Tag Archive: Lifetime Member


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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Philhealth Benefits

Are you a Philhealth member?  Do you regularly check if your contributions are posted on your account?  What could be the reasons why a paying member may not be able to use his Philhealth benefits?

Regular remittance of premium contributions must be maintained in order for a Philhealth member to avail of the benefits seamlessly.  Philhealth does not accept retroactive payments such that, if the member missed paying a certain period, he may not be able to use his Philhealth benefits.

Below is a summary of Philhealth’s Eligibility Requirements, based on the paying member’s type of membership:

Sponsored Membership Date of hospitalization / availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members (IPM)
  1. There are certain confinement cases wherein three months’ worth of premium within the last six months (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 (9/12) prior to confinement.
Lifetime Member The member just has to show their Lifetime ID card; no need to pay premium anymore.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers (OWP)
Date of hospitalization / availment must be within the coverage period specified in themember’s MDR.

How to maintain member’s eligibility?

The secret is simple: pay your premiums on time.  Any discrepancies or gaps in your premium contributions will definitely affect your eligibility to claim benefits.  Here are some tips to help you secure your Philhealth benefits:

a. Sponsored Members:

  • Member’s card must be kept updated all the time.  If card is about to or has expired already, Sponsored Member must proactively ask his Sponsor if his membership will still be renewed.
  • If Sponsor will no longer renew the Sponsored Member’s membership, the latter has the option to register as an Individually Paying Member.

b. Individually Paying Member (IPM)

  • He must make sure that each quarter of the year has been paid (and all payments are posted in his account).
  • You have the option to pay your premiums yearly (advance payments) for security and convenience.

c. Overseas Workers Program Member (OWP)

  • All premiums must be remitted and posted on member’s account before membership expires.
  • In cases when contract abroad has been terminated, inform Philhealth to process shifting of membership category from OWP to IPM (or other applicable categories).  Pay the corresponding premiums right away to avoid gaps in your contributions.

d. Employed Members

  • If you are an employed member and you will be taking a Leave Without Pay, you may pay your monthly contributions at any nearest Philhealth office under the IPM category.
  • Remember to bring a copy of your RF-1 issued by your employer (to attest to the fact that you are indeed on Leave without Pay status).
  • In case you resign or get separated from work, you have to shift your membership category to IPM.

Remember that Philhealth does not have a “grace period” for missing your monthly contributions.  Once a month is left unpaid, the member can no longer make a retroactive payment.  These gaps will impact your and your dependents’ benefit claims, so make sure your payments are properly posted and your account is consistently updated.

Source: https://www.scribd.com/doc/115987403/Phil-Health-FAQs

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