Labor - Employeer's Contribution, Medical Benefits and Disability Benefits

8/3/2019 Labor - Employeer's Contribution, Medical Benefits and Disability Benefits

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Employers Contribution


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Employer remits to the system the monthlycontribution equivalent to 1% of his actualsalary or monthly salary credit.

(Public /Private Sector)

Monthly Salary Credit The wage base forcontributions or actual salary.


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Salary Bracket Range of Wage or

Salary

Monthly Salary

Credit

Employers

ContributionI 1 144.99 125 10.00

II 150 199.99 175 14.00

III 200 249.99 225 18.00

IV 250 349.99 300 24.00

V 350 499.99 425 34.00

VI 500 699.99 600 48.00

VII 700 899.99 800 64.00

VIIII 900 1099.99 1000 80.00IX 1100 1399.99 1250 100.00

X 1400 1749.99 1500 120.00

XI 1750 2249.99 2000 160.00

XII 2250 2749.99 2500 200.00

XIV 3250 3749.99 3500 280.00

XV 3750 4249.99 4000 320.00

XVI 4250 4749.99 4500 360.00

XVII 4750 5249.99 5000 400.00

XVIII 5250 5749.99 5500

440.00

XIX 5750 OVER 6000 480.00


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Rate shall be reviewed periodically and may be

revised as the experience in the following:o

Risko Cost of Administrationo Actual, anticipated and unexpected losses

Shall be paid in entirety, otherwisedeductions from wages or salaries shall benull and void. (Art. 183c)

In case of death, disability or separation from

employment, employers obligation as tocontributions shall cease.


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Penalties:

As provided in SSS Circular No. 3-V,delinquent employers shall be allowed to payon installment all unpaid contributions and a3% monthly penalty.

Payment of DelinquentContributions


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More Than But Less Than Monthly Installment

P10,000 Within 4 months

P10,000 50,000 Within 6 months

50,000 100,000 Within 8 months

100,000 500,000 Within 12 months

500,000 1,000,000 Within 18 months

1,000,000 2,000,000 Within 22 months

2,000,000 Within 24 months

Amount of Delinquency


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Medical Benefits


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Medical Services, appliances and suppliesRehabilitation ServicesPermanent Total DisabilityPermanent Partial DisabilityDeath

Prescriptive Period:Within three years from the

time the cause of action accrued.

Types of Benefits (Incomeor Services)


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Medical BenefitsAs defined in Art. 167 Medical Benefits

mean all payments made to the providers ofmedical care, rehabilitation services andhospital care, such as attending physiciansand the hospitals.

Medical ServicesEmployee shall be provided with such

medical services and appliances during the

subsequent period of his disability as thenature of ailment or injury and progress ofhis recovery may require.


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Conditions:He has been duly reported to the System

He sustains an injury or contracts sicknessThe System has been duly notified of the

injury or sickness

Period

Extent:The employee shall be entitled only for the

ward services of an accredited hospital andphysician.


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The System shall have the authority tochoose or order a change of physician,hospital or rehabilitation facility.

Where the sick or injured party unreasonablyrefuses to submit to medical examinations or

treatment, the System shall stop thepayment of further compensation.

All fees and other charges for hospital

services, medical case and appliances shallbe minimal and not higher than thosecharges prevailing in other hospitals for thesame services. However, professional fees

shall only be appreciably higher than thoserescribed under the Phili ine Medical Care


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A process is provided where a balancedprogram of remedial treatment, vocationalassessment and preparation which isdesigned to help restore the employee to

suitable employment and help them becomephysically independent.

Assistance within its resources to helprehabilitee to develop his mental, vocationalor social potential.

Rehabilitation


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Rehabilitee Disabled Individual

Rehabilitation Center (Ex. WRCC) Site

Rehabilitation Facility Services

Governing Board Provides Policy Guidance

Placement Officer Person practicing theallied medical profession or discipline

Suitable Employment Remunerative

General Terms


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Conditions:He has been reported to the system

He sustains a permanent disability as aresult of a compensable injury or sicknessHe has not been placed in suitable

employment

Period - It shall be provided during the period

of disability unless suspended or terminated

under any of the ff. conditions:Upon suitable employmentUpon suspension or termination of such

services by the Rehabilitation Center

By self-termination


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Rehabilitation services shall consist of the ff.:

Medical-surgical Management

HospitalizationNecessary appliances and suppliesVocational trainingAssistance for Placement

Extent of Benefit


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The System shall not be liable for the injury,sickness, disability or death during

rehabilitation caused by the ff.:

His intoxication

His willful intention to injure or kill himself oranother

His notorious negligence

Liability Limitations


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Suspension, termination of Student orrehabilitee.

Cause Recommendation

Appeal Within 15 days from notice of the

governing board.


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Systems participation in payment of wages ofplaced rehabilitee:

50% first 2 weeks after the start of the on-the-job training

25% for 3rd and 4th weeks of the on-the-job

training

0% for the rest of the period of the on-the-job training

Participation of theSystem


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Disability Benefits


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Temporary Total Disability

Permanent Total Disability

Permanent Partial Disability

Income Benefit Disabilities compensable by cash payments.

In case of failure to submit a monthly medical report certified

by attending physician, monthly income benefit shall be

suspended.

3 Kinds of DisabilityBenefits


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He has been duly reported to the System

He sustains such disability as a result of theinjury or sickness

The System has been duly notified of theinjury or sickness which caused his disability.

His employer shall be liable for the benefit ifsuch

illness or injury occurred before the employee

is

Conditions:


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Employee is unable to perform any gainfuloccupation for a continuous period notexceeding 120 days.

Period of Entitlement:Shall not be paid longer than 120

consecutive days

Recurrence of illness after recovery whichresults to a disability

Temporary Total Disability


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An employee under such disability shall be

subject to the following conditions:

Shall be pain an income benefit equivalent to90% of his average daily salary credit foreach day of such disability, subject to the ff.

conditions:Daily income benefit shall not be less than

P10 nor more than P90 for a period of 120days.

Unless injury or sickness requires extensivetreatment, it may go beyond 120 days butdoes not exceed 240 days


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Employee is unable to perform any gainfuloccupation for a continuous periodexceeding 120 days.

Permanent Total Disability


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Shall be paid by the System an amountequivalent to the monthly income benefitdefined in Sec. 8(3), Rule VI of these Rules.

Plus ten percent thereof for each dependentchild, but not exceeding five, beginning withthe youngest and without substitution.

Provided, that the monthly income benefitshall be the new amount of the monthlybenefit for all covered pensioners.

An employee under such disabilityshall receive the ff. compensation:


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The monthly income benefit shall be

guaranteed for five years, and shall be

suspended under the ff. circumstances:Failure to present himself for examination at

least once a year upon notice by the System

Failure to submit a quarterly medical reportcertified by his attending physician

Complete or full recovery from hispermanent disability

Upon being gainfully employed


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1. Temporary total disability lasting

continuously for more than one hundredtwenty days, except as otherwise providedfor in the Rule X;

1. Complete loss of sight of both eyes;

1. Loss of two limbs at or above the ankle orwrist;

1. Permanent complete paralysis of two limbs;

1. Brain injury resulting in incurable imbecility

Total and Permanent:


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Employee suffers a permanent partial loss ofthe use of any part of his body.

Covered employee shall continue to receivebenefits even after he is gainfully employedand receiving his wages or salary.

The benefit shall be paid for not more thanthe period designated in the followingschedules:

Permanent PartialDisability

C l t d t l f th N f th


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Complete and permanent loss of the

use of

No. of months

One thumb 10

One Index finger 8

One middle finger 6One ring finger 5

One little finger 3

One big toe 6

Any toe 3

One arm 50

One hand 39

One foot 31

One leg 46

One ear 10

Both ears 20

Hearing of one ear 10

Hearing of both ears 50

Sight of one eye 25


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A loss of a wrist shall be considered as a lossof the hand

A loss of an elbow shall be considered as aloss of the arm.

A loss of an ankle shall be considered as lossof a foot

A loss of a knee shall be considered as a lossof the leg.

A loss of more than one joint shall be

considered as a loss of one-half of the whole


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In case of permanent partial disability lessthan the total loss of the member specified

in the preceding paragraph, the samemonthly income benefit shall be paid for aportion of the provided in the chart.

In cases of simultaneous loss of more thanone member or a part, the same monthlyincome benefit shall be paid for a periodequivalent to the sum of the periods

established for the loss of the member or thepart thereof.

If the result is a decimal fraction, the same

shall be rounded off to the next higher


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In cases of injuries or illnesses resulting in apermanent partial disability not listed in thepreceding schedule, the benefit shall be an

income benefit equivalent to the percentageof the permanent loss of the capacity towork.

Unlisted Injuries and Illnesses

Labor - Employeer's Contribution, Medical Benefits and Disability Benefits

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