Claiming Your SSS and Philhealth Benefits: A Right and A Responsibility

07 - 27

Matagal na akong hindi nakapag hulog sa aking SSS / Philhealth account; ngayon, may sakit ako at maco-confine.  Pwede ko bang habulin ang mga nalibanan kong buwan para makapag claim pa din ako ng benefits?

This is a common question we receive from followers.  Apparently, a lot of Filipinos think that paying their monthly contributions for government-mandated insurances is optional.

It isn’t.  We all need to activate our SSS and Philhealth memberships and diligently remit our monthly contributions to ensure that we are protected and covered by benefits.

We summarized SSS and Philhealth’s requirements and needed premium payments before a member can claim his benefits from these government agencies.  We aim to encourage everyone to update and maintain their monthly contributions to ensure hassle-free benefits claim anytime emergency strikes.

Read on.

Philhealth

  • Member must have paid at least three months’ premium contributions within the immediate six-month period prior to the first day of confinement to avail of benefits.
  • Philhealth does not accept retroactive payments for unpaid months.
  • Contributions made on admission date, during the confinement period, or after the member or dependent is discharged from the health care institution will not be counted as qualifying contributions.

What are the requirements for eligibility and when is a member eligible to claim?

Sponsored Members Date of hospitalization/availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members 1. There are certain confinement cases wherein three months worth of premium within the last sixmonths (3/6) prior to confinement is acceptable.

2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy and other selected surgical procedures, the member must have paid nine months worth of premium within the last twelve months.

Lifetime Member The member just has to show their Lifetime ID Card; no need to pay premiums anymore.  This now includes Senior Citizens; in which case, all they need to show is their SC IDs.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers Date of hospitalization/availment must be within the coverage period specified in the member’s MDR.

 

SSS

A. Maternity Benefits

The maternity benefit is offered only to female SSS members.  A member is qualified to avail of this benefit if:

  1. She has paid at least three 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 to SSS through her employer if employed; or submitted the maternity notification directly to the SSS if separated from employment, a voluntary or self-employed member.
  3. SSS does not accept retroactive payments for unpaid months.

The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages.

B. Sickness Benefits

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.

A member is qualified to avail of this benefit if:

  1. He is unable to work due to sickness or injury and confined either in a hospital or at home for at least four days;
  2. He has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury;
  3. He has used up all current company sick leaves with pay; and
  4. He has notified the ER, or directly the SSS, if separated from employment, VM or SE regarding his sickness or injury.

C. Retirement

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.

A member is qualified to avail of this benefit if:

  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:
    • At least 60 years old and separated from employment or has ceased to be an SE/OFW/Household Helper (optional retirement);
    • At least 65 years old whether still employed/SE, working as OFW/Household Helper or not (technical retirement);
    • At least 55 years old and separated from employment or has ceased to be an SE, if an “underground mineworker” (optional retirement);
    • At least 60 years old whether still employed/SE or not, if an “underground mineworker” (technical retirement); or
    • 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 re-employment / 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.

If you have questions regarding benefit claims from Philhealth and SSS, send us a message and we will do our best to find the answers for you.

 

Sources:

www.sss.gov.ph

www.philhealth.gov.ph

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17 thoughts on “Claiming Your SSS and Philhealth Benefits: A Right and A Responsibility

    1. Hi Lourdes,

      Pwede po kayong mag inquire mismo sa PhilHealth dahil sila po ang mag evaluate ng case ng PWD kung pwede siyang ma-declare as a dependent.

      Case to case basis po.

      MC

  1. Ang asawa ko po ay naka 3 yrs lang po sya naka paghulog sa SSS,mag 68 na po sya d nya po kc nahulugan na ng mawalan sya ng trabaho pwede po ba ma lump sum nya yun nahulog nya.

  2. nagfile po ako ng sickness claim ko pero may unpaid loan po ako. matatanggap ko po ba yung sickness claim ko?

    1. Hi Alex,

      Ito ang requirements para maka claim ng sickness benefits. Wala namang nabanggit na condition for loan payments:

      QUALIFYING CONDITIONS:
      The member is unable to work due to sickness or injury and is confined either in
      a hospital or at home for at least four (4) days;
      • He/she has paid at least three (3) months of contributions within the 12-month
      period immediately before the semester of sickness or injury;
      • He/she has used up all company sick leaves with pay for the current year
      and has duly notified his/her employer; or
      • He/she must notify the SSS directly by filing a sickness benefit application if
      he/she is separated from employment, a self-employed or voluntary member,
      including overseas Filipino worker (OFW)-member.

      AMOUNT OF BENEFIT:
      The amount of the member’s daily Sickness Benefit allowance
      is equivalent to ninety percent (90%) of his/her average daily
      salary credit (ADSC).

      The Sickness Benefit is granted up to a maximum of 120 days in
      one calendar year.

      Hope this helped!

      MC

  3. im just wondering if sss will accept the copy of the document for the petition ive made to rectify the error on my son’s birth certificate or do i really have to wait for the amended birth certificate before i submit it to them for my maternity benefits

  4. I have a question regarding my operation done for ectopic pregnancy last march 29,2017 at that time I was just recently separated from my work.but I already have more or less 3 mos. Contribution and then the only contribution that I just misses was April and may if not mistaken
    Then by June 15 i got hired and started to work again. So can I still get a refund to Phil health for my confinement? Thanks for your response.

    1. Hi Dina,

      Were your 3-month contributions prior to your surgery, consecutive?

      Philhealth’s policy on claims is that the member must have made three months’ worth of premium contributions within the last six months, prior to hospitalization.

      You may call the Philhealth hotline at 02 411 7442 to have your account checked. Just have your Philhealth number handy when you call. They are available 24/7.

      MC

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