July is so near that I'm feeling giddy just thinking of giving birth to my first child. Okay, maybe I'm both giddy and worried. Giddy because I'm excited to finally see my little boy after carrying him for 9 months. Worried because, well, let's face it, I'm not sure what to expect. My pain tolerance is not as high as my husband's but hopefully, I can manage.
The other thing that keeps me worried about my impending childbirth is the paper works. Yes, if you're a working mom like me, there are a lot of paper works to fill out. A piece of advice: don't do this on the last minute, it's the last thing you should worry about. Don't let the back log get you stressed when you're about to give birth!
Luckily, I had a meeting last week with our HR Specialist. And lucky enough, she briefed me about my benefits. Here's what she said (well, paraphrased of course):
SSS Maternity Benefits
What is the maternity benefit?
The maternity benefit is a daily cash allowance granted to a female member who was unable to work due to childbirth or miscarriage.
What are the qualifications for entitlement to the maternity benefit?
- She has paid at least three monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage.
- She has given the required notification of her pregnancy through her employer if employed, or to the SSS if separated, voluntary or self-employed member.
How much is the maternity benefit?
The maternity benefit is equivalent to 100 per cent of the member’s average daily salary credit multiplied by 60 days for normal delivery or miscarriage, 78 days for caesarean section delivery.
How is the maternity benefit computed?
- A quarter refers to three consecutive months ending March, June, September or December.
The maternity benefit is equivalent to 100 per cent of the member’s average daily salary credit multiplied by 60 days for normal delivery or miscarriage, 78 days for caesarean section delivery.
How is the maternity benefit computed?
- Exclude the semester of contingency (delivery or miscarriage).
- A quarter refers to three consecutive months ending March, June, September or December.
- Count 12 months backwards starting from the month immediately before the semester of contingency.
- Identify the six highest monthly salary credits within the 12-month period.
- Add the six highest monthly salary credits to get the total monthly salary credit.
- Divide the total monthly salary credit by 180 days to get the average daily salary credit. This is equivalent to the daily maternity allowance.
- Multiply the daily maternity allowance by 60 (for normal delivery or miscarriage) or 78 days (for caesarean section delivery) to get the total amount of maternity benefit.
The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages starting May 24, 1997 when the Social Security Act of 1997 (RA8282) took effect.
Can a member apply for sickness benefit if she has been paid the maternity benefit?
No. A female member cannot claim for sickness benefit for a period of 60 days for normal delivery or miscarriage or 78 days for caesarean delivery within which she has been paid the maternity benefit. As a rule, no member can be entitled to two benefits for the same period.
Is it necessary to notify the SSS of a member's pregnancy?
Yes. As soon as a member becomes pregnant, she must immediately notify her employer (if employed) or the SSS (if separated/voluntary/self-employed) of such pregnancy and the probable date of her childbirth at least 60 days from the date of conception by accomplishing SSS FORM MAT-1 (Maternity Notification Form) and by submitting proof of pregnancy.
The employer must, in turn, notify the SSS through the submission of the maternity notification form and proof of pregnancy immediately after the receipt of the notification from the employee member.
Failure to observe the rule on notification may result to the denial of the maternity claim.
How would the claimant be paid the maternity benefit?
For employed members - the benefit is advanced by the employer to the qualified employee, in full, within 30 days from the date of filing of the maternity leave application. The SSS, in turn, shall immediately reimburse the employer 100 percent of the amount of maternity benefit advanced to the female employee upon receipt of satisfactory proof of such payment and legality thereof.
According to my HR Specialist, SSS would provide a daily cash allowance of 100 percent my average daily salary credit multiplied by 60 days for normal delivery or miscarriage, 78 days for caesarean section delivery. It's usually Php 30,000 (normal and miscarriage) and Php 39,000 (c-section) being the maximum benefit computed according to your contribution.
If the employee member gives birth or suffers miscarriage without the required contributions having been remitted by the employer, or the employer fails to notify the SSS, the employer will be required to pay to the SSS damages equivalent to the benefits the employee would otherwise have been entitled to.
Philhealth Maternity Benefits
Q: How much is the total maternity benefit?
The total benefit is 6,500 pesos for normal delivery or normal childbirth while about 19,000 pesos for caesarean delivery.
Q: Can I receive this maternity benefit for all my normal deliveries?
No. Only the first 4 births are covered under the 6,500 package.
Q: Can I automatically receive the total benefit of 6,500 pesos?
Not always. The 6,500 pesos consists of the following:
2,500 pesos for hospital costs
2,500 pesos for the attending doctor
1,500 pesos for prenatal care
For lying-in clinics or midwife-managed facilities:
5,000 pesos for midwife and facility services
1,500 pesos for prenatal care
So if you didn’t avail of prenatal care, you get only 5,000 pesos, and if your doctor is not Philhealth-accredited, you receive only 2,500 pesos.
Q: If I’m one month pregnant now, can I apply for Philhealth membership so I can avail of the maternity benefits when I give birth?
No and yes. Nine months of prior contributions is required for receiving the maternity benefit package. Count 9 months within the 12-month period prior to child delivery. Let’s say your expected delivery month is September 2011. For the period from September 2010 to August 2011, you should have paid 9 monthly contributions. If Philhealth allows you to pay for December 2010 so you can reach the 9-month total, then you can avail. This depends on your prior Philhealth membership, meaning if you have been a Philhealth member before.
Q. If the hospital is Philhealth-accredited, can I be sure that I get the maximum hospital benefit?
No. You have to make sure that your doctor is also Philhealth-accredited.
Q: How do I get pre-natal care benefit?
Fill out the Philhealth Claim forms, have them signed by your doctor or hospital representative, and file with Philhealth together with official receipts of prenatal consultation and care.
Q: When should I file my claims?
Within 60 days from date of discharge. If your Philhealth maternity benefit is immediately deducted from your total hospital or clinic bill, the hospital or clinic is responsible for filing on time.
Q: What’s the best way to get the maximum Philhealth maternity benefits?
Find an obstetrics-gynecologist who is Philhealth-accredited, who works in a Philhealth-accredited hospital, and who is willing to help you get the maximum benefit starting from prenatal care.
Or find a midwife’s clinic or a lying-in clinic which is Philhealth accredited and willing to help you get the maximum benefit starting from prenatal care.
HMO (Health Insurance) Maternity Benefits
This actually depends on what health insurance your employer provides. In my case, I have Maxicare and the only maternity benefit I have is OB-GYNE consultation. It has helped me a lot especially since I am in constant contact with my doctor. No need to pay per visit (saves me about PHP 500-700 per consultation). Just think how much money I would used just for the consultation.
Of course I have to use out-of-pocket for the transvaginal ultrasound, lab works, pelvic ultrasound, etc. But, at least I was able to use my HMO card.
XOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXO
Now that you have been briefed about your maternity benefits, let's jump in to the forms that needs to be filled out:
- SSS Form MAT-1. This should be duly stamped received by the SSS prior to the date of childbirth/miscarriage. The member must have paid at least three monthly contributions within the 12 month period immediately preceding the semester of childbirth or miscarriage.
Ok- SSS Form MAT-2. This is actually the reimbursement form. When you fill this out, you need to also submit the following:
Caesarean delivery – certified or authenticated copy of duly registered birth certificate and certified true copy of operating room record/surgical memorandum.
Miscarriage or abortion - obstetrical history stating the number of pregnancy certified by the attending physician and dilatation and curettage (D&C) report for incomplete abortion, pregnancy test before and after abortion with age of gestation and hystopath report for complete abortion.
SSS digitized ID or E-6 acknowledgement stub with two valid IDs, one of which with recent photo.
To ensure receipt of benefits by members authorized company representatives who file maternity benefit claim shall present the members SSS digitized ID or E-6 acknowledgement stub with two valid IDs (at least one with photo). This requirement is in addition to the presentation by the company representative’s own SSS digitized ID and blue-card.
- PhilHealth Claim Form 1. This should be filled out by the employee.
- PhilHealth Claim Form 2. To be accomplished and signed by the hospital.
- PhilHealth Claim Form 3. To be accomplished and signed by the physician.
Okay, now that the important forms are filled out, we need to ensure, my dearest mommies, that we have updated our SSS and PhilHealth information with our new last name and beneficiaries. This is to make sure that no problem will occur during the reimbursement.
SSS E4 Form. For member information update.
PhilHealth Member Registration Form. For update on member's name, status and of course, beneficiaries.
Certificate of Update Exemption and of Employer's and Employee's Information. A Certificate to be accomplished and issued in case of increase or decreases in exemption, change of status, change in the person of employer, change in the type of employment, acquiring employment after having registered as engaged in business or exercise of profession, change in the working status of the spouse, execution of the "waiver to claim the Additional Exemption" by the husband, or revocation of the previously executed "waiver to claim the Additional Exemption" by the husband.
I think that's about it. I still need to update most of my paper works. It's really hard to file all these when I'm nearing childbirth. Oh well, might as well get started before it's too late. I hope this post answers all your questions! Have a safe pregnancy!
GIRL NAMES
BOY NAMES
)
