Professional Documents
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LABOR STANDARDS
Maternity Leave Sec. 14-A, R.A 8282 RA 7875 as amended by RA 9241 and Philhealth Law RA 10606 GSIS LAW OF 1997 (R.A. 8291)
Written report
Rodriguez, Rosario Rochelle D. Loredo, Juan Earl Cacho, Julian Paul Cruz, Mikka
Maternity leave
(RA 1161, as amended by RA 8282)
Coverage
Applies to all female employees, whether married or unmarried.
Amount
SSS maternity benefit shall be equivalent to 100% of the pregnant employees average daily salary credit for 60 days, or 78 days in case of caesarian delivery.
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Time of payment
The full payment of maternity benefits shall be advanced by the employer within 30 days from the filing of the maternity leave application.
Limitation on Availment
Entitlement to maternity leave under the Labor Code and maternity benefits under the SSS Law applies only for the first four delivery
RA 10606 was signed into law by President Benigno S. Aquino !!! on June 19, 2013, provides
mandatory universal healthcare coverage to Filipinos, especially the poor to access quality healthcare services in the country. It mandates the national government to subsidize the Philhealth contributions for indigents, abandoned children as well as the informal sector and citizens who are not capable to contribute such fees. This law provides expansion to the 3|Page
benefits of every Philhealth member to include preventive health care services and financial aid to health care providers. Some of the amendments includes wider concept to dependents that the new law states that parents who are 60 years old and has a monthly income below the amount determined by the Philippine Health Insurance Corporation (PHIC) can also be considered as dependents. It also included parents with permanent disability can now be declared legal dependents of the PhilHealth member. The new law will take effect 15 days after its publication in the Official Gazette or in two newspapers. The PHIC, in coordination with the Department of health, shall craft the implementing rules and regulations within 60 days from the effectivity of the law. REPUBLIC ACT NO. 10606 AN ACT AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS THE NATIONAL HEALTH INSURANCE ACT OF 1995, AS AMENDED, AND FOR OTHER PURPOSES
and facilities; prescription drugs and biologicals, subject to the limitations stated in Section 37 of this Act; and inpatient education packages; Outpatient care
services of health care professionals; diagnostic, laboratory, and other medical examination services; personal preventive services; and prescription drugs and biologicals, subject to the limitations described in Section 37 of this Act; Emergency and transfer services; and such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective. These services and packages shall be reviewed annually to determine their financial sustainability and relevance to health innovations, with the end in view of quality assurance, increased benefits and reduced out-of-pocket expenditure.
Contributions, Sec. 18
All members who can afford to pay shall contribute to the Fund, in accordance with a reasonable, equitable and progressive contribution schedule to be determined by the Corporation on the basis of applicable actuarial studies and in accordance with the following guidelines: Members in the formal economy and their employers shall continue paying the same monthly contributions as provided for by law until such time that the Corporation shall have determined a new contribution schedule: Provided, That their monthly contributions shall not exceed five percent (5%) of their respective monthly salaries. It shall be mandatory for all government agencies to include the payment of premium contribution in their respective annual appropriations: Provided, further, That any increase in the premium contribution of the national government as employer shall only become effective upon inclusion of said amount in the annual General Appropriations Act. 5|Page
Contributions from members in the informal economy shall be based primarily on household earnings and assets. Those from the lowest income segment who do not qualify for full subsidy under the means test rule of the DSWD shall be entirely subsidized by the LGUs or through cost sharing mechanisms between/among LGUs and/or legislative sponsors and/or other sponsors and/or the member, including the national government:Provided, That the identification of beneficiaries who shall receive subsidy from LGUs shall be based on a list to be provided by the DSWD through the same means test rule or any other appropriate statistical method that may be adopted for said purpose. Contributions made in behalf of indigent members shall not exceed the minimum contributions for employed members. The required number of monthly premium contributions to qualify as a lifetime member may be increased by the Corporation to sustain the financial viability of the Program: Provided, That the increase shall be based on actuarial estimate and study.
wrongfully claiming NHIP benefits or entitlement shall be punished with a fine of not less than Five thousand pesos (P5,000.00) or suspension from availment of NHIP benefits for not less than three (3) months but not more than six (6) months, or both, at the discretion of the Corporation. Violations of an Employer Failure/Refusal to Register/Deduct/Remit the Contributions Any employer who fails or refuses to register employees, regardless of their employment status, or to deduct contributions from the employees compensation or remit the same to the Corporation shall be punished with a fine of not less than Five thousand pesos (P5,000.00) multiplied by the total number of employees of the firm.
Any employer or any officer authorized to collect contributions under this Act who, after collecting or deducting the monthly contributions from his employees compensation, fails to remit the said contributions to the Corporation within thirty (30) days from the date they become due shall be presumed to have misappropriated such contributions. Unlawful Deductions Any employer or officer who shall deduct directly or indirectly from the compensation of the covered employees or otherwise recover from them his own contribution on behalf of such employees shall be punished with a fine of Five thousand pesos (P5,000.00) multiplied by the total number of affected employees.
If the act or omission penalized by this Act be committed by an association, partnership, corporation or any other institution, its managing directors or partners or president or general manager, or other persons responsible for the commission of the said act shall be liable for the penalties provided for in this Act. Misappropriation of Funds by Employees of the Corporation Any employee of the Corporation who receives or keeps funds or property belonging, payable or deliverable to the Corporation, and who shall appropriate the same, or shall take or misappropriate or shall consent, or through abandonment or negligence shall permit any other person to take such property or funds wholly or partially, shall likewise be liable for misappropriation of funds or property and shall be punished with a fine not less than Ten thousand pesos (P10,000.00) nor more than Twenty thousand pesos (P20,000.00). Any shortage of the funds or loss of the property upon audit shall be deemed prima facie evidence of the offense. Other Violations Other violations of the provisions of this Act or of the rules and regulations promulgated by the Corporation shall be punished with a fine of not less than Five thousand pesos (P5,000.00) but not more than Twenty thousand pesos (P20,000.00). 7|Page
All other violations involving funds of the Corporation shall be governed by the applicable provisions of the Revised Penal Code or other laws, taking into consideration the rules on collection, remittances, and investment of funds as may be promulgated by the Corporation. The Corporation may enumerate circumstances that will mitigate or aggravate the liability of the offender or erring health care provider, member or employer. Despite the cessation of operation by a health care provider or termination of practice of an independent health care professional while the complaint is being heard, the proceeding against them shall continue until the resolution of the case. The dispositive part of the decision requiring payment of fines, reimbursement of paid claim or denial of payment shall be immediately executory.
On October 1-2, 2013 after the RA 10606 signed into law, the NCS held the 12
th
National
Convention on Statistics discussed the dilemmas in validating PhilHealth Performance. PhilHealth plays a crucial part in maintaining standards and policies to help and maintain the benefits and rights of each member. According to Dr. Ramon Paterno, Author/Professor, Universal health care Study Group to be able to monitor how health inequities are being addressed, it is essential to answer the question; Who benefits from PhilHealth? See below report from NCS; PhilHealths Population coverage PhilHealth claimed a dramatic surge in population coverage of 84% in 2004, declaring the achievement of universal coverage as then self-defined by PhilHealth, former President Gloria Macapagal Arroyo herself announced an 87% coverage in 2009, and President Benigno S. Aquino III, in his SONA of 2013, reported a PhilHealth population coverage of 81% for the year 2012. DOH reported 84% PhilHealth population coverage by end of 2012. Page 4 of 6 But the National Demographic Health Survey in 2008 gave a very divergent PhilHealth population coverage of 38% of respondents compared to PhilHealths claimed 76% coverage for 2008. The NDHS question elicited the awareness of the respondent regarding any member of the household being a PhilHealth member so this 38% coverage may be deemed low, but the deviation between 76% and 38% is too large to be deemed insignificant. The SWS
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RA 7875 or the National Health Insurance Law of 1995 established the national health insurance program of the Philippines to be managed by PhilHealth, a government owned and controlled corporation, and an attached agency of the Department of Health. PhilHealths mandate was to provide all citizens of the Philippines with the mechanism to gain financial access to health services. (RA 7875 National Health Insurance Act of 1995, 1995) All citizens of the Philippines shall be covered by the National Health Insurance Program in over a period of not more than fifteen years. Universal coverage must have been achieved by 2010.
In 2004, RA 9241 amended RA 7875 and in the oversight provision, mandated the National Economic and Development Authority (NEDA), in coordination with the National Statistics Office (NSO) and the UP Manila National Institutes of Health, (UPM NIH) to conduct validation studies of PhilHealth performance. RA 10606, or the PhilHealth law 2013, retained the oversight provision which mandated the above three government agencies to conduct validation studies of PhilHealth performance, in recognition of the importance of having an external validation of PhilHealth performance outside of PhilHealths and the Department of Healths annual reports. It is therefore important for the National Statistics Office to recognize this mandated role. As public health policy, PhilHealth continues to be seen as the key to health finance reform of the Philippines. From the 2001 Health Sector Reform Agenda, the 2005 National Objectives for Health, the 2005 Fourmula One, the Health Care Financing Strategy 2010 2020, the mantra remains the same: Expand coverage, increase benefit payments, include outpatient benefits, use alternative forms of payment mechanisms, improve marketing to increase beneficiary knowledge, improve information system The latest 2012 DOH Annual Report continues to recognize a role for PhilHealth that goes beyond health financing: As the prime mover for reforms towards achieving UHC, the National Health Insurance program (NHIP) 9|Page
pursued policy reforms in 2012 (underscoring ours) (Health, 2013) Ever since PhilHealth became a flagship program of the previous administration which continues into the present administration, it has been a statistical dilemma in validating PhilHealth performance.
recommendations, to wit;
1. That NSO recognize its mandated task to assist in the validation of PhilHealth performance as set forth in the oversight provisions of RA 10606 amending RA 9241, amending RA 7875. That additional questions on PhilHealth, eg. PhilHealth membership status, should not be viewed as rider questions but as questions that are part of NSOs mandate. That as the leading government agency tasked with implementing national health surveys, NSO and NSCB should take a more proactive role, if not the leading role, in determining the appropriate questions to add in the national health surveys. 2. That an interagency TWG (composed of the three mandated government agencies (NEDA, NSO and NIH) plus DOH, PhilHealth and other concerned agencies be set up with the expressed task of determining the data that have to be included in National Health Surveys to assist in monitoring and evaluating not only PhilHealth performance, but also KP implementation a. PhilHealth population coverage: i. Include question on PhilHealth status (member or dependent) and other types of insurance in all National Health Surveys b. PhilHealth cost coverage or financial risk protection i. More timely National Health Accounts ii. For FIES 1. Finer segregation of composition of OOP expenditures: FIES 2009 items plus diagnostic and laboratory tests and informal payments (under the table or balance billing) 2. Include data on source of OOP expenditures: eg savings, loans, mortgage of property etc. c. Benefit incidence analysis to answer Who benefits from PhilHealth benefits and government subsidies for various health services d. Catastrophic health expenditures e. Deaths without medical attention and number of households who forgo consultation because of financial or physical barriers 3. To determine the source of funds for these additional questions for NDHS, APIS and FIES the funds mentioned in RA 1060 6 - .001% of PhilHealth revenues are too small for these additional questions in the national surveys.
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COVERAGE
The GSIS covers all government workers irrespective of their employment status, except employees who have separate retirement schemes under special laws, to wit:
Members of the Judiciary and Constitutional Commissions Contractual employees who have no employee-employer relationship with their agencies Uniformed members of the Armed Forces of the Philippines, and the Philippine National Police, including the Bureau of Jail Management and Penology, and the Bureau of Fire Protection.
LIFE INSURANCE
One of the many benefits of being a GSIS member is life insurance. GSIS gives you and your loved ones that much needed peace of mind. GSIS has two insurance programs available:
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If you entered the government service after July 31, 2003, you are automatically covered with an Enhanced Life Policy (ELP). Members whose policies have matured will also be covered by the ELP.
POLICY LOAN
Policy loan is a loan program which you can avail from your GSIS life insurance policy. The unique features of the Policy Loan are: (a) payment is not mandatory (unlike other GSIS loan products) and (b) it is renewable every year.
Retiring
following:
members who will opt to retire under RA 8291 are entitled to either of the
Option 1: 5-Year Lump Sum and Old Age Pension Under this option, the retiree can get his/her five-year worth of pension in advance. The lump sum is equivalent to 60 months of the Basic Monthly Pension (BMP) payable at the time of retirement. After five years, the retiree will start receiving his/her monthly pension. Option 2: Cash payment and Basic Monthly 12 | P a g e
In option 2, the retiree will receive a Cash Payment equivalent to 18 times the Basic Monthly Pension (BMP) payable upon retirement and then a monthly pension for life payable immediately after his retirement date. The maximum amount of the Average Monthly Compensation (AMC) to be used as the base for computing pensions and other benefits of a member shall be the AMC limit prevailing at the time the contingency/ies occurred. Thus, pursuant to the lifting of the AMC limit, the monthly pension of a member with at least 15 years of creditable service who is in the service on or after January 1, 2003 shall be computed on the basis of his/her AMCs without limit.
DISABILITY
Disability benefits are benefits granted to a member due to the loss or reduction in earning capacity caused by a loss or impairment of the normal functions of the employee's physical and/or mental faculties as a result of an injury or disease. The loss in earning capacity shall be determined on the basis of the following: 1. The employee's actual loss of income from the usual occupation 2. The capacity to engage in any other gainful occupation because of impairment A disability may either be: 1. Permanent Total 2. Permanent Partial 3. Temporary Total Injuries resulting in any of the following are deemed Permanent Total Disability (PTD) a. Complete loss of sight of both eyes b. Loss of two limbs at one or above the ankle or wrist c. Permanent complete paralysis of two limbs d. Brain injury resulting in incurable imbecility, insanity or other irreversible conditions
b. Cash payment of 18 times the Basic Monthly Pension 3. If the member is separated from service with 36 monthly contributions within the 5-year period immediately preceding PTD, benefit can be either: a. Basic Monthly Pension 4. If the member is separated from service with 180 monthly contributions prior to PTD, benefit can be either: a. Basic Monthly Pension 5. If the member has at least 3 years service with contributions, but PTD occurs 5 years after separation from the service, benefit is: Cash payment equal to 100% of AMC X Service (but not less than P12,000) payable immediately. No more separation benefit shall be paid in the future. Injuries resulting in any of the following are deemed Permanent Partial Disability (PPD) Complete and permanent loss of the use of: any one finger, any toe, one arm, one hand, one foot, one leg, one or both ears, sight of one eye or such other cases as may be determined by the System
Employment Compensation
The Employees' Compensation (EC) benefits or disability benefits is a compensation package for public and private sector employees and their dependents in the event of work-related injury, sickness, disability or death. The EC is a purely employer-based contribution benefit. Thus, the employee is not required to contribute any amount to the program. The employee compensation benefits are in the following options: 1. Cash income benefits for disability or death
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2. Medical and related services for injury or sickness 3. Rehabilitation services ( in addition to monthly cash income benefit) for permanent disability
The benefits given to the employee or his beneficiaries are in the form of:
Daily cash income benefit for temporary total disability (TTD) Monthly cash income benefit for permanent total disability (PTD) on a lifetime basis Monthly cash income benefit for permanent partial disability (PPD) Monthly cash income benefit for death, also on a lifetime basis, except for benefit paid to secondary beneficiaries, which is a monthly pension not to exceed 60 months but not less than fifteen thousand pesos Medical services, appliances and supplies for injury or sickness Rehabilitation services for permanent disability Career's allowance for permanent disability.
Burial Benefits
Death, although inevitable, is always an unpleasant incident in every one's life. It can also be costly to those who we leave behind. But with GSIS's funeral benefit, our survivors will have less to worry about.
Survivorship
When a member or pensioner dies, his or her beneficiaries are entitled to cash and/or pension benefits, subject to the existing rules and regulations on survivorship and policies on the maximum amount of survivorship pension. Coverage: All primary and secondary beneficiaries residing in the Philippines or abroad who are existing survivorship pensioners or claiming for survivorship benefit; Those who were receiving survivorship benefits but were suspended when the policy on the same was amended and implemented in August 2009; and Those who applied for survivorship benefits but were disapproved due to the issuance/approval of Management Implementing Guidelines (MIG) 01-2009 dated October 22, 2009 that took effect as early as August 2009, and MIG 04-2010 dated April 26, 2010.
Consolidated Loan
A member who has been in government service for at least 10 years can avail of a Conso-Loan equivalent to 10 months of their monthly salary. The minimum creditable years in service a member has to have to qualify is 20 months, with the Conso-Loan proceeds equivalent to three months of his monthly salary. The gross loan amount shall be a multiple of the basic monthly salary (BMS), depending on the members accumulated record of creditable service (RCS). Conso-Loan is a consolidation of five different loan products into oneSalary Loan, Restructured Salary Loan, Enhanced Salary Loan, Emergency Loan Assistance, and Summer One-Month Salary Loan. By availing of the Conso-Loan, you automatically fully settle your obligations from these loans. You likewise receive an automatic condonation from the outstanding penalties or surcharges incurred from the abovementioned loans. Thus, the Conso-Loan provides you with the opportunity to restore your status as a member in good standing and lower your monthly amortization, especially if you are experiencing difficulty in paying your loans and have incurred arrears, penalties, and surcharges. The privilege of having the penalties condoned can be enjoyed only during the first availment of the ConsoLoan. The Conso-Loan is renewable as long as there are proceeds available. The loan is payable in six years. The loan will be charged a minimal rate of 12% based on diminishing balance.
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Emergency Loan
The Emergency Loan is payable in three years or 36 equal monthly installments at an interest rate of six percent per annum. If an emergency loan is renewed, the balance of the outstanding loan will be deducted from the proceeds of the new loan. To qualify for the emergency loan, the member-applicant must be: a bona fide resident or employee of the government office within the declared calamity area; be in active service and not on leave of absence without pay; has no pending criminal or administrative charges; has no arrearages in the payment of mandatory social insurance contributions; and has no loan that has been declared in default. For a calamity-hit area, it must be declared in a state of calamity by its Sangguniang Panlalawigan/Panglungsod and approved by the GSIS Board of Trustees before members working in government offices in the said area become eligible for the Emergency Loan.
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