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Presented by:GAUDENCIA S. TECSONSickness, Maternity, EC SectionCebu Processing Center
TopicsTopics
Office Order No. 2012 - 023
MEMBERS/ERs* SUBMIT CLAIM APPLICATIONS TO SSS
SSS MAIN OFFICE/BRANCHES
* RECEIVES & PROCESSES CLAIMS
CHECKS and PAYMENT ADVICE
MEMBER/ERsRECEIVE PAYMENT
POST OFFICE* RECEIVES CHECKS / PAYMENT ADVICE AND DELIVERS TO MEMBERS/ERs
MEMBERS/ERs
* SUBMITS CLAIM APPLICATIONS TO SSSSSS MAIN OFFICE/BRANCHES
* RECEIVES & PROCESSES CLAIMS
CHECKS, CREDITADVICE & REPORTS
* BANK RECEIVES CHECKS & REPORTS AND CREDITS AMOUNT TO ER ACCOUNT
Disbursement Procedure thru Bank
The SMEC Benefit Payment thru the Bank Program involves the remittance by SSS of sickness and maternity reimbursements to the employer’s designated SSS accredited bank, which in turn shall be credited to the employer’s savings or current account.
Currently, payment thru the bank is mandatory for employers and implemented nationwide effective January 2014
SSC Res. No. 650-s. 2011 dated June 8, 2011 approved the mandatory nationwide implementation of payment thru the bank, with exemptions subject to approval by the VP, Benefits Admin. Division
Office Order 2012-023 & Circular 2012-008 SUPERSEDES Circular 8-P dated September 2002
Phase 2 implementation (Future)
14
1. Al-Amanah Islamic Investment Bank of the Phils
2. Allied Banking Corporation3. Asia United Bank4. Banco de Oro5. Bank of Commerce6. Bank of the Philippine Islands7. Century Savings Bank8. China Banking Corporation9. Citystate Savings Bank10. Country Rural Bank of
Taguig, Inc. 11. CTBC Bank (Phils) Corp.12. Eastwest Bank13. First Consolidated Bank14. Land Bank of the Philippines15. Maybank
1. Metropolitan Bank & Trust Co2. Phil. Bank of Communication3. Phil. Business Bank4. Phil. National Bank5. Phil. Postal Savings Bank6. Phil. Savings Bank7. Philtrust8. Phil. Veterans Bank9. Rizal Commercial Banking
Corporation (RCBC)10. RCBC Savings Bank11. Rural Bank of Pililla, Inc.12. Security Bank 13. Standard Chartered Banking
Corp.14. Union Bank of the Philippines15. UCPB
Employers shall submit SMB PB Form thru -
SSS Branch OTC - for exemption and cancellation of enrollment transaction
SSS-accredited Bank - for enrollment and amendment transaction
• Bank representative will submit 2 copies of the enrollment form to SSS
• Bank will return approved/disapproved enrollment form to employers
Thru SSS Website - (future enhancement)
Receipt & Processing of ER’s Enrollment in the Program
1. All employers shall be required to enroll in the program at any of the SSS-accredited bank using the prescribed SMB-PB Form.
2. Existing savings or current account of the employer in an SSS-accredited bank may be enrolled in the program.
1. The bank account Signatory/ies specified in the SMB-PB Form shall be the authorized bank account signatory/ies designated by the employers/company’s Board of Directors as appearing in the bank record.
1. The SMB-PB Form shall be signed by the authorized company signatory certified by the employer in the SSS Form-L501.
POLICY
1. Designated bank shall certify the correctness of the bank account information indicated in the SMB-PB Form and forward the form to SSS.
POLICY
1. The employer shall notify SSS of any change in the bank account information or closure of the bank account immediately by accomplishing the SMB-PB Form to avoid delay in the processing of reimbursement claims.
1. In case of revocation of bank’s accreditation with SSS, the employer shall be notified to open an account at other SSS-accredited bank under this program to avoid delay in the processing of reimbursement claims.
1. In case of bank closure or bank holiday, the benefit reimbursements remitted to the employer’s bank account shall be governed by the banking rules and regulations.
1. SSS branch shall evaluate and recommend approval/denial of the employer’s request for exemption from the program, for the following cases:a. Location is far from the bank/high risk areab. Number of personnel is less than 5c. Employer can not afford the average daily balance (ADB)
required by the bank
1. The Vice President of the Benefits Administration Division shall review and approve/deny the employer's request for exemption from the program as evaluated by the branch.
1. Employers with approved exemption from the program shall continue to receive their reimbursements thru checks mailed to their address.
POLICY
1. All sickness and maternity benefit reimbursement applications shall undergo verification to determine if employer is enrolled in the program or with approved request for exemption.
1. Only sickness and maternity benefit reimbursement applications of employers who are enrolled in the program or with approved request for exemption from the program shall be accepted for processing.
POLICY
SMB PB FORM - FRONT
SMB PB FORM - BACK
PART I (A) – To be filled-out by ER (EMPLOYER INFORMATION)
PART I (B & C) – To be filled-out by ER (BANK ACCOUNT INFORMATION & ER CERTIFICATION)
PART II – To be filled-out by Bank
Bank certifies the correctness of bank account information stated by the employer in Part I (B) of SMB-PB Form.
PART III of SMB-PB Form – To be filled-out by SSS
Indicate “BRSTN” in the SMB-PB Form; and Affix signature over printed name and indicate date and time
in the “Processed By” portion of the SMB-PB Form.
APPROVED ENROLLMENT Affixes signature over printed name & indicates date and time
at the “Reviewed by” portion of the Form
PART III of SMB-PB Form – To be filled-out by SSS
Affixes signature over printed name & indicates date and time at the “Processed by” portion of the Form
REJECTED ENROLLMENT
PART I (A & C) – To be filled-out by ER (ER INFORMATION & CERTIFICATION
EXEMPTION IN SMB PB
Affixes signature over printed name & indicates date and time at the “Processed & Confirmed by” portion of the Form
APPROVED EXEMPTION
Affixes signature over printed name & indicates date and time at the “Processed by” portion of the Form
REJECTED EXEMPTION
Affixes signature over printed name & indicates date and time at the “Processed & Confirmed by” portion of the Form
DISAPPROVED EXEMPTION
Coverage: Medical BenefitsCoverage: Medical Benefits
SSSSSS
Sickness
Maternity
Disability
Unable to work due to sickness or injury;
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 or the SSS, if unemployed/SE/VM regarding his sickness or injury; and
Has used up all company sick leave with pay for the current year. [For employed members]
Failure to observe the rule on notification shall be a ground for the reduction or denial of the sickness claim application.
HOME CONFINEMENT
HOSPITAL CONFINEMENT
HOME CONFINEMENT
HOSPITAL CONFINEMENT
• Within 1 year from the start of confinement
• Within 1 year from the start of confinement
The daily cash allowance is equivalent to 90% of the member’s average daily salary credit.
120 days in one calendar year
Another 120 days for the succeeding year on account of the same illness
If the sickness persists he may be entitled to disability
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.
Where To File
ANY SSS BRANCH THAT IS MOST CONVENIENT TO MEMBER.
Office Order # 2012-068 dated Oct. 23, 2012
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); and
Multiply the ADSC by 90 %, then multiply it by the approved number of days.
April-Sept: Semester
MONTHLY SALARY CREDIT
Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2013 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 0 0 0
2012 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000
Confinement Period Sept 1-30, 2013 30 days
Current Company Sick Leave with pay Sept 1-5, 2013 5 days
Sum of the 6 highest MSC from the 12 month period preceding the
semester of contingency
2012 Oct 15,0002012 Nov 15,0002012 Dec 15,0002013 Jan 15,0002013 Feb 15,000
2013 Mar 15,000Total Monthly Salary Credits 90,000Divided by 180Average Daily Salary Credit 500.00Multiplied by 90% 90%Daily Sickness Allowance 450.00Multiplied by approved number of days 25
30 days confinement less 5 days company sick leave w/ pay Amount Of Sickness Benefit P 11,250.00
Sickness Benefit Reimbursement Application (SSS Form B-304)
Approved Sickness Notification (SN) – SSS Form CLD 9-N
Member’s SS card or two (2) valid IDs both with signature and at least one with photo; or
Photocopy of member’s SS card or two (2) valid IDs duly certified by the member and authenticated by the authorized company signatory (in the absence of the original required ID/s and filed by company representative)
ADDITIONAL DOCUMENTS FOR MEMBER SEPARATED FROM EMPLOYMENT
If the confinement period applied for is within employment or prior to date of separation, the following is to be submitted, whichever is applicable:
Certificate of separation from employment with effective date of separation; or
Certificate of separation from employment with effective date of separation and certification that no advance payment was granted; or
Notice of strike duly acknowledged by DOLE and duly notarized affidavit that no advance payment was granted; or
Certification from DOLE and duly notarized affidavit that no advance payment was granted, if with pending labor case; or
Duly notarized affidavit of separation with reason and effective date of separation and that no advance payment was granted, subject to further verification by SSS, if company ceased operation.
Has given the required notification to her employer or if she is unemployed, voluntary or self-employed member to the SSS; and
Paid at least three (3) monthly contributions within the 12-month period immediately before the semester of member’s childbirth or miscarriage.
• 100% of Average Daily Salary Credit (ADSC) multiplied by 60 days for normal delivery or miscarriage and 78 days for caesarean cases.
• The ADSC is obtained by dividing the sum of the six (6) highest monthly salary credits (MSC) in the 12-month period immediately before the semester of contingency by 180.
Payment will be made only for the 1st four deliveries or miscarriages.
Abortion and miscarriage included (effective May 24, 1997)
Payment of maternity benefit will be a bar to the recovery of sickness benefit for the same period for which daily maternity benefits have been received.
•Claim application shall be filed within ten (10) years from the date of delivery or miscarriage.
ANY SSS BRANCH THAT IS MOST CONVENIENT TO MEMBER.
Office Order # 2012-068 dated Oct. 23, 2012
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.
MONTHLY SALARY CREDIT
Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2013 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 0 0 0 0
2012 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000
TYPE OF DELIVERY DELIVERY DATE NO. OF DAYS
Normal July 1, 2013 60 days
Caesarean July 1, 2013 78 days
Sum of the 6 highest MSC from the 12 month period before the semester of contingency
201220122012201320132013
Oct 15,000Nov 15,000Dec 15,000Jan 15,000Feb 15,000Mar 15,000
90,000
180
500
100%
500.00
60
78
P 30,000.00
1. Maternity Reimbursement Form;
1. Maternity Notification (MN) received by SSS prior to delivery;
1. Photocopy of the member’s SS card or two (2) valid IDs duly certified by the member and authenticated by the authorized company signatory (in the absence of the original required ID/s and filed by company representative).
1. Member’s SS card or two (2) valid IDs both with signatures and at least one with photo; or
OTHER DOCUMENTS:Present the original/certified true copy and submit the photocopy
of the following whichever is applicable:
NORMAL DELIVERY - CHILD’S BIRTH OR FETAL DEATH CERTIFICATE (IF CHILD DIED OR STILLBORN) DULY REGISTERED WITH THE LCR.
CAESAREAN DELIVERY –
CHILD’S BIRTH OR FETAL DEATH CERTIFICATE (IF CHILD DIED OR STILLBORN DULY REGISTERED WITH THE LCR; AND
OPERATING ROOM RECORD (ORR) OR SURGICAL MEMORANDUM.
MISCARRIAGE - to be iscussed by the SSS Medical Officer
ECTOPIC PREGNANCY & H-MOLE - to be discussed by the SSS Medical Officer
ADDITIONAL REQUIRED DOCUMENTS FOR THE FOLLOWING, WHICHEVER IS APPLICABLE:
Certificate of separation from employment with effective date of separation and that no advance payment was granted, if date of delivery/ miscarriage is within the employment period; or within six (6) months from date of separation;
Certificate of separation from employment with effective date of separation, if date of delivery/ miscarriage is beyond six (6) months from date of separation;
Notice of strike duly acknowledged by the DOLE and duly notarized affidavit that no advance payment was granted, if company is on strike;
MEMBER SEPARATED FROM EMPLOYMENT
ADDITIONAL REQUIRED Cont’n
Certification from DOLE and duly notarized affidavit that no advance payment was granted, if with pending labor case; or
Duly notarized affidavit of separation from employment with reason and effective date of separation and that no advance payment was granted, subject to further verification by SSS, if company ceased operation.
MEMBER SEPARATED FROM EMPLOYMENT
SELF-EMPLOYED AND VOLUNTARY MEMBERS (PREVIOUSLY EMPLOYED)
Certificate of separation from employment with effective date of separation and that no advance payment was granted, if date of delivery/miscarriage is within the employment period; or within six (6) months from date of separation
NOTE: Documents issued by foreign country should be in English translation and duly authenticated by Philippine Embassy/ Consulate Office or duly notarized by notary public in host country.
DELIVERIES/MISCARRIAGES HAPPENED ABROAD -DELIVERIES/MISCARRIAGES HAPPENED ABROAD -
NORMAL DELIVERY - CHILD’S BIRTH OR FETAL DEATH CERTIFICATE (IF CHILD DIED OR STILLBORN).
CAESAREAN DELIVERY –
CHILD’S BIRTH OR FETAL DEATH CERTIFICATE (IF CHILD DIED OR STILLBORN); AND
OPERATING ROOM RECORD (ORR) OR SURGICAL MEMORANDUM.
Present the original/certified true copy and submit the photocopy of the following whichever is applicable:
DELIVERIES / MISCARRIAGES HAPPENED ABROAD -DELIVERIES / MISCARRIAGES HAPPENED ABROAD -
In the absence of the duly authenticated birth/fetal death certificate, submission of at least two (2) of the following shall be required in addition to child’s birth/fetal death certificate.
Certification from SSS foreign office or Liaison Officer of Social Security agencies in countries with bilateral agreements that the documents are true copies of the original presented by the member or certified by the hospital where the member was confined;
Child's passport, if any and if immigrant, copy of member's alien registration certificate;
Certification from employer that the member gave birth abroad (for employed member);
Certificate of employment abroad (for OFW).
A. SSS Branch OTC (Enhanced Processing of MN - 2011)a) Encoding of data and monitoring of maternity notification in the
data entry module of the SMEC System;b) MN System checks the eligibility of the member to the maternity
benefit; andc) Eligibility results will be printed at the back of the MN Form
B. Thru SSS Website (Enhanced SSS Website – June 6, 2011)a) Allows member (SE/VM/OFW/NWS) & employer to submit online
thru web their maternity notification ;b) EE/ER should register at the My.SSS Service Portal of the SSS
Website to be able to submit maternity notification;c) System shall send confirmation, status/update and actions taken
on submitted transactions to the member’s/ER email.
Maternity Notification maybe filed in 2 ways:
Enhanced SSS Website - Office Order # 2011-061 dated June 7, 2011
Maternity Notification
SSS Web Facility
SSS Web Facility
SSS Web Facility
SSS Web Facility
SSS Web Facility
SSS Single Sign On Maternity Notification Module
A. For delivery or completion of miscarriage in a hospital duly licensed by DOH
Maternity Notification is not required
In the absence of Maternity Notification under Office Order 85-P dated May 21, 2003
A. For delivery or miscarriage in a place other than a hospital duly licensed by DOH
Normal Delivery
J/SMR, Branch, shall confirm fact of birth from at least two (2) of the following sources:
Lying-in Clinics Local Civil Registrar Employer Townspeople/Neighbors
Miscarriage
The Medical Officer, Branch, shall evaluate and establish the compensability of maternity benefit claim due to miscarriage based on supporting documents submitted, such as D & C report or histopath report, pregnancy test report or ultrasound report.
However, verification of fact of birth from at least two of the sources may be dispensed with and payment be recommended if the maternity claim of the member 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.
PERMANENT TOTAL
PERMANENT PARTIAL
PERMANENT TOTALPERMANENT 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 PARTIALPERMANENT PARTIALInjury 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:
Number of MonthsComplete & Permanent loss of use of
One ThumbOne Index FingerOne Middle FingerOne Ring FingerOne Little FingerOne Big ToeOne HandOne ArmOne FootOne LegOne EarBoth EarsHearing of One EarHearing of Both EarsSight of One Eye
10 8 6 5 3 6395031461020105025
PERMANENT PARTIALPERMANENT PARTIAL
DEEMED PAID CONTRIBUTIONSDEEMED PAID CONTRIBUTIONS REFERS TO THE REFERS TO THE POSTED CONTRIBUTIONS OF A MEMBER FOR THE POSTED CONTRIBUTIONS OF A MEMBER FOR THE MONTHS DURING WHICH HE/SHE RECEIVED PARTIAL MONTHS DURING WHICH HE/SHE RECEIVED PARTIAL DISABILITY PENSION. SAID CONTRIBUTIONS SHALL DISABILITY PENSION. SAID CONTRIBUTIONS SHALL AUTOMATICALLY BE POSTED IN THE DEEMED PAID AUTOMATICALLY BE POSTED IN THE DEEMED PAID CONTRIBUTION TABLE (DPCT) UPON FULL CONTRIBUTION TABLE (DPCT) UPON FULL SETTLEMENT OF THE PENSION DURATION.SETTLEMENT OF THE PENSION DURATION.
DEEMED PAID CONTRIBUTIONSDEEMED PAID CONTRIBUTIONS ARE USED IN THE ARE USED IN THE ADJUDICATION OF RETIREMENT, DEATH AND ADJUDICATION OF RETIREMENT, DEATH AND PERMANENT TOTAL DISABILITY CLAIMS.PERMANENT TOTAL DISABILITY CLAIMS.
BASIC BENEFITMonthly Pension - with at least 36 months contributions prior to the semester of contingency
Lump sum - with less than 36 months contributions prior to the semester of contingency
SUPPLEMENTAL ALLOWANCE of P 500.00/month
13th MONTH PENSION - payable every December to total & partial disability pensioners with at least 12 months pension duration
DEPENDENTS PENSION - 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
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.
Transferable upon death of pensioner [If beneficiary /ies is/are primary]
Guaranteed for five [5] years [If there is/are no primary beneficiary/ies]
THE NUMBER AND THE AMOUNT OF MONTHLY CONTRIBUTIONS PAID BY THE MEMBER;
HIS CREDITED YEARS OF SERVICE; AND
THE NUMBER OF QUALIFIED DEPENDENT CHILDREN, IF ANY
The higher of the following :
P 300 + (20% x AMSC) + [2% x AMSC x (CYS - 10)]
40% x AMSC, or
MINIMUM PENSION
Effective May 24, 1997 (RA 8282)
P 1,000.00 IF WITH LESS THAN 10 CYS
P 1,200.00 IF WITH AT LEAST 10 CYS
P 2,400.00 IF WITH AT LEAST 20 CYS
FOR TOTALLY DISABLED MEMBER
THE TOTALLY DISABLED MEMBER WHO HAS NOT PAID AT LEAST THIRTY SIX (36) MONTHLY CONTRIBUTIONS PRIOR TO THE SEMESTER OF CONTINGENCY IS ENTITLED TO A LUMP SUM BENEFIT EQUIVALENT TO THE HIGHER OF THE FOLLOWING :
MONTHLY PENSION TIMES THE NUMBER OF MONTHS PAID; OR
TWELVE (12) TIMES THE MONTHLY PENSION
FOR PARTIALLY DISABLED MEMBER
IF THE PARTIALLY DISABLED MEMBER WHO HAS NOT PAID AT LEAST THIRTY SIX (36) MONTHLY CONTRIBUTIONS PRIOR TO THE SEMESTER OF CONTINGENCY, HE IS ENTITLED ONLY TO A PERCENTAGE OF LUMP SUM BENEFIT :
EXAMPLE : DEGREE OF DISABLITY - 20% OB
MINIMUM LUMPSUM BENEFIT -P 1,000.00 x 12 = P 12,000.00
LUMP SUM BENEFIT -P 12,000.00 x 20% = P 2,400.00P 2,400.00
LEGITIMATE , LEGITIMATED, LEGALLY ADOPTED AND ILLEGITIMATE CHILDREN WHO ARE BELOW 21 YEARS OLD OR OVER 21 YEARS OLD PROVIDED THEY ARE PHYSICALLY OR MENTALLY INCAPACITATED WHICH IS CONGENITAL OR ACQUIRED DURING MINORITY
THE DEPENDENT’S PENSION FOR EACH CHILD STOPS IF :
He or she reaches 21 years old; Gets married; Gets employed; or Dies
ANY SSS BRANCH THAT IS MOST CONVENIENT TO MEMBER
CLAIM APPLICATION MUST BE FILED WITHIN 10 YEARS FROM THE OCCURRENCE OF DISABILITY.
SS CARD OF THE MEMBER OR TWO VALID IDS BOTH WITH SIGNATURE AND AT LEAST ONE WITH PHOTO;
DISABILITY CLAIM APPLICATION;
SS MEDICAL CERTIFICATE FORM FILLED-OUT BY ATTENDING PHYSICIAN;
ANY OF THE FOLLOWING (IF PENSION)
● Photocopy of passbook
● Photocopy of ATM card and validated deposit slip
● Cash Card Enrollment Form
SUPPORTING MEDICAL DOCUMENTS
Note: The original copy of the passbook/ATM Card/deposit slip shall be presented for authentication purposes.
For member under guardian:
Guardian of member is the spouse or parent
Special Power of Attorney or Affidavit of Guardianship
Guardian of member is other than spouse or parent
Application for Representative Payee and Guarantor’s Bond form
Medical Certificate
EC PROGRAMEC PROGRAM
Income Cash Benefit for:
• Temporary total disability/sickness
• Permanent total disability
• Permanent partial disability
Medical Services, Appliances and Supplies
Rehabilitation Services
An income cash benefit equivalent to 90% of the average daily salary credit with a minimum of P10.00 and a maximum of P200.00 per day..
Sickness or injury is work- connected;
Employee has been duly reported to SSS;
SSS has been notified of such sickness or injury; and
Employee has the required monthly contributions.
INTOXICATION / DRUNKENNESS
WILLFULL INTENTION TO INJURE OR KILL HIMSELF OR ANOTHER
NOTORIOUS NEGLIGENCE
Three (3) years prescriptive period from date of contingency.
• 240 days in one calendar year.
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.
SSS ECCriteria
Min. # of days of confinement
At least 4 days Even 1 day conft. is compensable
Max. # of days allowed
120 calendar days/year
240 calendar days/year
Company SL Exhaust all current company SL
Need not have to exhaust Co. SL
Qualifying Contributions
W/ at least 3 cont. w/in 12 mo. period prior to the semester of contingency
1st day of employment is covered
Prescriptive Period
1 year 3 years
IF EC SICKNESS IS FOR MEMBERS WITH MORE THAN 12 MONTHS COVERAGE
MONTHLY SALARY CREDIT
YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2013
10,000
8,000
11,000
10,000
8,000
8,500
7,000
9,000
8,000
9,000
2012
5,000
9,000
8,000
10,000
5,000
-
8,000
6,000
7,500
7,500
8,000 8,000
Sum of the 6 highest MSC from the 12 month period preceding the semester of contingency
YEAR MONTH EC SS2012 Apr 10,000 10,0002012 Jul 8,000 8,0002012 Nov 8,000 8,0002012 Dec 8,000 8,0002013 Jan 10,000 10,000
2013 Mar 11,000 11,000Total Monthly Salary Credits (TMSC) 55,000 55,000Divided by 180 180Average Daily Salary Credit (ADSC) 305.56 305.56Multiplied by 90% 90% 90%Daily Sickness Allowance (DSA) 275.00 275.00Maximum Daily Salary Allowance (DSA) 200.00 275.00Multiplied by number of days 30 30Amount of Benefit P 6,000.00 P 8,250.00
IF EC SICKNESS IS FOR MEMBERS WITH LESS THAN 12 MONTHS COVERAGE
MONTHLY SALARY CREDIT
YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2013 0 0 0 0
5,000
6,000
3,000
5,000 6,000 0 0 0
2012 0 0 0 0 0 0 0 0 0 0 0 0
Sum of the MSC from month of coverage to month prior
the contingency
YEAR MONTH EC
2013 May 5,0002013 Jun 6,0002013 Jul 3,000
2013 Aug 5,000Total Sum 19,000Divided by number of months 4Average 4,750Multiplied by 6 months (constant) 6Total Monthly Salary Credit (TMSC) 28,500Divided by 180Average Daily Salary Credit (ADSC) 158.33Multiplied by 90% 90%Daily Sickness Allowance (DSA) 142.50Multiplied by number of days 15Amount of EC Sickness Benefit P 2,137.50
MONTHLY SALARY CREDIT
YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2013 0 0 0 0
5,000
6,000
3,000
5,000
6,000
0 0 0
2012 0 0 0 0 0 0 0 0 0 0 0 0
IF EC SICKNESS IS WITHIN THE MONTH OF COVERAGE
IF EC SICKNESS IS WITHIN THE MONTH OF COVERAGE
Earnings per day P 450.00Multiply by # of days worked - July 5 - 15, 2013 11Total Earnings P 4,950.00 Convert to Salary Credit 5,000 Multiply by Constant factor 6Total Monthly Salary Credit (TMSC) 30,000 Divided by 180 180Average Daily Salary Credit (ADSC) 166.67Multiply by 90% 90%Daily Sickness Allowance 150.00Number of days approved - July 16 - 31, 2013 16Amount of Benefit P 2,400.00
Note: If qualified under the double recovery scheme, employer must submit another sickness reimbursement under SS Sickness.
EC claims should be filed within 3 years from date of work-related accident or illness
