SSS Maternity Benefits Denied

Our article on the SSS Maternity Benefits Reimbursement gathered a lot of feedback and questions from women wanting to avail of the SSS maternity benefits.  A handful were asking why their claims were denied in spite of following the step-by-step process we posted.

We conducted further research on the reasons why some are not granted the expected maternity benefits and were able to gather the following.  Note that these were collected from various women’s personal experiences when applying for the said benefits from SSS.

a. Child’s birth certificate is not authenticated by the Local Civil Registrar or by the Philippine Statistics Authority PSA (formerly NSO).

You may order for a copy of your child’s birth certificate by calling (02) 737-1111 or order online at psahelpline.com.  You will receive an PSA-authenticated copy of your child’s birth certificate in 2 to 3 days.  You may also get a Certified True Copy of your child’s birth certificate from the LCR where your child’s birth was registered.  The birth certificate issued by the hospital alone will not be honored by the SSS.

b. The Signature on MAT1 is not the same as the signature appearing on MAT2.

This happens when the mother’s personal data in her SSS account is not duly updated; a common reason is that her civil status has not been updated from Single to Married.  Her maiden name is reflected in her MAT1 form while her MAT2 already shows her married name.

When changing your last name while you are processing your claim, wait until the change has taken effect before your submit your MAT2 claim.  You may check your SSS online account regularly to see if your last name has been updated already.

c. Member has paid contributions but employer has failed to remit or has not posted the payments yet.

For employed members, make sure to check that the six monthly contributions to be considered by SSS in computing the benefit are properly posted and reflected in your SSS account.

d. Coverage Status on record is not the same as Coverage Status on member’s claim.

It could be that in the MAT2 form, the member checked his status as VOLUNTARY while her status on her SSS account is employed.  Double-check all entries in your MAT2 form before submitting to the SSS.

e. Clarifications on the child’s Middle and Last Names

In cases when the mother’s last name (if she is married) is not the same as the middle name reflected on the child’s birth certificate or that the child’s last name is not the same as the father’s last name, you will need to submit an Affidavit to Explain Discrepancy in Names.

f. The MAT1 form was not submitted to the SSS prior to child’s birth.

It is important to report your pregnancy to the SSS at the earliest possible time.  If you fail to do so and you give birth before you are able to submit your MAT1 or notify SSS of your pregnancy, your claim may be denied.

If you failed to notify SSS of your pregnancy, attach a letter of explanation to your MAT1 form, along with the ultrasound reports or pregnancy test reports as supporting documents.  Take note that the decision to approve the claim entirely depends on the SSS officer evaluating your claim.

g. Member is not qualified / eligible for maternity benefits.

This happens when the member fails to pay her contributions for at least three of the 12 months before semester of delivery or semester of contingency.  Visit this site to see how the semester of delivery is determined.

h. The member gave birth by Caesarean Section but failed to submit an Operating Room record.

Secure a list of documentary requirements for SSS Maternity Benefits reimbursement before giving birth.  Make a checklist of the documents you already have on hand and those that will be collected from the hospital.  You can actually begin collecting the documents while you are waiting for your due date.

i. Member had a miscarriage and failed to submit the required Histopathology Report and Medical Certificate.

Similar with number 8, you need to make sure that your documentary requirements are complete when claiming for maternity benefits when you had a miscarriage.

j. If the member resigned from work within six months of date of delivery, she needs to submit the following documents when claiming for maternity benefits.  Failure to do so may result to disapproval of claim.

  • Certificate of Separation
    • Date of separation must be included.
  • Certificate of Non-Advancement of Maternity Benefit
    • This will prove that your employer did not give you any amount of maternity benefit.
  • L-501 Form
    • 2 copies of specimen signature card.

On the other hand, if the date of resignation and date of delivery has more than a 6-month gap but less than 1 year, you still need to prepare the said documents as there are officers who may still require these documents.

If you have recently confirmed that you are having a baby, make sure you are well-informed of everything you need to know about claiming your maternity benefits.  The secret is to have a checklist of the documentary requirements and constant communication with SSS to make sure that you are following the correct processes.

Remember Moms, Daig ng maagap ang masipag!

Source: http://sssphilippinesnotes.blogspot.com/2013/07/reasons-sss-maternity-benefit-denied.html