduce the payment for claims when such claims are attended by false or
incorrect information and when the claimants fail without justifiable cause to comply with the pertinent
rules and regulations of this Act.

Reimbursement and Period to File Claims

All claims for reimbursement or payment for services rendered shall be filed within a period of sixty (60) calendar
days from the date of discharge of the patient from the health care provider.

GRIEVANCE AND APPEAL

Grievance System
A system where members, dependents, or health care providers of the Program who believe they have
been aggrieved by any decision of the implementors of the Program, may seek redress of the grievance

 Grounds for Grievance

a)    any violation of the rights of patients;
b)    a willful neglect of duties of Program implementors that results in the loss or non-enjoyment of
benefits by members or their dependents;
c)    unjustifiable delay in actions or claims;
d)    delay in the processing of claims that extends beyond the period agreed upon; and
e)    any other act or neglect that tends to undermine or defeat the purposes of this Act.
 When PhilHealth Office receives a grievance complaint, it shall be referred to the Grievance and Appeals
Review Committee (GARC) within five (5) calendar days.
 The GARC may censure, reprimand, or suspend the guilty respondent implementor from office,
depending on the gravity of the offense; provided, that the suspension shall not exceed thirty (30) days.
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 The Board en banc shall have exclusive appellate jurisdiction to review the decisions of the GARC in
grievances filed under RA 7875 as amended and this Rules.

II. RA No. 8291: Government Service Insurance Act of 1997

Who are covered?

1. EMPLOYER – the national government, its political subdivisions, branches, agencies or instrumentalities,
including GOCCs, and financial institutions with original charters, the constitutional commissions and the
judiciary 
2. EMPLOYEE – any person receiving compensation while in service of an employer as defined herein,
whether by election or appointment

Dependents:
1. Legal spouse entitled for support; 
2. Child, whether legitimate, legitimated, legally adopted or illegitimate; 
3. Parents dependent for support

Beneficiaries:
1. PRIMARY
1. Legal, Dependent Spouse until remarriage AND
2. Dependent Children     
2. SECONDARY
1. Dependent Parents AND
2. Legitimate descendants subject to restrictions on dependent children, legitimate descendants

Benefits:
1. ALL MEMBERS 
1. Life Insurance
2. Retirement
3. Disability
4. Survivorship
5. Separation
6. Unemployment

2. JUDICIARY

Coverage:
    COMPULSORY for all employees receiving compensation who have not reached compulsory retirement age,
irrespective of employment status

Exceptions from the coverage:

1. Members of the AFP
2. Members of the PNP
3. Contractual employees, who have no employer-employee relationship with the agency to serve
4. Members of judiciary and constitutional commissions: covered by life insurance only

Compensation:
    The basic pay or salary received by an employee, pursuant to his election/appointment, excluding per diems,
bonuses, overtime pay, honoraria, allowances and any other emoluments received in addition to the basic pay

Effects of Separation from Employment:

    A member separated from the service shall continue to be a member, and shall be entitled to whatever benefits
he has qualified to in the event of any contingency compensable under this Act
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Funding:
1. Employer’s contributions
2. Employee’s/member’s contributions

*Property, assets, and revenues of GSIS are all exempt from taxes, and all benefits paid by GSIS shall likewise
be exempt from taxes, assessments, fees, charges, and duties of all kind

Dispute Settlement:
    Jurisdiction: GSIS
    When decision made: 30 days from receipt of the hearing officer’s findings and recommendations or 30 days
after submission for decision
    Appeal: CA – Rule 43, Section 31 SC – Rule 45

Prescriptive Period:
    4 years from date of contingency

III. RA No. 11199: SOCIAL SECURITY ACT OF 2018

SSS was created into law on September 1, 1957 under RA 1161 and was amended under RA 8282 on May 1,
1997
COVERAGE
Who are covered under the SSS?
COMPULSORY COVERAGE
 1. Coverage of Employees
a)       A private employee
b)      A household-helper
c)       A Filipino seafarer
d)     An employee of a foreign government, international organization of their wholly owned
instrumentality based in the Phils., which entered into an administrative agreement with SSS for the
coverage of its Filipino workers
e)     The parent, spouse or child below 21 years old of the owner of a single proprietorship business
 2. Coverage of Employers
a)      Any person who uses the services of another person in business, trade, industry or any
undertaking.
b)     A foreign government, international organization such as the embassy in the Philippines, may enter
into administrative agreement with the SSS for coverage of its Filipino employees.
3.      Coverage of Self-employed Persons
a)      Self-employed professional
b)      Business partners, single proprietors
c)       Actors, actresses, directors, scriptwriters and news reporters are not under an employer employee
relationship
d)      Professional athletes, coaches, trainers, and jockeys
e)     Farmers and fisherfolks
f)       Workers in the informal sector such as cigarette vendors, watch-your-car boys, hospitality girls,
among others.
VOLUNTARY COVERAGE
1. Separated Members
2. Overseas Filipino Workers (OFWs)
3. Non-working Spouse of SSS members
Effectivity of Compulsory Coverage
1.  For an employee - on the first day of employment
2.  For an employer - on the first day the employer hires employee/s
3.  For self-employed persons – upon payment of the first   valid contribution, in case of initial coverage
Voluntary Members
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This is to inform all concerned that we cannot pay our premiums on our own after securing an sss Number unless
you are an OFW.

REGISTRATION
Employee - SSS Form E-1(Personal Data Record)        
For Employers
Single Proprietorships - SSS Form R-1(Employer Registration) and
                                            R-! A (Employment Report) /E-1              
Partnerships - SSS Form R-1/R1-A/E-1/Articles of Partnership
 Corporations - R-1/R1-A/E-1/Articles of Incorporation
Self-employed Members - SSS Form RS-1(Self-employed Date Record)
Non-working Spouse      - NW-1(duly signed by the spouse with MC)
Overseas Filipino Workers (OFWs) - OW-1
Changes in member’s records - SSS Form E-4         
Note: The original or certified true copies of the documents should be presented to 
          the SSS for authentication purposes.
                                                                         
CONTRIBUTIONS
 Monthly contributions based on the gross compensation of SSS members are payable under two programs, as
follows:
SSS- 9.4% of the average monthly compensation not exceeding P15,000                                                   
Employee share is 3.33%                   
Employer share is 6.07%
·        For non-working spouse ½ of the MSC of the working spouse
EC- 1% or (P10.00)of average monthly and payable only by the employer.
·        (P30.00) for employees earning P15,000.00/mo
·        OFW is not less than 5,000 MS

BENEFITS
Sickness benefit?                                        
The sickness benefit is a daily cash allowance paid for the number of days a member is unable to work due to
sickness or injury.
What is the maternity benefit?
The maternity benefit is a daily cash allowance granted to a female member who was unable to work due to
childbirth or miscarriage.
SICKNESS & MATERNITY BENEFIT
·        Sickness benefit is a 90% replacement of lost earning and is compensable on to an employee with at least
minimum of 4 days confinement either at home or in the hospital
·        Maternity benefits 100% of the ave. daily salary credit paid to female employee for the first 4
deliveries/abortion/miscarriage
·        60 days for normal & 78 days for caesarean delivery
What is the disability benefit?
It is a cash benefit granted either as a monthly pension or a lump sum amount - to a member  who becomes
permanently disabled, either partially or totally.
Who may qualify for the disability benefit?
The member has paid at least one monthly contribution prior to the semester of contingency.
How much is the amount of Benefit?
·        The amount is granted a monthly disability pension, plus P500 supplemental allowance, if he/she has paid
at least 36 monthly contributions
·        If less than 36 monthly contributions, a lump sum amount.
·        The lowest monthly pension is P1,000 if the member has less than ten (10) credited years of service (CYS);
P1,200 with at least 10 CYS; and P2,400 with at least 20 CYS. 
What is a retirement benefit?
·        It is a cash benefit granted - either as a monthly pension or a lump sum amount - to a member who can no
longer work due to old age.
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Who may qualify for a retirement benefit?

·        A member who is 60 years old (optional retirement), separated from employment or has ceased to be self-
employed, and has paid at least 120 monthly contributions prior to the semester of retirement; or
·        A member who is 65 years old (mandatory retirement), whether employed or not, and has paid at least 120
monthly contributions prior to the semester of retirement.
How much monthly pension will a retiree receive?
·        The member is granted a monthly retirement pension, if he/she has paid at least 120 monthly contributions
prior to the semester of retirement.
·If with less than 120 monthly contributions, he/she is granted a lump sum amount.
·The lowest monthly pension is P1,200 if the member has 120 monthly contribution or with at least 10 credited
years of service (CYS); P2,400 if with at least 20 CYS.
What is the funeral grant?
·        A cash benefit given to whoever pays the burial expenses of the deceased member or pensioner.
(pensioner-refers to retiree or partial/total disability pensioner)
How much is the amount of funeral benefit?
·        The amount of P20,000 is given to whoever pays the deceased member’s burial expenses.
What is the death benefit?
·        A cash benefit granted - either as a monthly pension or a lump sum amount - to the beneficiaries of a
deceased member.
Who may qualify for a death benefit?
·        The member has paid at least one monthly contribution.                                                                35 mos.
and below contributions – lumpsum
36 mos. and above – monthly pension
·        The lowest monthly pension is P1,000 if with less than 10 credited years of service (CYS); P1,200 if with at
least 10 CYS; and P2,400 if with at least 20 CYS

MEMBER LOAN
What is a salary loan?
·        A cash loan granted to an employed, currently paying self-employed or a voluntary member.  It is intended
to meet a member's short-term credit needs.
Who may qualify for a salary loan?
·        An employed, currently paying, self-employed or voluntary member (SE/VM) who has 6 posted monthly
contributions for the last 12 months prior to filing of application.
·        For one-month loan, the member-borrower must have 36 posted monthly contributions, prior to the month of
filing of application.
·        For two-month loan, the member-borrower must have 72 posted monthly contributions.
·        If employed, the member’s employer must be updated in contributions and loan remittances.  The member
must updated in payment of other loans with the SSS
How much is the loanable amount?
·        A one-month salary loan is equivalent to the average of the member's latest 12 monthly salary credits
posted.
·        A two month salary loan is equivalent to twice the average of the member's latest 12 monthly salary credits
posted (rounded to the next higher monthly salary credit), but not to exceed P24,000.

IV. RA No. 7699: Limited Portability Law

“What if a private employee shifts to work as government employee and vice versa, how can he/she claim
retirement benefits?”

As a rule, private employees are mandated to be members of Social Security System (SSS) while
government employees are to be members of Government Service Insurance System (GSIS).

 What is Portability?
Portability refers to the transfer of funds for the account, and benefit of a worker who transfers from one
system to the other (Section 1(b), Rule III of R.A. No. 7699).
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 Coverage. Section 1, Rule I of R.A. No. 7699 provides that the rules and regulations shall apply to all
worker‐members of the Government Service Insurance System (GSIS) and/or Social Security System
(SSS) who transfer from one sector to another, and who wish to retain their membership in both Systems.

 What is the scheme all about?

R.A. No. 7699 was enacted to enable those from the private sector who transfer to the
government service or from the government sector to the private sector to combine their years of service
and contributions which have been credited with the SSS or GSIS, as the case may be, to satisfy the
required number of years of service for entitlement to the benefits under the applicable laws

 Totalization
Totalization refers to the process of adding up the periods of creditable services or contributions under
each of the Systems (SSS or GSIS), for the purpose of eligibility and computation of benefits. Hence, if a
worker is not entitled to any benefits under SSS or GSIS because the periods of his creditable
services or contributions does not qualify to avail any benefit under SSS or GSIS, as the case may be,
he/she could apply the totalization rule. His services or contributions shall be totalized for the purposes of
eligibility, and computation of, his old-age, disability, survivorship, and other benefits.

 Note: All contributions paid by the member personally, and those that were paid by his employers to both
Systems shall be considered in the processing of benefits which he can claim from other or both systems.
However, the amount of benefits to be paid by one system shall be in proportion to the number of
contributions actually remitted to that System. If a work qualifies for benefits in both Systems, totalization
shall not apply (Section 5, Rule V of R.A. No. 7699).

 Applying the totalization rule:

Section 3, Rule V of R.A. No. 7699 provides instances where totalization applies, to wit:
1. If a worker is not qualified for any benefits from both Systems;
2. If a worker in the public sector is not qualified for any benefits in the GSIS; or
3. If a worker in the private sector is not qualified for any benefits from the SSS.