Maternity benefits from SSS and Philhealth [Merged]

[tifosi_1]

just need clarification...other than the 60 days normal/70+ for ceasarian maternity leave...may pay ba matatanggap si misis frm her employer while she's on leave? ang gulo kasi, parang iba-iba ang policy ng ibat-ibang kumpanya...

ex. sa company ko sa kontrata ko sabi meron daw...pero *** isang opismate ko na nanganak lang recently...wala daw siya nakuha..

di ko lang sure ano *** policy dun sa kumpanya nila misis

guys..share your experiences naman

[yangie]

iba iba ang policy ng company...ang sure na makukuha nya yung sss benefit...
like sa company namin normal delivery ako so 2 mos leave with pay yung lang ang benefit ..then sa health card namin na 4 thou lang...

[racacj]

maternity benefit can be obtained from two sources: (1) SSS and (2) Employer

(1) if your wife is an SSS member with contributions enough to qualify her for a maternity benefit, she will be able to get a maximum of 30k for normal deliveries or 39k maximum for a ceasarean delivery; whichever benefit your wife is qualified to get, it will be given to your wife thru her employer, which means, the company will advance the amount of benefit to your wife then the SSS will reimburse her company (pay back)

(2) employer maternity benefit is not compulsary, meaning not all companies are generous enough to include this benefit into the compensation package of their female employees; if the company of your wife does not include maternity pay on their compensation and benefits package, then there will be no such benefit to your wife; again this is not compulsary from your wife's company not unless it is stipulated as added benefit being a female employee

for husbands: you will be able to enjoy 7-days leave of absence with pay (paternity leave-a compulsary policy for every employer because it is law-mandated)

[mytitagirl]

i know that SSS maternity benefit may be obtained only if your wife filed a Maternity Notification prior to her delivery, then you may claim the maternity benefit either if her company is generous enough to advance the payment OR you have to wait for the SSS check after you file all the necessary documents like the baby's birth certificate and etc. i do not think that companies give monetary rewards to female employees filing maternity leave, unless ofcourse it is in the contract.

[princ3ss.m0m]

yup, di po sa lahat ng company with pay ang maternity leave. pero ang SSS sure naman basta na-file nya yung maternity notification sa SSS ng maaga. kelangan ATA 4 months or less pa lang yung tummy and submit ng med cert/ultrasound. you have to check with your wife's company.

[chummykins]

Ask ko lang kung makakapag-claim pa ba ako ng PhilHealth maternity benefit for the 2nd child? Wala kasi akong PhilHealth nung first child ko and ngayon pa lang ako mag-a-apply and I'm currently preggy with 2nd child. Balak ko bayaran na ng buo yung 1 year but the question is maco-cover pa ba yung 2nd child ko? Kasi sabi sakin nung accountant ng tita ko, pang first child lang daw yung maternity benefit. Ganon nga ba?

[mytitagirl]

Circular No. 16, s-2003

To: All Concerned

Subject: PhilHealth Maternity Care Package For Normal Spontaneous Delivery (NSD) Performed In Non-Hospital Facilities
Date: March 25 , 2003

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Pursuant to PhilHealth Board Resolutions Number 486 and 501 series of 2002 and to properly guide all concerned in the implementation of the new PhilHealth Maternity Care Package for normal spontaneous delivery (NSD), PhilHealth hereby issue its implementing guidelines for your reference effective to maternity care services initiated on May 1, 2003.

General Rules:

1) The following non-hospital health facilities shall be accredited by PhilHealth before they can provide the NSD package: Lying-in Clinics, Midwife-managed Clinics, Birthing Homes, or any other analogous health facilities.

2) Currently accredited Rural Health Units (RHU) and Ambulatory Surgical Clinics (ASC) shall also be allowed to provide the NSD package; provided, that they comply with all the requirements enumerated in Philhealth Circular Nos. 15, s. - 2001 and 09, s. - 2003. No additional accreditation fee shall be imposed on currently accredited RHU and ASC for their accreditation as providers of the NSD package.

3) The new PhilHealth Maternity Care Package for normal spontaneous delivery utilizes a case payment scheme in claims reimbursement. The Relative Value Unit (RVU) assigned for theses procedures (Relative Value Scale code number 59409) shall no longer apply.

4) Pursuant to PhilHealth Board Resolution No. 501, this package shall only be limited to the first two (2) normal deliveries.

5) A case rate of 4,500 pesos shall be paid to accredited health care providers.

6) For this fee, accredited providers shall provide all the services the member or dependent requires including prenatal care, delivery, newborn care and postnatal services.

7) The payment for the health facility is expected to cover for the necessary room and board, drugs and medicines, diagnostics, operating room, professional fees and all other medically necessary care. Services rendered for maternal complications during delivery is integrated in the package.

8) In order to ensure a holistic quality health care for both mother and child, case rate payment for theses facilities shall be divided as follows:

Claims Payments For "Non-Hospital Health Facilities"

Covered Services Period Benefits
Prenatal care & Normal delivery (1st payment) After delivery P 3,650.00
Postnatal care & Family planning services (2nd payment)After postnatal consultation P 850.00
Total P 4, 500.00

9) The Corporation shall not reimburse claims with incomplete provision of services.

10) Availment of the Philhealth Maternity Care Package shall be charged one-day to the annual 45-day benefit limit.


Eligibility Rules:

1) All members and qualified dependents of the National Health Insurance Program (NHIP) who satisfy the criteria of eligibility and are not disqualified by the exclusion criteria may avail of the NSD benefit package.

2) An individually paying member should comply with the rule on sufficient regularity of premium contributions and should have at least nine (9) months or three (3) quarters of premium payments in the immediate twelve (12) months prior to delivery. However, IPP enrolled as a group or through the IPP-OWWA program and for all other types of membership need not satisfy the sufficient regularity rule and rare governed by current eligibility requirements.

3) Moreover, the first prenatal visit of the member or qualified dependent must not exceed the four (4) months age of gestation (AOG) of the current pregnancy.

4) The following conditions are considered as exclusion criteria for the NSD package in non-hospital facilities, and shall be denied payment when claimed:

a) Maternal age under 19 years old
b) Elderly primies with maternal age of 35 years and older
c) Multiple pregnancy
d) Ovarian abnormalities (e.g. ovarian cyst)
e) Uterine abnormalities (e.g. myoma uteri)
f) Placental abnormalities (e.g. placenta previa)
g) Abnormal fetal presentation (e.g. breech)
h) History of at most three (3) miscarriages or one (1) stillbirth
i) History of previous major obstetric/gynecologic operative intervention (e.g. caesarean section, uterine myomectomy)
j) History of medical conditions (e.g. hypertension, heart disease, pre-eclampsia, eclampsia, diabetes, thyroid disorders, obesity, moderate to severe asthma, epilepsy, renal disease, bleeding disorders)
k) Other risk factors that may arise during the present pregnancy (e.g. premature contractions, vaginal bleeding) what warrants a referral for further management.

Claims Filing:

1) Duly accomplished Claims Form 4 shall be required in filing for reimbursement of benefit. Until this new claim form is distributed to providers, they may still use PhilHealth Claim Form No. 2.

2) All claim applications for the Maternity Care Package shall be covered by the rules on ICD-10 requirements for the Corporation.

3) Claims for the prenatal, delivery and newborn care must be filed within sixty (60) calendar days from date of discharge, while the second claim for postnatal and family planning services must be filed within ninety (90) days from date of discharge.


For the information and guidance of all concerned.


(Sgd.) Francisco T. Duque III, MD, MSc.
President and Chief Executive Officer

[tonie_mau]

here's a copy of philhealth newsletter to members


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[smilewarrior]

From what I know, for Philhealth you are required to pay 4 times a year (quarterly), per year, regularly.

If you miss a quarter, Philhealth will not cover your health expenses.

For hospitalization coverage, I think they require 6 previous consecutive quarters fully paid (for example: 2nd, 3rd quarter and 4th quarter of 2006, 1st, 2nd and 3rd quarter of 2007).

[grayscale06]

i beg to differ. dapat paid ang maternity leave, no matter what company you work in. the SSS offers 2 kinds of benefits for mommies-to-be.

(1) cash payout - different for normal and caesarian. to check how much you'll get go to https://sss-online.sss.gov.ph/sss/controller. That's SSS's online inquiry system.

(2) maternity leave - 60 days for normal, 78 days for caesarian.

in addition to the 2nd benefit, companies are REQUIRED to pay you daily maternity benefit equivalent to 100% of your present basic salary. This is required by law, RA 7322, Section 14-A.

Please see: http://www.chanrobles.com/legal4maternitybenefits.htm

Kaya mga mommies-to-be. Be aware of all the benefits we're entitled to. Sayang din dahil malaking tulong din satin yan. If you're not sure about something, research and ask. Ako din, still in the process of researching. Ang hindi na lang clear sakin eh yung sa PhilHealth. If anyone can give more information about PhilHealth benefits, pa-enlighten naman po.

Hope this helps!

[momicez]

Based on experience...

SSS Benefit, makukuha mo depende sa contributions and kind of delivery (CS/Normal/Miscarriage/Abortion). Mas malaki makukuha mo pag CS. Kasali ang abortion kasi diba may mga cases na may sakit ang mommy and she'll have a choice kung gusto nya ituloy *** pregnancy. Dapat talaga maaga pa lang nag-aapply na ng SSS maternity benefit para kung ano man ang mangyari (miscarriage) may makukuha pa din. Kung masunurin *** employer, they shell out first, tapos sila na bahala mag-ayos sa SSS. Pero may ibang companies na walang pakialam, so ikaw pa ang maglalakad sa SSS. Actually REQUIRED sa company na inaadvance ang SSS benefit. Pwede mo isumbo sa SSS or DOLE kung hindi iaadvance ng company *** SSS benefit.

PhilHealth Benefit, depende sa hospital. Kung PhilHealth accredited *** hospital, mayhihingin lang silang contribution documents then automatic na ibabawas nila *** cover ng philhealth sa bill. Kung hindi accredited ng PhilHealth *** hospital, babayaran mo muna *** buong bill then ikaw na ang maglalakad sa philhealth. Tapos hihintayin mo kung kelan darating *** cheque mo galing sa philhealth (matagal to ng konti).

Company Benefit, not all companies have this. Luckyly our company have 2 months maternity leave with pay, but unfortunately this is only available after 2 years of work or residence in the company. so kung CS ka *** 60 days lang ang bayad *** 18 days no pay na. Wala pa akong one year sa company namin nung nanganak ako, but they still gave me maternity leave, without pay nga lang. Pero ok na din atleast after 78 days may binalikan pa din akong trabaho diba.

hope nakatulong *** sharing ko...

[honeymom]

can somebody help me?
re philhealth and sss benefits: this is my 3rd time if ever to apply for this benefits. am i is still eligible to apply?i'm no longer active contributor in both companies. so do i still get something if i will be paying the lumpsum contirbutions. if so, how much? i'm due to give birth on Aug. 27. so i would appreciate if anyone would give me insights on this. thanks a lot!

[laineybogz]

hmmm... from what i know on sss benefit claims, you can't pay in lump sum the months that uve missed. that's why it's important to pay regularly

im just not sure with philhealth if this applies

[honeymom]

hmmm... from what i know on sss benefit claims, you can't pay in lump sum the months that uve missed. that's why it's important to pay regularly

im just not sure with philhealth if this applies

I appreciate if someone could give me a CLEAR info. thanks

[laineybogz]

okay... i was only trying to help. why don't you contact sss or philhealth for that matter? they should know about that more than anyone here. try visiting their websites or calling their hotlines.

[honeymom]

okay... i was only trying to help. why don't you contact sss or philhealth for that matter? they should know about that more than anyone here. try visiting their websites or calling their hotlines.

i appreciate your concern to help my query. it's hard to contact their (SSS and Philhealth) hotline. having this kind of forum wherein you are a member would help in any concern. i.e. the thread "how much manganak?" im sure they have an idea already but someone started a thread so that people who have experienced related to the post would share their infos and experiences.

peace!

[sweetwahm]

^^ Here's what I know:

SSS - You can apply for maternity benefits up to 4 pregnancies, regardless of whether you've availed in your initial pregnancies or not. So for example, di ka naka avail nung 1st pregnancy mo, pero sa 2nd naka avail ka. 2 na ang count sa yo. Tas pag nag avail ka sa 3rd pregnancy mo, 3 na ang count sa yo with regards to availment. This includes miscarriages.

Are you a voluntary member? I assume you are, otherwise di ka dapat remiss sa payments mo sa SSS because your employer is obliged to do that for you. Kung matagal ka nang di active, baka di ka maka avail. You can't pay a lumpsum amount for the months you've missed payment on. If ever nagbayad ka lumpsum, it'll be applied to the current month and future months. Now, to avail of maternity benefits, you need to have paid at least any 3 monthly contributions within a 12 month period right before the semester of your expected due date. If you do qualify for benefits, the amount is computed depending on the number of contributions you've made. If you are updated in your payments, may factor din yan. Obviously, you stand to get a bigger amount kung di ka remiss sa payments mo. if you are I hope that makes sense.

Kung employed ka, it is your employer who will advance the amount to you when you go on maternity leave, tas SSS na bahala mag reimburse sa kanila. If you are a voluntary member, you get the amount after you give birth and after you present the necessary documents.

IMPORTANT: You have to properly notify SSS that you are pregnant within the 1st 3 months of your pregnancy. Otherwise you won't qualify for benefits! Go to SSS, they have a form, (MAT1) that you need to fill up and attach proof of pregnancy, like lab results or an ultrasound report. This is also important if in case mag ka miscarriage ka. Wag naman sana! But if it does happen, and you've made proper notification to SSS, you still get maternity benefits as if you've given birth.

If it's still early, and you haven't paid contributions for a long time, baka pwede pa humabol. You might not get a big sum for maternity benefits after you give birth.... pero at least meron di ba?


Philhealth - Sorry, I don't know of any maternity benefits they provide. Do they have???? Ang alam ko lang deductions sa hospital bill mo for you and the baby. Up to P2,500, but I could be mistaken.

[sweetwahm]

Oh yeah, you can download the Adobe Acrobat version of the SSS Guidebook at the SSS website www.sss.gov.ph. Keep a copy, lahat ng pwede ma avail, including how to compute nandyan yan.

[sororityslut]

sa company namin, 30k maternity benefit from sss and then 8000 maternity subsidy from the company

[gaucho0722]

pwede pa humabol ng file ng mat1 kahit more than 3 months na.. ako kasi almost 6 months na nung magfile eh