SSS

Title

RA 8282 (Social Security Act)

GSIS
RA 8291 (Government Service
Insurance Act)

PAG-IBIG
RA 9679 (Home Development
Mutual Fund Pag-Ibig)
What is PAG-IBIG Fund?
Pagtutulungan sa

Kinabukasan: Ikaw,
Bangko, Industriya at
Gobyerno; strengthening

PhilHealth
RA 7875 as amended by RA
9241 and RA 10606 (Act
Instituting a National Health
Insurance Program &
establishing the Philippine
Health Insurance Corporation)

the Home Development

Mutual Fund

Purpose of the
Law

Establish, develop,
promote & perfect a sound
& viable tax-exempt social
security service suitable to
the needs of the Filipino
people which shall
promote social justice &
provide meaningful
protection to members &
their beneficiaries against
hazards of disability,
sickness, maternity, old
age, death & other
contingencies resulting in
loss of income or financial
burden

Promote efficiency and

welfare of employees of the
government, administer the
laws that grant to its
members social security
and insurance benefits
Preserve at all times the
actuarial solvency of funds
administered by GSIS
Guarantee government
employee all benefits due
to him and increase the
benefits made available to
him and his dependents to
the extent permitted by
available resources

Establish, develop, promote,

and integrate a nationwide
sound & viable tax-exempt
mutual provident savings
system suitable to the needs
of the employed earning
groups & to motivate them to
better plan & provide for their
housing needs by membership
in the HDMF
Improve quality of life by
providing sufficient shelter
Provide for an integrated
nationwide savings system
Provide housing through
mobilization of funds for
shelter finance

Adopt an integrated and

comprehensive approach to
health development which
shall endeavor to make
essential goods, health &
other social services
available to all people at
affordable cost
Provide health insurance
coverage & ensure
affordable acceptable,
available & accessible
health care services for all
citizens

a. Provide all citizens of the

Philippines with the mechanism
to gain financial access to
health
services;
b. Establish the Program to
serve as the means to help the
people pay for health care
services;17
Implementing Rules and
Regulations of Republic Act
7875 As Amended Otherwise
Known As the National Health
Insurance Act of 2013
c. Prioritize and accelerate the

provision of health services to

all Filipinos, especially that
segment of the population who
cannot afford these services.
*Limited to paying for utilization
of health services by covered
beneficiaries or to purchasing
health services in behalf of such
beneficiaries
*prohibited from providing
health care directly, from buying
& dispensing drugs &
pharmaceuticals, from
employing physicians for
purpose of directly providing
care, & from owning or
investing in health care facilities

Beneficiaries

1. PRIMARY
a Dependent spouse until
remarriage
b Dependent legitimate
or legitimated or legally
adopted and
illegitimate children
Share of
illegitimate: 50%
of share of
legitimate,
legally adopted
or legitimated; in
the absence of
the 3, illegitimate
will get 100%

2. SECONDARY
a Dependent parents
b Absent primary or
secondary
beneficiaries, any
other person

1. PRIMARY
a. Legal dependent spouse
until remarriage
b. Dependent children

2. SECONDARY
a. Dependent parents
b. Legitimate descendants
subject to restrictions on
dependent children

designated by
member as
secondary
beneficiary

Coverage

1. COMPULSORY COVERAGE
a) All employees not over
60 yrs. of age and their
employers
Effectivity of Coverage:
Employer - first day of
his operation
Employee first day of
employment
b) Self-employed persons
as may be determined
by the Commission:
self-employed
professionals, partners
& single proprietors of
business, actors &
actresses, directors,
scriptwriters, news
correspondents who
are not employees,
professional athletes,
coaches, trainers,
jockeys, individual
farmers and fishermen
Effectivity of
Coverage: upon
registration with the
SSS
c) Domestic helpers 60
yrs. old or age and
below with a monthly
income of not less than
P1,000
2. VOLUNTARY COVERAGE
a) Filipinos recruited by
foreign-based
employers for
employment abroad
b) Employees separated

1. COMPULSORY COVERAGE
a) All employees
(government employed)
who have not reached
the compulsory age of
retirement, irrespective
of employment status
2. VOLUNTARY COVERAGE
a) If already terminated
from service and
continues to pay monthly
contribution, provided
that such former
employee previously
worked in the
government

1. COMPULSORY COVERAGE
a Employees covered by SSS
and GSIS
b Employers covered by SSS
and GSIS
c Uniformed members of AFP,
Bureau of Fire Protection,
Bureau of Jail Management
and Penology, PNP
d Filipinos employed by
foreign-based employers
2. VOLUNTARY COVERAGE
Who may qualify?
At least 18 yrs. old but
not more than 65 yrs. old
a

d
e

Spouses who devote full

time to managing household
and family affairs, unless
engaged in another
vocation which is subject
to mandatory coverage
Filipino employees of foreign
government or international
organization, or their whollyowned instrumentality based
in the Philippines
Employees of an employer
who is granted a waiver or
suspension of coverage by
the Fund under RA 9679
Leaders and members of
religious groups
Member separated from
employment, local or
abroad, or ceased to be
employed but would like to
continue paying PAG-IBIG
contributions
Public officials or employees

All citizens of the Philippines

(MANDATORY COVERAGE)
*Program shall enroll
beneficiaries in order for them
to be placed under coverage
that entitles them to avail of
benefits
Nature & Scope of Coverage:
A. MEMBERS IN THE
FORMAL ECONOMY
Government
employee
Private employee
All other workers
rendering services,
whether in
government or
private offices, such
as job order
contractors
Owners of microenterprises
Owners of small,
medium & large
enterprises
Household help &
family drivers
B. MEMBERS IN INFORMAL
ECONOMY
migrant workers
informal settler
self-earning
individual
Filipinos with dual
citizenship
Naturalized Filipino
citizen

from employment to
maintain his rights and
full benefits
c) Self-employed who
realizes no income for a
certain month
d) Spouses who devote
full time to managing
household and family
affairs unless
specifically mandatorily
covered
EXCEPTIONS FROM
COVERAGE
Employment purely casual
and not for purpose of
occupation or business
employer
Service performed or in
connection with alien
vessel, if employed when
such vessel is outside the
Philippines
Employees of Philippine
government or
instrumentality
Service performed in the
employ of a foreign
government or
international organization,
or wholly owned
instrumentality employing
workers in the Philippines
or employing Filipinos
abroad
Services performed by
temporary employees &
other employees excluded
by SSS regulations;
employees of bona fide
independent contractors
shall not be deemed
employees of the employer

EXCEPTIONS FROM
COVERAGE
Members of AFP
Members of PNP
Contractual employees who
have employer-employee
relationship with agency to
serve
Members of judiciary and
constitutional commissions
(who shall have life
insurance only)

who are not covered by GSIS

such as barangay officials
Other earning groups as
may be determined by the
Board

EFFECTIVITY OF COVERAGE
a Employer first day of
business operation
b Employee date of
employment

Citizens of other
countries working
and/or residing in
the Philippines
C. INDIGENT
D. SPONSORED MEMBER
E. LIFETIME MEMBER (has
reached age of retirement &
had paid at least 120
monthly premium
contributions)

MEMBERSHIP TERM: 20 years

commencing from first day of
the month to which the
members initial contribution to
the Fund applies; Provided: he
shall have contributed a total of
240 monthly contributions at
the time of maturity
Exception: when earlier
terminated by reason of retirement,
disability, insanity, death, departure
from the country or other causes as
may be provided by the Board of
Trustees
*Those who become members of
the Fund after effectivity of RA 9679
(July 2009) may withdraw the total
accumulated value of their
contributions to the Fund after 15th
year of continuous membership;
provided that said members have
no outstanding housing loans with
the Fund and such option shall not
prejudice the members continuing
membership in the Fund

When is the commencement

of membership in the Fund?
Remittance of the initial
contribution to the Fund

EFFECTIVITY OF
MEMBERSHIP: membership
shall take effect upon
enrollment and payment of the
required premium monthly
contributions

engaging the services of an

independent contractor

Effect of
Separation from
Employment

Employees obligation to
contribute ceases but may
be continued voluntarily
Employers contribution
on his account ceases
Employees obligation
to contribute also
ceases at the end of
the month of
separation
Employee shall be
credited with all
contributions paid on
his behalf and entitled
to benefits according to
the Act
o He may continue to pay
total contributions to
maintain his right to full
benefit
EFFECT OF INTERRUPTION OF
BUSINESS OR PROFESSIONAL
INCOME (If self-employed
member realizes no income in
any given month)
Not required to pay
contribution for that
month
May be allowed to
continue paying
contributions under
same rules and
regulations applicable
to self-employed
member, Provided no
retroactive payment
of contributions shall

*Actual membership in SSS is

not a condition precedent for
membership in PAG-IBIG

Member separated shall

continue to be a member and
shall be entitled to whatever
benefits he has qualified to in the
event of any contingency
compensable under the Act

be allowed other
than as prescribed
under Section 22-A

Benefits

1. DEPENDENTS PENSION

1. SEPARATION BENEFITS

2. RETIREMENT BENEFITS

2. UNEMPLOYMENT or
INVOLUNTARY
SEPARATION BENEFITS

Voluntary retirement 60 yrs.

old
Compulsory retirement 65
yrs. old

3. RETIREMENT BENEFITS

3. DEATH BENEFITS

4. PERMANENT DISABILITY
BENEFITS

4. PERMANENT DISABILITY
BENEFITS

5. TEMPORARY DISABILITY
BENEFITS

Permanent Total Disability:

a. Complete loss of sight of
both eyes
b. Loss of 2 limbs at or above
the ankle or wrists
c. Permanent complete
paralysis of 2 limbs
d. Brain injury resulting to
incurable imbecility or
insanity
e. Such cases as determined
and approved by SSS

6. SURVIVORSHIP BENEFITS

5. FUNERAL BENEFITS
P12,000.00 to help defray
costs of funeral expenses
6. SICKNESS BENEFITS
7. MATERNITY LEAVE
BENEFITS
8. LOAN GRANT

7. FUNERAL BENEFITS
P12,000.00 but shall be
increased to at least
P18,000.00 after 5 years
8. LIFE INSURANCE
BENEFITS

1. PROVIDENT SAVINGS
PROGRAM

2. LENDING PROGRAMS

Multi-purpose loan
Calamity Loan
Housing Loan

A. Inpatient hospital care

Room and board
Services of health care
professionals
Diagnostic, laboratory,
& other medical
examination services
Use of surgical or
medical equipment &
facilities
Prescription drugs and
biologicals
Inpatient education
packages
B. Outpatient care
Services of health care
professionals
Diagnostic, laboratory,
& other medical
examination services
Personal preventive
services
Prescription drugs and
biologicals
C. Emergency and transfer
services
D. Other health care
services that the
Corporation shall
determine to be
appropriate & costeffective
*EXCLUDED PERSONAL HEALTH
SERVICES
Non-prescription drugs &
devices
Out-patient
psychotherapy and

Entitlement to
Benefits

1. DEPENDENTS PENSION
can be availed on account of
death, permanent total
disability or retirement
10% of the monthly
pension or P250.00,
whichever is higher
Only 5 dependents can
avail of the pension
beginning with the
youngest and without
substitution
Legitimate children shall
be preferred where there
are illegitimate children
2. RETIREMENT BENEFITS
Voluntary retirement 60 yrs.
old
Compulsory retirement 65
yrs. old
Who can avail?
member who has paid at
least 120 monthly
contributions prior to
the semester of
retirement & who has
reached 60 yrs. old and
already separated from

1. SEPARATION BENEFITS
a) Cash payment equivalent
to 100% of average
monthly compensation for
each year of service he
paid contributions but not
less than P12,000 upon
reaching 60 yrs. old or
upon separation
Member who resigned
or separated has
rendered at least 3
years of service but
less than 15 years
b) Cash payment equivalent
to 18x basic monthly
pension payable at the
time of separation or
resignation + old-age
pension benefit upon
reaching 60 yrs. old
Member has rendered
at least 15 years of
service and is below 60
yrs. old at time of
separation or
resignation
2. UNEMPLOYMENT or

HOUSING LOAN
member in good standing
shall be eligible to apply for
housing loans under such
conditions as may be
authorized by the Board of
Trustees, taking into account
the ability to pay

counselling for mental

disorders
Drug, alcohol abuse or
dependency treatment
Cosmetic surgery
Home & rehabilitation
services
Optometric services
Normal obstetrical
delivery
Cost-ineffective
procedures which
shall be defined by
the Corporation
Members, or their dependents
are entitled to avail of the
benefits if:
a) Paid premium contribution
for at least 3 months within
6 months prior to first day
of availment; or
b) Paid in full the required
premium for the calendar
year
In addition, member is not
currently subject to legal
penalty of suspension and
has paid the premium with
sufficient regularity
Need not pay Monthly
Contributions:
i.
Retirees & pensioners of
SSS & GSIS prior to March 4,
1995
ii.
PhilHealth members who
have reached age of
retirement, not gainfully
employed or continuing
their practice as
professional & have met the
required at least 120
monthly premium
contributions

employment or has
ceased to be selfemployed or reached
65 yrs. old
Entitled to the monthly
pension for as long as he
lives
If 60 yrs. old at retirement
& does not qualify for
pension benefits
entitled to lump sum
benefit equal to the
total contributions paid
Monthly pension
suspended upon reemployment or
resumption of selfemployment of a retired
member below 65 yrs. old

Who is entitled to monthly

pension following death of
member?
Upon death of retired
members, primary
beneficiaries shall be
entitled to pension; if
no primary beneficiaries
and dies within 60 months
from start of pension
secondary beneficiaries
shall be entitled
3. DEATH BENEFITS
Upon death of member
who has paid at least 36
monthly contributions
prior to semester of death
Who can avail?
Primary beneficiaries
Absence of primary
beneficiaries, secondary
beneficiaries entitled to
lump sum benefit
equivalent to 36x monthly

INVOLUNTARY SEPARATION
BENEFITS
a) 50% of average monthly
compensation
b) Paying integrated
contributions for at least 1
year prior to separation
Who can avail?
Permanent employee
who is involuntarily
separated from service
due to abolition of his
office or position
usually resulting from
reorganization
3. RETIREMENT BENEFITS
a) Lump sum payment +
old-age pension benefit
equal to monthly pension
payable for life (starting
upon expiration of 5-yr.
guaranteed period
covered by lump sum)
b) Cash equivalent to 18
months of basic monthly
pension + monthly
pension for life payable
immediately with no 5
yr. guaranteed period
Who can avail?
member who has
retired from service
rendered at least 15
years of service
at least 60 yrs. old at
time of retirement
not receiving monthly
pension for permanent
total disability
4. PERMANENT DISABILITY
BENEFITS

pension
If he has not paid required 36
monthly contributions:
entitled to lump sum
benefit equivalent to
monthly pension x number
of monthly contributions
paid or 12x monthly
pension, whichever is
higher
4. PERMANENT DISABILITY
BENEFITS
Upon permanent total
disability of member who
has paid at least 36
monthly contributions
prior to semester of
disability
If he does not comply with
required # contributions:
entitled to lump sum
benefit equivalent to
monthly pension x number
of monthly contributions
paid or 12x monthly
pension, whichever is
higher
Permanent partial
disability: monthly
pension shall be given in
lump sum if it is payable
for less than 12 months
Permanent Total Disability:
f. Complete loss of sight of
both eyes
g. Loss of 2 limbs at or above
the ankle or wrists
h. Permanent complete
paralysis of 2 limbs
i. Brain injury resulting to
incurable imbecility or
insanity

Who can avail?

Member who suffers
permanent disability
for reasons not due to
his grave misconduct,
notorious negligence,
habitual intoxication or
willful intention to kill
himself or another
5. TEMPORARY DISABILITY
BENEFITS
Who can avail?
Member who suffers
temporary total
disability for reasons
not due to any
conditions enumerated
in permanent disability
6. SURVIVORSHIP BENEFITS
a) Basic survivorship
pension = 50% of the
basic monthly pension
b) Dependent childrens
pension not exceeding
50% of basic monthly
pension

Deceased member was

in the service at the
time of his death
If separated from
service, has at least 3
years of service at the
time of his death & had
paid 36 monthly
contributions within 5
yr. period immediately
preceding death or has
paid at least 180
monthly contributions
prior to his death

j.

Such cases as determined

and approved by SSS
Who is entitled to monthly
pension following death of
member?
Upon death of retired
members, primary
beneficiaries shall be
entitled to pension; if no
primary beneficiaries and
dies within 60 months from
start of pension
secondary beneficiaries
shall be entitled
If disability is partial & occurs
before 36 monthly
contributions have been paid:
percentage of lump sum
benefit described
(equivalent to total
monthly pensions
corresponding to balance
of 5-yr. guaranteed period
excluding dependents
pension) with due regard
to degree of disability
determined by Commission
If disability is partial & occurs
after 36 monthly contributions
have been paid: monthly
pension for permanent for
total disability subject to
following periods
5. FUNERAL BENEFITS
P12,000.00 to help defray
costs of funeral expenses
6. SICKNESS BENEFITS
Who can avail?
Member who has paid at
least 3 monthly
contributions in 12-month
period immediately
preceding semester of

7. FUNERAL BENEFITS
Death of:
a) Active member
b) Member who has been
separated from service
but may be entitled to
future benefit
c) Pensioner
d) Retiree who at the time of
his retirement was of
pensionable age
8. LIFE INSURANCE BENEFITS
(except for AFP members and
PNP members, life insurance
shall be compulsory)

sickness or injury and is

confined for more than 3
days in a hospital with
approval of SSS
Employer will advance for
the benefit and will pay for
the employee

Employee shall notify

employer of the fact of
his sickness or injury
within 5 calendar days
after start of
confinement

When employee have

given notification and
employer fails to notify
SSS: employer shall have
no right to recover the
corresponding daily
allowance he advanced to
the employee

7. MATERNITY LEAVE
BENEFITS
Who can avail?
Female member who has
paid at least 3 monthly
contributions in the 12month period immediately
preceding the semester of
her childbirth or
miscarriage
How much?
Entitled to 100% of her
average monthly daily
salary credit for 60 days or
78 days in case of
caesarean delivery
*Maternity benefits shall
only be paid for the FIRST
4 DELIVERIES OR
MISCARRIAGES

Dependents

a. Legal spouse of member

entitled to support
b. Legitimate, legitimated,
legally adopted and
illegitimate children, not
gainfully employed & have not
reached 21 yrs. old
c. Parents receiving regular
support

Quasi-Judicial

If employee member gives

birth or suffer miscarriage
without required
contributions having been
remitted by her employer
to SSS, or without SSS
having been notified by
employer, employer
shall pay to SSS
damages equivalent to
benefits which
employee would
otherwise would have
been entitled.

Power to administer oath

and affirmation, take
depositions, certify to

a. Legal spouse dependent for

support
b. Legitimate, legitimated,
legally adopted and
illegitimate children who is
unmarried, not gainfully
employed and not over age
of majority
c. Parents dependent upon the
member for support

Power to administer oath

and affirmation, take
depositions, certify to official

Legal dependents of deceased

member as defined in the Family
Code

Legal Dependents:
1. Legitimate spouse who is
not a member
2. Unmarried &
unemployed legitimate,
illegitimate, legitimated,
adopted children below
21 yrs. old
3. Children 21 yrs. old or
above but suffering from
congenital disability
(renders them totally
dependent)
4. Parents 60 yrs. old or
above monthly income
is below amount to be
determined by
Corporation
5. Foster child
6. Parents with permanent
disability regardless of
age
Powers of the Corporation:
a. Conduct investigations for
the determination of
questions, controversy,
complaint or unresolved

Powers

official acts, and issue

subpoena and subpoena
duces tecum to compel the
attendance of witnesses
and the production of
books, papers,
correspondence and other
records deemed necessary
as evidence in connection
with any question arising
under this Act.

acts, and issue subpoena

and subpoena duces tecum
to compel the attendance of
witnesses and the
production of books, papers,
correspondence and other
records deemed necessary
as evidence in connection
with any question arising
under this Act.

grievance brought to its

attention & render decisions,
orders or resolutions. It shall
proceed to hear & determine
the case even in the
absence of any party who
has been properly served
with notice to appear.
b. Summon parties to a
controversy, issue
subpoenas (subpoena duces
tecum & subpoena ad
testificandum)
c. Suspend temporarily, revoke
permanently or restore the
accreditation of health care
provider or right to benefits
or member or impose fines
*Decision shall immediately
be executory even pending
appeal when public interest
requires
*Suspension of accreditation
not exceed 6 months
*Suspension of right to benefits
not exceed 6 months
d. Revocation of health care
providers accreditation
(operate to disqualify him from
obtaining another accreditation
in his own name, under different
name or through another
person)

Grievance
Procedure/Settle
ment of Disputes
and Claims

SETTLEMENT OF DISPUTES
Disputes arising from:
coverage, benefits,
contributions & penalties, any
matter related thereto
Jurisdiction: SOCIAL
SECURITY COMMISSION
When decision is made:
within mandatory period of

SETTLEMENT OF DISPUTES:
GSIS shall have original and
exclusive jurisdiction to
settle any disputes arising
under this Act

Decided within 30
working days from the
time they are submitted
by the parties for decision

JURISDICTION ON CLAIM OF
COVERAGE
Board of Trustees of
HDMF
PAG-IBIG Regional Office
Adjudication and settlement
of claims and disputes and
the procedures for the same
on any matters involving the

Jurisdiction: Grievance and

Appeals Review Committee
(GARC) hear & decide all
grievances filed by health care
provider or by any member
against any program
implementor

20 days after the

submission of evidence
Finality of decision: decision
becomes final & executory
15 days after the date of
notification; judicial review
permitted only if aggrieved
party has exhausted remedies
before Commission
Appeal: Court of Appeals
(questions of law and facts)
-CA appeal must be taken
within 15 days from
notification of decision
Supreme Court (questions of
law only)
Is an appeal bond
necessary?
No appeal bond shall be
required
*Case shall be heard in
summary manner and shall
take precedence over all cases
except that in SC, criminal
cases wherein life
imprisonment or death has
been imposed by trial court
shall take precedence

*No appeal shall act as

supersedeas or a stay of
the order of the
Commission unless the
Commission itself or the
Court of Appeals or the
Supreme Court, shall so
order
PRESCRIPTIVE PERIOD: 20
years from accrual of right
of action

APPEAL: governed by Rules

43 & 45 of Rules of Civil
Procedure
*appeal shall not stay the
execution of the order or
award unless ordered by the
Board, Court of Appeals, or
by Supreme Court and the
appeal shall be without
prejudice to a special civic
action of certiorari when
proper

Execution of Decision: when

no appeal is perfected and there
is no order to stay by the Board,
CA or Supreme Court, enforced
and executed in the same
manner as decisions of the
RTC

interests of members in the

Fund
File a complaint to the Chief
Executive Officer

When will decisions be final and

executory?
Decisions shall be final and
executory after 15 days from
notification of decision
Appeal may be made to the
HDMF

Grounds for Grievance:

Any violation of rights of
patients
Willful neglect of duty
resulting in the loss or
non-availment of
benefits by members or
their dependents
Unjustifiable delay in
actions on claims
Delay in the processing
of claims that extends
beyond the prescribed
period
Other act or omission
that tends to undermine
or defeat purpose of Act
Not covered: action of a
program implementor which can
be basis of administrative or
criminal complaint under
jurisdiction of Ombudsman,
Sandiganbayan, Civil Service
Commission or regular courts
Who may file?
Any aggrieved health care
provider or member
Where to file grievance
complaint?
PhilHealth Office where the
aggrieved health care provider
is located or where member
resides
*upon receipt of complaint,
PhilHealth Office shall forward it
to GARC within 5 calendar days
Quorum and Votes Required:
Quorum: 3 members of GARC
Votes Required to reach
decision: at least 3 GARC
members which shall include

Can you withdraw from

membership in SSS?
NO, he is deemed a member
for life; obligation to pay for
the contributions would only
be suspended

President as presiding officer

Finality of Decision of GARC:
decision shall be final &
executory 15 days after
notice to parties, unless
appeal is filed with the Board
within the same period
APPELLATE JURISDICTION OF
BOARD OVER GRIEVANCE
CASES: exclusive appellate
jurisdiction to review GARC
grievance decisions
Period to file review?
Within 30 days from receipt of
decisions of GARC
Who may file review?
Any of the parties in the
grievance complaint decided by
GARC
Decision of Board?
Resolve the petitioner within 30
days from receipt of records of
case
Finality of decision of Board:
decision shall be final &
executory 15 days after
notice to parties
Decisions of the Board may
be reviewed by the COURT
OF APPEALS on questions of
facts and law & SUPREME
COURT on purely questions
of law