We gathered these information to give you the idea on how much benefit you can get by being a member.
Sickness Benefit Computation
Benefit Computation:Exclude the semester of sickness.
-A semester refers to two consecutive quarters ending in the quarter of sickness.
-A quarter refers to three consecutive months ending March, June, September or December.
-Count 12 months backwards starting from the month immediately before the semester of sickness.
-Identify the six highest monthly salary credits within the 12-month period.
-Monthly salary credit salary credit means the compensation base for contributions and benefits related to the total earnings for the month.
- -Add the six highest monthly salary credits to get the total monthly salary credit. -Divide the total monthly salary credits by 180 days to get the average daily salary credit. -Multiply the average daily salary credit by 90 percent to get the daily sickness allowance. -Multiply the daily sickness allowance by approved number of days to arrive at the amount of benefit due. For example, let us say that an SSS member gets sick or injured in October 2013 for 20 days: The semester of sickness would be from July 2013 to December 2013. The 12-month period would be from July 2012 to June 2013 within which the six highest monthly salary credits will be chosen. Let us assume that the six highest monthly salary credits are P15, 000 each. The total monthly credit would be P90, 000 (P15, 000 x 6). The total monthly salary credit would be divided by 180 to get the average daily salary credit of P500 (P90,000/180). The daily sickness allowance is 90 percent of the of the average daily salary credit or P450 (P500 x 90%). The sickness benefit due is P9,000 (P450 x 20 days).
- The payment of the daily sickness allowance is advanced by the employer every regular payday. The SSS will then reimburse the employer of the amount legally advanced upon receipt of satisfactory proof of such payment and legality thereof. For unemployed, self-employed or voluntary members, the sickness benefit will be paid directly by the SSS to the member.
- The SSS will reimburse the employer only for confinements within the one year period immediately preceding and the date the claim for benefit or reimbursement is received by the SSS, except for confinements in hospital.
For example, SSS receives the employer's reimbursement claim on Oct. 3, 2016 for the sickness period September 23 to Oct. 14, 2015. The employer will be reimbursed for the period Oct. 4 to 14,2015 only as Sept. 23 to Oct. 3, 2016 falls outside the prescribed one-year period for reimbursement claim.
- For hospital confinement, the claim for benefit must be filed within one (1) year from the last day of confinement from the hospital. For home confinement, the claim for reimbursement by the employer must be filed within one (1) year from the start of illness. Failure to file the claim within the prescribed period will result to denial of the claim.
- A member can be granted sickness benefit for a maximum of 120 days in one calendar year. Any unused portion of the allowable 120 days sickness benefit cannot be carried forward and added to the total number of allowed compensable days for the following year.
- The sickness benefit shall not be paid for more than 240 days on account of the same illness. If the sickness or injury still persists after 240 days, his claim will be considered a disability claim.
MATERNITY MATERNITY BENEFIT
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. What are the qualifications for entitlement to the maternity benefit?
1. She has paid at least three (3) monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage.
2. She has given the required notification of her pregnancy through her ER if employed, or directly to the SSS, if a SE or VM or Member Separated from Employment. Is the SE or VM also entitled to the maternity benefit? Yes. An SE or VM is entitled to the maternity benefit provided that she meets the qualifying conditions. How much is the maternity benefit? The maternity benefit is equivalent to 100 percent of the member’s average daily salary credit (ADSC) multiplied by 60 days for normal delivery/miscarriage/ectopic pregnancy without operation/hydatidiform mole (H-mole) and 78 days for caesarean section delivery/ectopic pregnancy with operation.
How is the maternity benefit computed?
1. Exclude the semester of contingency (delivery/miscarriage/procedure). A semester refers to two (2) consecutive quarters ending in the quarter of contingency. A quarter refers to three (3) consecutive months ending March, June, September or December.
2. Count twelve (12) months backwards starting from the month immediately before the semester of contingency.
3. Identify the six (6) highest MSC within the 12-month period. Monthly salary credit (MSC) means the compensation base for contributions and benefits related to the total earnings for the month. The maximum covered earnings or compensation is P16,000, effective January 1, 2014.
Please refer to the following table:
Still adopting the World Health Organization’s (WHO) definition of disability as any “restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being,” the SSS redesigned the granting of disability benefit to its members. The aim is to improve the delivery of services without compromising the need to ensure that the appropriate disability benefit is paid to deserving members.
What are the salient features of the redesigned disability program?
1. Use of the new Manual on Medical Benefits (Disability, Sickness and Maternity), which is a compilation of the three (3) medical benefits granted by SSS to its members. It adopts the International Classification of Diseases and Related Health Problem codes (ICD-10) and includes the most recent medical management of illnesses/injuries and their corresponding ratings. It has been validated internationally and locally by the different Medical societies.
2. The evaluation guidelines of illnesses/injuries also consider the current physical state of the member, thus, allowing several claims to be evaluated first based on supporting documents. Who is qualified for disability benefit under the new program? A member who suffers partial or total permanent disability, with at least one (1) monthly contribution paid to the SSS prior to the semester of contingency, is qualified.
What are some of the partial permanent disabilities?
A complete and permanent loss or use of any of the following body parts:
One thumb, one big toe, one index finger, one hand, one middle finger, one arm, one ring finger, one foot, one little finger' one leg, hearing of one ear, one ear hearing of both ears, both ears, sight of one eye.
What are some of the total permanent disabilities?
The following fall under total permanent disability:
1. complete loss of sight of both eyes;
2. loss of two limbs at or above the ankles or wrists;
3. permanent complete paralysis of two limbs
4. brain injury resulting to incurable imbecility or insanity; and
5. such cases as determined and approved by the SSS.
What are the types of disability benefits?
1. Monthly pension – a cash benefit paid to a disabled member who has paid at least 36 monthly contributions to the SSS prior to the semester of disability.
2. Lump sum amount – granted to those who have not met the required 36 monthly contributions. If the approved disability period is payable for less than twelve (12) months, it is also given in lump sum.
How much is the monthly pension?
The amount of monthly pension will be based on the member’s number of paid contributions and the years of membership prior to the semester of contingency.
The minimum monthly pension is P1,000 for members with less than ten (10) credited years of service (CYS);
P1,200 with at least ten (10) CYS and
P2,400 with at least twenty (20) CYS.
Is the monthly pension for life?
The member who suffers from permanent total disability shall receive monthly pension for life. However, the pension shall be suspended if the member recovers from the permanent total disability, or resumes employment, or fails to report for the annual physical examination upon notice by SSS. If the pensioner is unable to report for medical examination due to the disability, then domiciliary service by an SSS physician may be requested at any branch office.
The member who suffers from permanent partial disability shall receive a monthly pension based on the equivalent number of months of the degree of disability. If the member’s condition due to same illness/injury deteriorates, resulting in progression of his/her disabling manifestations, he/she is entitled to claim additional disability benefit. This is calculated based on the remaining percentage of disability after deducting from the percentage of disability in the current claim, the percentage of disability granted in the previous claim.
How is the monthly pension paid?
The monthly pension is paid thru the bank account that the member chose under the “SSS Pensioner’s Remittance thru Bank” Program. This became mandatory effective September 1, 1993.
A member must open a single savings account (or use an existing one, if any) and submit to SSS a photocopy of any of the following:
a) the savings account passbook;
b) the ATM card bearing the member’s name and account number;
c) a validated initial deposit slip; or
d) Visa Cash Card Enrollment Form, upon filing of benefit application.
The original passbook/ATM card must be presented for authentication purposes. 60 For members without an existing single savings account, the SSS shall issue an LOI form to be presented to his/her chosen SSS-accredited bank for the purpose of opening a single savings account.
Upon approval of the claim, the SSS will mail a notice-voucher to the member with the information when to withdraw the benefit from the bank. How much is the lump sum amount?
There are two (2) basic formulas for calculating the lump sum amount. For permanent total disability, the lump sum benefit is equivalent to the monthly pension multiplied by the number of monthly contributions paid to the SSS, or twelve (12) times the monthly pension. Whichever result is higher of the two will be the member’s lump sum benefit. For permanent partial disability, the lump sum is equivalent to the monthly pension multiplied by the number of monthly contributions, multiplied by the percentage of disability in relation to the whole body; or the monthly pension twelve (12) times the percentage of disability, whichever is higher.
For example, the Member’s degree of disability is determined to be twenty percent (20%) and the number of contributions paid by the Member is equivalent to 24 months only:
a. P1,000 (monthly pension) x 24 (monthly contributions) x 20% (percentage of disability) = P4,800; or
b. P1,000 (monthly pension) x 12 x 20% (percentage of disability) = P2,400 The lump sum benefit to be given to the Member would be P4,800, which is the higher amount based on the two (2) computations.
Upon approval of the claim, the SSS will mail a notice voucher to the member informing him/her when to withdraw the benefit from the bank.
How is the lump sum amount paid?
Effective May 2016, the member may opt to receive the lump sum benefits for SS and EC Disability, SS Death and Retirement directly through his/her bank account, instead of receiving the check through the mail. The Payment thru-the-Bank Program shall become mandatory upon implementation of the Benefits Workflow System.
The member will be asked to open a single savings account (or use an existing one, if any) and submit to SSS a photocopy of any of the following:
a) the savings account passbook;
b) the ATM card bearing the member’s name and account number;
c) a validated initial deposit slip;
d) bank statement or certification; or
e) Visa Cash Card Enrollment Form, upon filing of benefit application. The original passbook/ATM card must be presented for authentication purposes.
For members without an existing single savings account, the SSS shall issue an LOI form to be presented to his/her chosen SSS-accredited bank for the purpose of opening a single savings account.
Upon approval of the claim, the SSS will mail a notice voucher to the member informing him/her when to withdraw the benefit from the bank. Aside from disability benefit, what else can a disability pensioner receive?
In addition to the monthly pension, a supplemental allowance of P500 is paid to the total or partial disability pensioner to provide additional financial assistance to meet the extra needs arising from his disability.
A total disability pensioner is also entitled to a 13th month pension payable every December. For a partial disability pensioner, 13th month pension shall be paid provided that the pension duration is at least twelve (12) months. Total disability pensioners and their legal dependents prior to the effectivity of RA 7875 on March 4, 1995 are entitled to the hospitalization benefits under PhilHealth.
A copy of Death Disability-Retirement (DDR) print-out indicating the type of claim is disability in nature and the effectivity date of pension or a Copy of Disability Pensioner Certification, must be submitted.
Total disability pensioners upon the effectivity of RA 7875 on March 4, 1995 and thereafter, are no longer covered except when they have accumulated 120 Medicare monthly contributions and have reached age 60.
They need to register with PhilHealth for the issuance of their PhilHealth ID card for Non-Paying Members. Those who wish to avail of PhilHealth benefits may enroll in the Individually-Paying Program (for SE/VM) or the Sponsored Program of PhilHealth.
What is Death Benefit?
The death benefit is a cash benefit paid either in monthly pension or lump sum to the beneficiaries of a deceased member.
What are the types of death benefits?
1. Monthly pension – granted to the primary beneficiaries of a deceased member who had paid 36 monthly contributions before the semester of death.
2. Lump sum amount – granted to the primary beneficiaries of a deceased member who had paid less than 36 monthly contributions before the semester of death. In case of secondary beneficiaries, they are paid a lump sum benefit only.
Which beneficiaries of a deceased member are eligible to receive the death benefit?
The death benefit goes to the primary beneficiaries of the deceased member. These are the legitimate dependent spouse, until he/she remarries, and the dependent legitimate, legitimated, or legally adopted, and illegitimate children of the member who are not yet 21 years old or over 21 years old, provided they are incapacitated and incapable of self-support due to physical or mental disability which is congenital in nature or acquired during minority. In the absence of primary beneficiaries, the dependent parents are considered the secondary beneficiaries. In their absence, any other person designated by the member in his/her SSS records are considered as the beneficiary. If there is no designated beneficiary, the benefit shall be paid to the deceased member’s legal heirs in accordance with the law of succession under the Family Code of the Philippines.
How much is the monthly pension?
The monthly pension depends on the member’s paid contributions, including the CYS and the number of dependent minor children, which should not exceed five (5).
The monthly pension is paid for not less than 60 months.
The amount of monthly pension will be the highest of:
1. the sum of P300 plus twenty percent (20%) of the average monthly salary credit (AMSC) plus two percent (2%) of the AMSC for each CYS in excess of ten (10) years; or
2. forty percent (40%) of the AMSC; or
3. P1,000 if the member had less than ten (10) CYS; P1,200 if with at least ten (10) CYS; or P2,400 if with at least twenty (20) CYS.
What is the Retirement Benefit?
The retirement benefit is a cash benefit paid either in monthly pension or as lump sum to a member who can no longer work due to old age.
What are the types of retirement benefits?
1. Monthly pension – a lifetime cash benefit paid to a retiree on a regular monthly basis.
2. Lump sum amount – one-time payment granted to a retiree.
The amount is equal to the total contributions paid by the member and/or by his/her ERs, including interest earned.
Who may qualify for a retirement pension?
1. Member must have paid at least 120 monthly contributions prior to the semester of retirement and is any of the following, whichever is applicable:
a) at least 60 years old and separated from employment or has ceased to be an SE/ OFW/Household Helper (optional retirement);
b) at least 65 years old whether still employed/SE, working as OFW/Household Helper or not (technical retirement);
c) at least 55 years old and separated from employment or has ceased to be an SE, if an “underground mineworker” (optional retirement);
d) at least 60 years old whether still employed/SE or not, if an “underground mineworker” (technical retirement); or
e) a total disability pensioner who has recovered from disability and is at least 60 years old (or at least 55 years old, if an underground mineworker).
2. A former retiree-pensioner whose monthly pension was suspended due to reemployment/self-employment and is now separated from employment or has ceased to be an SE.
3. A member who is 60 years old and above, but not yet 65, with 120 contributions or more may continue paying as VM up to 65 years old to avail of the higher amount of benefit.
What are the other terms and conditions for retirement of Underground Mineworkers?
An Underground Mineworker is any person employed to extract mineral deposits underground or whose workplace is beneath the ground performing and coordinating activities for the purpose of searching for and extracting mineral deposits, which includes the muckers, 67 miners, bull-gang workers, etc. and any other person working underground regardless of positions such as geologist, security guards, mechanics or sampler.
An Underground Mineworker must have been employed as such for at least five (5) years (either continuous or accumulated) prior to the semester of retirement as certified by his/her ER/s, regardless if employment as underground mineworker is his/her last or not. The actual date of retirement should not be earlier than March 13, 1998 and the ER/s must be duly registered with the Bureau of Mines as a mining company.
Who may qualify for a lump sum retirement amount?
Member is at least 60 years old (or 55 years old, if an underground mineworker) for optional retirement, or 65 years old (or 60 years old, if an underground mineworker) for technical retirement, and has paid less than 120 monthly contributions A member filing for retirement benefit and has paid less than 120 monthly contributions shall be given the option to continue paying the contributions as a VM to complete the 120 months to avail the full benefits thru monthly pension.
How is the monthly pension computed?
The monthly pension shall be the highest of:
a) 300 + (20% x AMSC*) + (2% x AMSC) x (CYS** – 10); or
b) 40% x AMSC; or
c) The minimum pension of P1,200, if with at least 10 CYS; or P2,400, if with at least 20 CYS, whichever is applicable.
*AMSC (Average Monthly Salary Credit)
** CYS (Credited Years of Service)
The monthly pension of a member who retires after age 60 and who has contributed the required 120 monthly contributions shall be the higher of the following:
a) monthly pension computed at the earliest time the member could have retired had he/she been separated from employment or ceased to be SE, plus all adjustments thereto; or
b) monthly pension computed at the time when the member actually retires.
What is the 18-months advance pension?
A retiree has the option to receive the first eighteen (18) months pension in lump sum, discounted at a preferential rate of interest to be determined by the SSS. This option can be exercised only upon filing of the first retirement claim, and only advance payments shall be discounted on the date of payment.
The Dependent’s Pension and 13th Month Pension are excluded from the advanced 18 months pension. Should there be an increase in the monthly pension within the 18-month period, the same shall also be subjected to interest. The retiree will receive the regular pension on the 19th month and every month thereafter.
A wife of an OFW asked OWWA about what sort of business she can start as a spouse of an OFW who is an active member. Samantha Natividad said that her husband is an OFW for a long time and she wants to start a business to help her husband as their children are growing up as well as their expenses.As a helpful information for other OFW spouses who also want to help their OFW partners, we made this info graphics regarding this topic.
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