TRAINING COURSE ON Elizabeth C. ReyesSSS BRANCH OPERATIONS OIC, NCR RPD

DISABILITY BENEFITS

Outline of Presentation

1. Disability Benefits

2. Required Documents in Filing Disability Benefit

3. Existing Process Workflow

4. Annual Confirmation of Total Disability Pensioners

CASH BENEFIT GRANTED TO A MEMBER WHO BECOMES PERMANENTLY DISABLED EITHER PARTIALLY OR TOTALLY.

PERMANENT TOTAL

SEC. 13-A Permanent Disability Benefits - Upon the permanent total disability of a member who has paid at least thirty-six (36) monthly contributions prior to the semester of disability, he shall be entitled to the monthly pension: Provided, That if he has not paid the required thirty-six (36) monthly contributions, he shall be entitled to a lump sum benefit equivalent to the monhtly pension times the number of monthly contributions paid to the SSS or twelve (12) times the monthly pension, whichever is higher xxx.

KINDS OF DISABILITY :

PERMANENT TOTALThe ff. disabilities shall be deemed permanent total (SEC. 13-A. (d)) :

Injury resulting to any of the following shall be deemed Permanent Partial Disability. The benefits shall be payable not longer than the period designated in the schedule (section 13-A,(f)):

PERMANENT PARTIALPERMANENT PARTIAL

PENSION BENEFITPENSION BENEFIT

MEMBER WITH AT LEAST 36 MONTHLY CONTRIBUTIONS PRIOR TO THE SEMESTER OF CONTINGENCY.

LUMP SUM BENEFITLUMP SUM BENEFIT

TYPE OF DISABILITY BENEFITS :

MEMBER WITH LESS THAN 36 MONTHLY CONTRIBUTIONS PRIOR TO THE SEMESTER OF CONTINGENCY.

COMPUTATION OF BASIC MONTHLY PENSION (MP):

(SECTION. 12.) THE HIGHEST OF THE THE HIGHEST OF THE FOLLOWING :FOLLOWING : P 300 + (20% x AMSC) + [2% x AMSC x (CYS -

10)]

40% x AMSC, or

MINIMUM PENSION EFFECTIVE MAY 24, 1997 (RA 8282)EFFECTIVE MAY 24, 1997 (RA 8282)

P 1,000.00 IF WITH LESS THAN 10 CYS

P 1,200.00 IF WITH AT LEAST 10 CYS

P 2,400.00 IF WITH AT LEAST 20 CYS

AVERAGE MONTHLY SALARY CREDIT (AMSC)

“SEC. 8. (m) Average monthly salary credit-The result obtained by dividing the sum of the last sixty (60) monthly salary credits immediately preceding the semester of contingency by sixty (60), or the result obtained by dividing the sum of all the monthly salary credits paid prior to the semester of contingency by the number of monthly contributions paid in the same period, whichever is greater. Provided, That the injury or sickness which caused the disability shall be deemed as the permanent disability for the purpose of computing the average monthly salary credit.

CREDITED YEARS OF SERVICE (CYS) :

CYS is the sum of: 1985 minus date of coverage; number of years with at least 6 monthly contributions from 1985 to 2001; and total number of monthly contributions paid divided by 12 beginning Jan. 2002.

CYS = A + B + C

Where A = 1985 minus the calendar year of coverage

B = number of years with at least 6 monthly contributions from 1985 to 2001

C = total number of monthly contributions paid beginning January 2002 divided by 12

January 1985less: doc 1970

AA

CYS 15

Year # of mos. paid CYS

1985 6 11986 3 01987 2 01988 6 11989 4 01990 5 01991 4 01992 4 01993 2 01994 - 01 0

0CYS 2

BB 2002 12 1.002003 6 0.502004 3 0.252005 3 0.25

Year # of mos. pd CYS

CYS 2.00

CC

CYS = A + B + C = 15 + 2 + 2

= 19

Total Disability:

MP x No. of monthly contributions paid; or MP x 12 (whichever is higher)

Partial Disability:

Benefit shall be such percentage of the lump sum benefit described in the preceding paragraph with due regard to the degree of disability.

Lump Sum Benefit

1. Rating of Disability – 25% of the body Contributions – 30 months Monthly Pension – P1,200 Lump Sum Benefit: (P1,200 x 30) x 25%

2. Rating of Disability – 50% of the Right Leg Contribuions - 11 months Monthly Pension – P3,000 Lump Sum Benefit:

= (P3,000 x 12) x ( 50% x 46) 75

Example of Lump sum Partial Disability

PERMANENT PARTIAL & TOTAL DISABILITY PERMANENT PARTIAL & TOTAL DISABILITY PENSIONERS ARE ENTITLED TO SUPPLEMENTAL PENSIONERS ARE ENTITLED TO SUPPLEMENTAL ALLOWANCE OF P 500.00ALLOWANCE OF P 500.00

DEPENDENT’S PENSION (FOR TOTAL DISABILITY) - DEPENDENT’S PENSION (FOR TOTAL DISABILITY) - 10% OF THE MEMBER’S BASIC MONTHLY PENSION 10% OF THE MEMBER’S BASIC MONTHLY PENSION OR P250, WHICHEVER IS HIGHEROR P250, WHICHEVER IS HIGHER

1313THTH MONTH PENSION IS GRANTED TO TOTAL MONTH PENSION IS GRANTED TO TOTAL DISABILITY PENSIONERS AND TO PARTIAL DISABILITY PENSIONERS AND TO PARTIAL DISABILITY PENSIONERS WITH AT LEAST 12 DISABILITY PENSIONERS WITH AT LEAST 12 MONTHS PENSION DURATIONMONTHS PENSION DURATION

MONTHLY PENSION IS TRANSFERABLE UPON DEATH OF A MONTHLY PENSION IS TRANSFERABLE UPON DEATH OF A TOTAL DISABILITY PENSIONER TO HIS PRIMARY TOTAL DISABILITY PENSIONER TO HIS PRIMARY BENEFICIARIESBENEFICIARIES

IF WITHOUT PRIMARY BENEF, HIS SECONDARY BENEFICIARIES IF WITHOUT PRIMARY BENEF, HIS SECONDARY BENEFICIARIES

SHALL BE ENTITLED TO LUMP SUM BENEFIT EQUIVALENT TO SHALL BE ENTITLED TO LUMP SUM BENEFIT EQUIVALENT TO THE TOTAL MONTHLY PENSIONS CORRESPONDING TO THE THE TOTAL MONTHLY PENSIONS CORRESPONDING TO THE BALANCE OF THE FIVE-YEAR GUARANTEED PERIOD BALANCE OF THE FIVE-YEAR GUARANTEED PERIOD EXCLUDING THE DEPENDENTS' PENSION.(SEC. 13-A (c))EXCLUDING THE DEPENDENTS' PENSION.(SEC. 13-A (c))

IN CASE OF PERMANENT PARTIAL DISABILITY, THE MONTHLY IN CASE OF PERMANENT PARTIAL DISABILITY, THE MONTHLY PENSION BENEFIT SHALL BE GIVEN IN LUMP SUM IF IT IS PENSION BENEFIT SHALL BE GIVEN IN LUMP SUM IF IT IS PAYABLE FOR LESS THAN TWELVE (12)MONTHS. (SEC. 13-A PAYABLE FOR LESS THAN TWELVE (12)MONTHS. (SEC. 13-A (h))(h))

FOR THE PURPOSE OF ADJUDICATING RETIREMENT, DEATH FOR THE PURPOSE OF ADJUDICATING RETIREMENT, DEATH AND PERMANENT TOTAL DISABILITY PENSION BENEFITS, AND PERMANENT TOTAL DISABILITY PENSION BENEFITS, CONTRIBUTIONS SHALL BE DEEMED PAID FOR THE MONTHS CONTRIBUTIONS SHALL BE DEEMED PAID FOR THE MONTHS DURING WHICH THE MEMBER RECEIVED PARTIAL DISABILITY DURING WHICH THE MEMBER RECEIVED PARTIAL DISABILITY PENSION: PENSION: PROVIDED,PROVIDED, THAT SUCH CONTRIBUTIONS SHALL BE THAT SUCH CONTRIBUTIONS SHALL BE BASED ON HIS LAST CONTRIBUTION PRIOR TO HIS BASED ON HIS LAST CONTRIBUTION PRIOR TO HIS DISABILITY. (SEC. 13-A (I))DISABILITY. (SEC. 13-A (I))

A MEMBER WHO (1) HAS RECEIVED A LUMP SUM BENEFIT A MEMBER WHO (1) HAS RECEIVED A LUMP SUM BENEFIT AND (2) IS RE-EMPLOYED OR HAS RESUMED SELF-AND (2) IS RE-EMPLOYED OR HAS RESUMED SELF-EMPLOYMENT NOT EARLIER THAN ONE (1) YEAR FROM THE EMPLOYMENT NOT EARLIER THAN ONE (1) YEAR FROM THE DATE OF HIS DISABILITY SHALL AGAIN BE SUBJECT TO DATE OF HIS DISABILITY SHALL AGAIN BE SUBJECT TO COMPULSORY COVERAGE AND SHALL BE CONSIDERED A NEW COMPULSORY COVERAGE AND SHALL BE CONSIDERED A NEW MEMEBER. MEMEBER.

DEPENDENT’S PENSION

(SEC. 12. A)

QUALIFYING CONDITIONS FOR DEPENDENTS’ PENSION :

LEGITIMATE , LEGITIMATED, LEGALLY ADOPTED AND ILLIGITIMATE CHILDREN WHO ARE BELOW 21 YEARS OLD OR OVER 21 YEARS OLD PROVIDED INCAPACITATED OR INCAPABLE OF SELF-SUPPORT)

THE DEPENDENT’S PENSION STOPS IF CHILD:

REACHES 21 YEARS OLD; GETS MARRIED; GETS EMPLOYED; OR DIES

WHERE TO FILE :

APPLICATION FOR DISABILITY BENEFITS CAN BE FILED AT ANY SSS BRANCH.

CLAIM APPLICATION SHALL BE FILED WITHIN TEN (10) YEARS FROM THE DATE OF CONTINGENCY

WHEN TO FILE :

REQUIRED DOCUMENTS IN FILING DISABILITY BENEFIT

DISABILITY DISABILITY HAPPENED IN THE HAPPENED IN THE

PHILIPPINESPHILIPPINES

A. Basic Documents

Same with SS

SS EC

Disability Claim Application

Medical Certificate signed by attending physician

SS Card or 2 valid IDs both with signature and at least one with photo

Medical records Note: Medical Specialist shall decide on the checklist of the required medical documents based on a separate checklist.

For member under guardian: Guardian of member is the spouse or parent:

• Special Power of Attorney or Affidavit of Guardianship

Guardian of member is other than the spouse or parent

• Application for Representative Payee and Guarantor’s Bond Form

For disability claim filed thru a representative• Sketch of member's residence

B. Other Documents

Type of Benefit

Type of Disability

Partial Total

Pension Any of the following:-Copy of passbook-ATM card and validated deposit slip -Cash Card Enrollment Form

Any of the following:-Copy of passbook-ATM card and validated deposit slip -Cash Card Enrollment Form

Additional Documents:

• For member with qualified dependentLegitimate/legitimated child/children Birth certificate of dependent child/children or

Baptismal certificate (in case birth certificate is not available)

Illegitimate child/children Birth certificate of dependent child/children; or Proof of filiations, e.g, will/ statement before a court

of record/any authentic writing (if child was not acknowledged by the parent in the birth certificate)

Legally adopted child/children Birth certificate of dependent child/children; and Legal adoption paper

Other Documents - continuation

Type of Benefit

Type of Disability

Partial Total

Additional Documents:

• For member with qualified dependent who is incapacitated Medical certificate of incapacitated

dependent

For member with dependent child/children living with guardian (spouse/parent of member) Claim for dependents' pension benefit

(SSS Form BPN-106)

For member with dependent child/children living with guardian (other than spouse/parent of member) Application for Representative Payee

and Guarantor's Bond Form

DISABILITY DISABILITY HAPPENED ABROADHAPPENED ABROAD

Note: Documents issued by foreign country Note: Documents issued by foreign country should be in English translation and should be in English translation and duly authenticated by the Philippine duly authenticated by the Philippine Embassy/Consulate Office or duly Embassy/Consulate Office or duly notarized by notary public in host notarized by notary public in host country.country.

A. Basic Documents

Same with SS

SS EC

Disability Claim Application

Medical Certificate signed by attending physician

PE report describing disabling manifestation signed by attending physician

Medical records Note: Medical Specialist shall decide on the checklist of the required medical documents based on a separate checklist.

Photocopy of any of the ff: SS card, passport, Alien Resident Certificate

For member under guardian: Guardian of member is the spouse or parent:

• Special Power of Attorney or Affidavit of Guardianship

Guardian of member is other than the spouse or parent

• Application for Representative Payee and Guarantor’s Bond Form

-

accident/master's report (seaman)/Sickness report

B. Other DocumentsType of Benefit

Type of Disability

Partial Total

Pension Any of the following:-Copy of passbook-ATM card and validated deposit slip -Cash Card Enrollment Form

Any of the following:-Copy of passbook-ATM card and validated deposit slip -Cash Card Enrollment Form

Additional Documents:

• For member with qualified dependentLegitimate/legitimated child/children Birth certificate of dependent child/children or

Baptismal certificate (in case birth certificate is not available)

Illegitimate child/children Birth certificate of dependent child/children; or Proof of filiations, e.g, will/ statement before a court

of record/any authentic writing (if child was not acknowledged by the parent in the birth certificate)

Legally adopted child/children Birth certificate of dependent child/children; and Legal adoption paper

Other Documents - continuation

Type of Benefit

Type of Disability

Partial Total

Additional Documents:

• For member with qualified dependent who is incapacitated Medical certificate of incapacitated

dependent

For member with dependent child/children living with guardian (spouse/parent of member) Claim for dependents' pension benefit

(SSS Form BPN-106)

For member with dependent child/children living with guardian (other than spouse/parent of member) Application for Representative Payee

and Guarantor's Bond Form

DISABILITY UNDER THE DISABILITY UNDER THE PORTABILITY LAWPORTABILITY LAW

Republic Act 7699Republic Act 7699

““An Act Instituting Limited Portability An Act Instituting Limited Portability Scheme in the Social Security Scheme in the Social Security

Insurance Systems by Totalizing the Insurance Systems by Totalizing the Worker’s Creditable Services or Worker’s Creditable Services or

Contributions in Each of the Systems”Contributions in Each of the Systems”

Applicability: Members who do not qualify in either or both Systems for benefits covering the ff. Contingencies

Old-age or RetirementSicknessDisability or InvaliditySurvivorship or Death

CASES WHEN LIMITED PORTABILITY WILL APPLY

SSS GSIS

QUALIFIED → NOT QUALIFIED

NOT QUALIFIED

NOT QUALIFIED NOT QUALIFIED

QUALIFIED→→

PORTABILITY LAW

Overlapping of creditable services or contributions in both Systems shall be credited only once.

Whenever totalization applies, payment shall be made by the System under which the member is currently covered.

Amount of Pension benefit is pro-rated.

Applicable to a member covered by GSIS effective June 19, 1997.

Effectivity is May 20, 1994.

EXAMPLE: (No Overlapping of Contributions)

Before Totalization After Totalization

Not qualified under both Systems

Qualified under both Systems

SSS GSIS TOTAL

Number of Contributions32 5 37

Credited Years of Service15 0 15

AMSC P1,000

Computation of Pro-Rated Pension:

Theoretical Monthly Pension: The highest of:

• 300 + .20 x P1,000 x (15-10) = P1,300.00

• 40% of P1,000 = P 400.00

• Minimum Pension = P1,200.00 Theoretical Monthly Pension = P1,300.00

Monthly Pension = P1,300.00 x (32 / 37)

= P1,124.32 • Dependent’s Pension shall be equivalent to 10% of pro-

rated monthly pension or P250.00 whichever is higher

A. Basic Documents

1. Disability Claim Application

2. Medical Certificate signed by the attending physician

3. SS Card or 2 valid IDs both with signature and at least

one with photo

4. Medical records

Note: Medical Specialist shall decide on the checklist of the

required medical documents based on a separate checklist

1. Certification of total contributions under the

Portability Law from GSIS

2. Copy of passbook or ATM card and validated deposit slip

or Cash Card Enrollment Form

B. Other Documents

1. For member under guardian

• Guardian of member is the spouse or parent Special Power of Attorney or Application for Representative Payee

• Guardian of member is other than the spouse or parent Application for Representative Payee and Guarantor’s Bond Form

2. For member with qualified dependent Legitimate/legitimated child/children

• Birth certificate of dependent child/children or Baptismal certificate (in case birth certificate is not available)

Illegitimate child/children• Birth certificate of dependent child/children; or • Proof of filiations, e.g, will/ statement before a court of record/any authentic

writing (if child was not acknowledged by the parent in the birth certificate) Legally adopted child/children

1. Birth certificate of dependent child/children or Baptismal certificate; and• Legal adoption paper

3.For member with qualified dependent who is incapacitated– Medical certificate of incapacitated dependent

Other Documents - Continuation

4. For member with dependent child/children living with guardian (spouse/parent of member)

•Claim for dependents' pension benefit (SSS Form BPN-106)

5. For member with dependent child/children living with guardian (other than spouse/parent of member)

• Application for Representative Payee and Guarantor's Bond Form

BILATERAL AGREEMENTBILATERAL AGREEMENT

PROGRAM*PROGRAM*Totalization of member's

contributions / insurance periods under SSS and country with bilateral agreement ( Austria, Belgium, Canada, France, Spain, Switzerland, UK) to qualify to DDR monthly pension (pro-rated) under SSS.

A. Basic Documents

B. Other Documents

1. .For member under guardian

• Guardian of member is the spouse or parent Special Power of Attorney or Application for Representative Payee

• Guardian of member is other than the spouse or parent Application for Representative Payee and Guarantor’s Bond Form

1. For member with qualified dependent Legitimate/legitimated child/children

• Birth certificate of dependent child/children or Baptismal certificate (in case birth certificate is not available)

Illegitimate child/children• Birth certificate of dependent child/children; or • Proof of filiations, e.g, will/ statement before a court of record/any authentic

writing (if child was not acknowledged by the parent in the birth certificate) Legally adopted child/children

1. Birth certificate of dependent child/children or Baptismal certificate; and• Legal adoption paper

3. For member with qualified dependent who is incapacitated1. Medical certificate of incapacitated dependent

Other Documents - Continuation

4. For member with dependent child/children living with guardian (spouse/parent of member)

•Claim for dependents' pension benefit (SSS Form BPN-106)

5. For member with dependent child/children living with guardian (other than spouse/parent of member)

• Application for Representative Payee and Guarantor's Bond Form

The monthly pension and dependents pension shall be suspended upon the reemployment or resumption of self-employment or the recovery of the disabled member from his permanent total disability or his failure to present himself for examination at least once a year upon notice by the SSS.

“SEC. 13-A. (b)

PE& medical evaluation

Encoding in the CCCS & MEDVS

Process claim Applications Review and approve

payment of benefit

MemberReceive Payment

Generate checks, notices & bank reports and deliver to Post Office or Bank

Bank

Post Office

Process Workflow (Existing)

(Branch)

(Processing Center) (Processing

Center)(DCOD/OSD)

Receipt & screening, identity authentication of claimant & on-

line eligibility verification

(Branch)

(Branch)

(Branch)

Medical Review

CASES BEING PAID UNDER CASES BEING PAID UNDER SPECIAL PENSION SYSTEM (SPS)SPECIAL PENSION SYSTEM (SPS)

(Office Order 196-V)(Office Order 196-V)

CASE CODES:

01 – EC DEATH SECONDARY W/ > 5 DEPENDENTS

02 – RET / TOT DIS W/ DEPENDENTS C/O GUARDIAN

03 – DEATH PENSION OF DEPENDENTS WITHHELD (DUE TO LACK OF DOCUMENTS)

04 – DEATH CLAIM W/ > 1 PAYEE AND ONE OF THEM IS OVERPAID

05 – DEATH PENSION W/ SPOUSE INCAPACITATED

09 – BILATERAL / PORTABILITY

CASES BEING PAID UNDERCASES BEING PAID UNDER SPECIAL VOUCHERSPECIAL VOUCHEROffice Order 196-VOffice Order 196-V

1. Retirement or total disability claim with date of contingency earlier than the date of settlement of funeral or death claim, as reflected in the DDR database.

2. Partial disability claim with date of contingency earlier than the date of settlement of total disability, retirement, death or funeral claim, as reflected in the DDR database

3. Replacement of returned cheque in favor of payees different from the persons reflected on the subject cheque such as the following

– Initial DDR cheque not encashed because of death of payee

– Regular DDR pension cheque not encashed because of death of pensioner

4. Replacement of returned pensions remitted through the bank wherein benefit amount was deducted from the death benefit.

5. Unpaid dependent's pension of a retiree/total disability pensioner who died and his death is already posted in the database.

6. Payment of the 13th month pension

– If the same was part of the voided/cancelled initial DDR cheque

– If the same was part of the voided/cancelled regular DDR cheque on account of the death of the pensioner

7. Payment of dependent's pension of a retiree/total disability pensioner who died prior to January 1, 1980

ANNUAL CONFIRMATION ANNUAL CONFIRMATION OF TOTAL DISABILITY OF TOTAL DISABILITY

PENSIONERSPENSIONERS

Social Security Commission Resolution No. 350-s.2011 dated March 16, 2011, approved the resumption of the Annual Confirmation of Pensioners (ACOP), with the following guidelines:

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. All total disability, retiree and death pensioners shall be required to present themselves for ACOP during their month of contingency; i.e., for total disability pensioner, month of disability; for death pensioner, month of member’s death; for retiree pensioner, month of retirement.

1. Pensioners who are unable to report personally due to the following conditions shall submit the required documents either through their representatives or through mail to the nearest SSS branch:

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Conduct of Medical Fieldwork Services (MFS) shall be done for local resident total disability pensioners whose compliance is through representative or through mail.

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Notice of ACOP Schedule

1. Non-compliance with ACOP shall result to automatic suspension of pension a month after the month of contingency, except for the following cases:

Total disability pensioners who are:

Above total disability pensioners shall be subject to MFS within three months after the month of contingency. If MFS is not done by the branches, the pension shall be automatically suspended.

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Pensions shall be cancelled due to the following:

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Dependents pension shall be cancelled due to the following:

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Recall of overpayments:

ANNUAL CONFIRMATION OF ANNUAL CONFIRMATION OF PENSIONERSPENSIONERS

1. Pensions of those who complied after the required “compliance period” shall be resumed within two months from date of compliance either through the pension resumption module or re-adjudication of claim in accordance with the established procedures.

REQUIRED REQUIRED DOCUMENTS:DOCUMENTS:1. Pensioners who are able to report personally shall submit the

following documents to SSS

1. Pensioners who are unable to report personally shall submit the following documents either through their representatives or through mail to the nearest SSS Branch.

REQUIRED REQUIRED DOCUMENTS:DOCUMENTS:

For local residents confined at home

For local residents confined in institution such as retirement home, nursing facility, hospital, correctional institution, penitentiary, rehabilitation center.

Sketch of residence

Certification from the applicable institution confirming pensioner’s confinement.

REQUIRED REQUIRED DOCUMENTS:DOCUMENTS:For residents abroad:

63

EXERCISES (Cases 1-5)

1. PREPARE FACTS OF THE CASE.

2. COMPUTE BENEFIT (SHOW SOLUTION.).

3. INDICATE LACKING DOCUMENT/S, IF ANY.