7.06.2023

 

Reasons Why SSS Maternity Benefit Claims Are Denied

Updated November 3, 2015

Here are some reasons why SSS maternity benefit claims are denied. These are based on the personal experiences of women SSS members who have commented on our blogs.

1. Birth Certificate of Child is not Authenticated by the local registrar or NSO.




    Do not submit the birth certificate issued by the hospital.  Get your child's birth certificate from NSO, or get a Certified True Copy of your child's birth certificate from your Local Civil Registrar.   

2. Signature in MAT1 is different from Signature in MAT2 because in MAT1, the maiden name is used, and in MAT2, the married name is used, and that SSS has not yet been updated about the change in civil status using SSS E4 form.

   If you want to change your surname as you are processing your claim, it is best to first wait that the change in surname is effected before you submit your MAT2 claim. Check your online SSS account from time to time.

3.  Applicable Contributions are Paid, but Not yet Remitted by Employer or Not Yet Posted

     If you're Employed, before you file your maternity claim, make sure that the 6 monthly contributions that will be considered by SSS in computing your Maternity Benefit are already posted in your SSS account.  Check your online SSS account.

4.  Your Coverage Status in your Record is Different from your Status in your Claim

Example:  You checked VOLUNTARY in your MAT2 form, but your status in your SSS account is  EMPLOYED.

5.  Questions about the Child's Middle Name and Surname

Example:  The child's middle name is different from the mother's surname, and the child's surname is different from the father's surname.  

Remedy for this:  Submit Affidavit to Explain Discrepancy in Names

6.  MAT1 was not submitted to SSS before delivery of the child.  Or maternity notification was not filed online before date of delivery.

If you were not able to submit MAT1 or notify SSS online before delivering your child, attach your letter of explanation to your MAT1 form and ultrasound report or pregnancy test report.

Not all explanations are accepted; it depends on your reason and on the SSS officer evaluating your claim.

7.  Member is not eligible for maternity benefit.

Member has not paid her contributions for at least 3 of the 12 months BEFORE semester of delivery or semester of contingency.

8.  Member delivered her child by CS, but did not submit Operating Room Record

9.  Member had Miscarriage, but did not submit Histopathology Report and Medical Certificate

10. Member recently resigned from work, but did not submit these 3 documents:
        Certificate of Separation
        Certificate of Non-Advancement of Maternity Benefit
        L-501 form

If your date of separation from employment is within 6 months of your date of delivery, you need to submit these 3 documents from your former employer:
 . Certificate of Separation from Employment (must include date of separation)
 . Certificate of Non-Advancement of Maternity Benefit (this means your employer did not advance any amount of maternity benefit to you)
 . 2 copies of Specimen Signature Card (SSS Form L-501)

If the gap between your Date of Separation and Date of Delivery is more than 6 months, but less than 1 year, prepare to submit these 3 documents. The rule mentions 6 months, but there are officers still requiring these documents even if the gap is more than 6 months.

There was one member who commented here, saying that the gap in her case is 11 months and 28 days, and her claim papers were accepted. But later on, her claim was Denied  due to lack of separation papers. She had to wait for her rejected papers, and had to resubmit her claim.

11.  There's an error in the Certificate of Separation or L-501.

Example: The signatures on the L-501 and Certificate of Separation are not the same. Or there is No Date of Separation in the Certificate of Separation.

12.  It was Certificate of Employment that was submitted. 

Submit Certificate of Separation. These 2 kinds of certificates have almost the same contents, but they have different emphasis.  There have been at least 3 members whose claims were Denied because of this reason. 

13.  The Numbers of Pregnancies or Deliveries or Miscarriages in the Forms or in Previous Maternity Claims are not consistent.

Example:  In your MAT1 form, you wrote 2nd pregnancy, but the Birth Certificate shows 3rd in Birth Order.  Another Example: 3rd pregnancy in MAT1, but MAT2 shows 2 miscarriages and 2 deliveries or the Birth Certificate shows 4 in Total No. of Children Born Alive.

14.  Member has no Date of Coverage.

Usually, a member discovers that she has no Date of Coverage upon submission of MAT1, but there are cases that are not detected early, especially now that MAT1 can be submitted online.

Why are  there members without Date of Coverage (DOC)?
These members without DOC are usually the ones who have been paying their contributions as Voluntary without first registering properly and correctly.

You have a Date of Coverage if:
 . you were reported to SSS by your employer as Employee
 . you registered at an SSS branch as Self-Employed using RS1 form and your Proof of Source of Income       and your application was approved
 . you registered as Non-Working Spouse and your application was approved
 . you registered as OFW and your application was approved

Making your FIRST payment to SSS as Voluntary is not allowed. You become Voluntary only when you stop being an Employee, Non-Working Spouse, Self-Employed or OFW, and you decide to continue making SSS contributions.

15.   5th or Subsequent Pregnancy or Miscarriage

Only the first four deliveries or miscarriages are covered under the SSS maternity benefit program.  This policy started on May 24, 1997. Even if you were not able to claim your maternity benefit for your first four deliveries or miscarriages, you can no longer claim for your 5th or subsequent deliveries or miscarriages.

16.  Your Employer Has Not Filed Its Sickness and Maternity Benefits Payment Thru the Bank (SMB) form
       
        SSS now requires every employer to file its SMB PB form. SSS will pay your maternity benefit through the SSS-registered bank account of your employer.  If you're Employed, ask your employer if it has filed its SMB PB form before filing your maternity benefit claim. 

UPDATE as of June 2016
There's now a separate application form for those EMPLOYED and those NOT EMPLOYED:
Maternity Benefit Application Form for Self-Employed, Voluntary Member and OFW
Maternity Benefit Reimbursement Form for Employed Member

No. of Pregnancies or Deliveries or Miscarriages in Your SSS Maternity Benefit Claim
documents should be consistent

What to Do When Your SSS Maternity Benefit Is Denied 

Previous Comments from Users Can Be Seen Here: Reasons Why SSS Maternity Benefit Claims Are Denied
Comments from July 12, 2013 to May 28, 2014
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3.11.2019

 

Is There SSS Maternity Benefit for My Husband?

We often receive these questions, so we will answer.

I am not a member of SSS, but my husband is a member. Can I avail of SSS maternity benefit under his name?
Sorry, no. You should be a member of SSS.



Both my husband and I are members of SSS. Aside from my SSS maternity benefit, is there a separate maternity benefit for my husband? 
None. There is no separate maternity benefit for your husband.

I don't have a job or a business, so I'm not an SSS member. Can I apply for SSS membership so I can avail of SSS maternity benefit?
Yes, if your husband is an Employed member of SSS, you can apply as a Non-Working Spouse.

How do I apply as a Non-Working Spouse?
Get 2 copies of the registration form for Non-Working Spouse from the nearest SSS branch. You can also download the form from the SSS website sss.gov.ph and have it printed.
Accomplish the forms and have your spouse sign your forms. Go to the nearest SSS with your ID and marriage certificate (original and photocopy) and submit your forms.

View or download the SSS Non-Working Spouse Record form here.

How much will be my monthly contribution?
The basis of your monthly contribution will be one-half of your husband's latest monthly salary credit.

If I pay now, can I avail of SSS maternity benefit?
It depends on your delivery date. Kapag malayo pa ang due date mo, malamang meron ka pang time na habulin yong required contributions.

Ang requirement ng SSS ay naka-contribute ka ng at least 3 monthly contributions within the 12-month period immediately BEFORE your semester of contingency.

Kung one- to 4-months pregnant ka pa lang, baka puede ka pang humabol, depende kung nasa simula o nasa dulo ng semester of delivery ang buwan ng delivery mo.


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Approved SSS Maternity Benefit Claims for Miscarriage


Learn from the experiences of SSS members who had miscarriage and whose SSS maternity benefit claims were approved.





From Michelle, June 1, 2016

Hi, I had filed my maternity claim for miscarriage (Incomplete Abortion With D&C Procedure) this May 30,2016. Though I was not able to talk to the SSS doctor (coz there’s none on duty) I was told to go back on June 1 for approval. I just got my claim and was APPROVED already (yeey!) and luckily my company would reimburse me right away this coming pay-out. Thanks for your blog that helps me a lot to understand the process of claim better. Your blog answered most of my inquiries since it was my first time to have D&C procedure.


Here is the list of the documents I’d submitted. Hope this will be of great help.
- MAT2
- Medical certificate (Orig copy)
- Complete Obstetrical History (form available at SSS/your HR dept)
- Clinical Case summary/Medical abstract (Certified true copy)
- Discharge summary (certified true copy)
- Surgical Memorandum (certified true copy)
- Anesthesia Record (I guess this was just a supporting doc but will be given still by the hospital)
- Histopathogy Report (certified true copy)
- Mat 1
- Ultrasound result before my miscarriage, Certified true copy (I didn't have Ultrasound result after since I have other supporting docs)
- Our HR Dept also provided me with my contributions to SSS for the past 6 months (but I guess this is just a supporting doc also)

P.S.
Make sure to have the hispathology report to be certified true copy because this was a big issue with a colleague's application. Since it was done by another lab, the hospital won't certify it and SSS wants it certified.
If your hospital is also conducting the same test, better do it there if the price is reasonable, I got mine at P1,200, but the price range is from 900-2500 depending on the laboratory.
And lastly, make sure the date of your procedure would be the same with all your documents to avoid inconvenience at SSS. I hope this will help because before I was confused with the requirements listed given by SSS, as what were given at the hospital's Record Section because the docs were labeled differently.

Thanks again and more power!


From Mizpah, July 24, 2016

Just like to add, I was able to get maternity benefit. Had miscarriage on my 6th-7th week of pregnancy.  Hugs to all angel moms.


From Liah, May 6, 2016

Hi. I filed my claim a week after my miscarriage. At first, I was hesitant to file it because it’s just 5 1/2 weeks. But I just submit the requirements, then they told me that they would assess it first and follow it up after a month, And to my surprise, I didn’t expect to get my cheque earlier.

For those filing, just try to file your SSS claim, even if you don't have the before-ultrasound. Just present to them the after-ultrasound, OB history and Medical certificate. I did not submit to them my PT kit.
But I think it also depends on person who will assess your documents, I first went to SSS Marikina. They were asking me to provide the before and after ultrasound. I told them that I just had the after ultrasound and I also don’t have histopath since there is no raspa done to me. Thats why I decided to go to another SSS branch which is the Fairview branch. They told me to wait. After a month I thought they will not approve my claim. But I got my cheque after 2 to 3 weeks.

In summary:
I had miscarriage 5 1/2 weeks, No raspa performed.
I got my cheque 2-3 weeks after I submitted the requirements,
- MAT 1
- Before and after ultrasound
- OB history
- Medical certificate
- Since I have a B-HCG result, I also attached it
- Also submit if you have a histopathology report.
I filed it at the SSS Fairview Branch.



From Gwen, August 27, 2014

Hi. I would just like to give you the updates of what I’ve been through since your blog helped me and educated me in all possible ways. Here's my story:

June - I had a miscarriage and have not filed MAT1.
July 9 -  Had my d&c
July 27 - Submitted my MAT2 & MAT1 altogether
Aug17 - I emailed our HR partner and asked if I'm still eligible for the said maternity benefit.
Aug20 - Here’s what our HR partner replied:
“Please take note that employees who had miscarriage need not to submit MAT1. Benefits will be credited to employees payroll.”
Aug27 - Checked my online account and amount has been credited !!! yey!
Thanks so much. Kung hindi dahil sa blog mo, hindi ko malalaman na may mga benefits ako.

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9.09.2017

 

MySSS Online: How to Change Password







How to Change Password in MySSS

1) Go to https://www.sss.gov.ph/ and Log in found at the right portion of the website using your registered Username and Password.


2) At MEMBER'S PROFILE, click on Change Password.

At the right portion, you will see the expiry date of your current password.










3) Fill on your current password then your new password. Click Change.






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