COMPARATIVE MATRIX OF SOCIAL LEGISLATIN IN THE PHILIPPINES

CRITERIA GSIS SSS Philhealth PAG-IBIG Book IV, Labor Code

State Insurance Code

1. Governing RA8291 RA8282 RA10606 RA9679 PD626

Law and RA7875 PD1752
Amendments RA9241 RA7742

2. Compulsory for all 1. Compulsory upon Mandatory Coverage. All Membership in the Fund Coverage in the State Insurance
Membership employees all employees not citizens of the Philippines shall shall be for a period of Fund shall be compulsory upon
Qualifications receiving over sixty (60) years be covered by the National twenty (20) years, except all employers and their
/ Eligibility compensation who of age and their Health Insurance Program. In when earlier terminated by employees not over sixty years
have not reached employers. accordance with the principles reason of retirement, of age; Provided, That an
the compulsory 2. Spouses who of universality and compulsory disability, insanity, death, employee who is over sixty years
retirement age. devote full time to coverage enunciated in Section departure from the country of age and paying contributions
managing the 2(b) and 2(l) hereof, or other causes as may be to qualify for the retirement or
household and implementation of the Program provided for by the Board of life insurance benefit
family affairs, unless shall ensure sustainability of Trustees: Provided, That administered by the System shall
they are also coverage and continuous those who become be subject to compulsory
engaged in other enhancement of the quality of members of the Fund after coverage.
vocation or service: Provided, That the the effectivity of this Act
employment which Program shall be compulsory in may withdraw the total
is subject to all provinces, cities and accumulated value of their
mandatory municipalities nationwide, contributions to the Fund
coverage, may be notwithstanding the existence after the tenth or the
covered by the SSS of LGU-based health insurance fifteenth year of continuous
on a voluntary basis. programs: Provided, further, membership: Provided,
3. Filipinos recruited That the Corporation, further, That said members
by foreignbased Department of Health (DOH), have no outstanding
employers for local government units (LGUs), housing loans with the
employment abroad and other agencies including Fund: provided, finally, That
may be covered by nongovernmental this option may be exercised
the SSS on a organizations (NGOs) and other only once and shall not
voluntary basis. national government agencies prejudice the members
4. All selfemployed (NGAs) shall ensure that continuing membership in
professionals members in such localities shall the Fund.
5. Partners and have access to quality and cost- *Membership to the Fund
single proprietors of effective health care services. shall be mandatory for the
businesses following:
6. Actors and a. All employees,
actresses, directors, workers, professionals,
scriptwriters and officers and companies who
news are compulsorily covered by
correspondents who the SSS and GSIS
do not fall within b. Uniformed
the definition of the members of the Armed
term "employee"; in Forces of the Philippines,
Sec. 8 (d) of this Act the Bureau of Fire
7. Professional Protection, the Bureau of
athletes, coaches, Jail Management and
trainers and jockeys Penology, and the
8. Individual farmers Philippine National Police;
and fishermen c. Overseas Filipino
Workers (OFWs)
d. Filipinos
employed by foreign-based
employers, whether
deployed locally or abroad.

Membership to the Fund is

also open to the following:
a. Non-working
spouses of Pag-IBIG
members;
b. Filipino employees
of foreign government or
international organization,
or their wholly-owned
instrumentality based in the
Philippines, in the
absence of an
administrative agreement
with the Fund;
c. Employees of an
employer who is granted a
waiver or suspension of
coverage by the Fund under
RA 9679;
 d. Leaders and
members of religious
groups;
e. A member
separated from
employment, local or
abroad, or ceased to be self-
employed but would like to
continue paying his/her
personal
contribution;
f. Public officials or
employees who are not
covered by the GSIS such as
barangay officials; and
g. Filipinos
naturalized in other
countries.
3. Mandatory for the 1. Employee's All members who can afford to Coverage of the Fund Employer's contributions.
Contributions member and the Contribution pay shall contribute to the and/or the payment of
/ Fees employer to pay Beginning as of the Fund, in accordance with a monthly contribution to the (a) Under such regulations as the
the monthly last day of the reasonable, equitable and same may be rules and System may prescribe, beginning
contributions. calendar month progressive contribution resolutions of the Board of as of the last day of the month
when an employee's schedule to be determined by Trustees be waived or when an employee's compulsory
compulsory the Corporation on the basis of suspended by reasons of coverage takes effect and every
coverage takes applicable actuarial studies and nature of employment, month thereafter during his
effect and every in accordance with the condition of business, ability employment, his employer shall
month thereafter following guidelines: to make contributions and prepare to remit to the System a
during his (a) Members in the formal other reasonable contribution equivalent to one
employment, the economy and their employers considerations. percent of his monthly salary
employer shall shall continue paying the same credit.
deduct and withhold monthly contributions as
from such provided for by law until such (b) The rate of contribution shall
employee's monthly time that the Corporation shall be reviewed periodically and,
salary, wage, have determined a new subject to the limitations herein
compensation or contribution schedule: provided, may be revised as the
earnings, the Provided, That their monthly experience in risk, cost of
employee's contributions shall not exceed administration, and actual or
contribution in an five percent (5%) of their anticipated as well as
amount respective monthly salaries. unexpected losses, may require.
corresponding to his It shall be mandatory for all
salary, wage, government agencies to (c) Contributions under this Title
compensation or include the payment of shall be paid in their entirety by
earnings during the premium contribution in their the employer and any contract
month. respective annual or device for the deduction of
2. Employer's appropriations: Provided, any portion thereof from the
Contributions further, That any increase in wages or salaries of the
Beginning as of the the premium contribution of employees shall be null and
last day of the the national government as void.
month when an employer shall only become
employee's effective upon inclusion of said (d) When a covered employee
compulsory amount in the annual General dies, becomes disabled or is
coverage takes Appropriations Act. separated from employment, his
effect and every (b) Contributions from employer's obligation to pay the
month thereafter members in the informal monthly contribution arising
during his economy shall be based from that employment shall
employment, his primarily on household cease at the end of the month of
employer shall pay, earnings and assets. Those contingency and during such
with respect to such from the lowest income months that he is not receiving
covered employee, segment who do not qualify for wages or salary.
the employer's full subsidy under the means
contribution in test rule of the DSWD shall be
accordance with the entirely subsidized by the LGUs
schedule indicated or through cost sharing
in Section Eighteen mechanisms between/among
of this Act. LGUs and/or legislative
Notwithstanding sponsors and/or other
any contract to the sponsors and/or the member,
contrary, an including the national
employer shall not government: Provided, That
deduct, directly or the identification of
indirectly, from the beneficiaries who shall receive
compensation of his subsidy from LGUs shall be
employees covered based on a list to be provided
by the SSS or by the DSWD through the same
otherwise recover means test rule or any other
from them the appropriate statistical method
employer's that may be adopted for said
contributions with purpose.
respect to such (c) Contributions made in
 employees. behalf of indigent members
3. The contributions shall not exceed the minimum
to the SSS of the contributions for employed
self-employed members.
member shall be (d) The required number of
determined in monthly premium
accordance with contributions to qualify as a
Section Eighteen of lifetime member may be
this Act. increased by the Corporation to
sustain the financial viability of
the Program: Provided, That
the increase shall be based on
actuarial estimate and study.
4. All Benefits 1. Separation 1. Retirement A member whose premium Provident (savings) benefits ART. 185. Medical services. -
and Rules on Benefits payable Benefits. (a) A contributions for at least three claim: Immediately after an employee
Entitlement upon reaching 60 member who has (3) months have been paid Pag-IBIG Fund guarantees contracts sickness or sustains an
years of age or paid at least 120 within six (6) months prior to the refund of member's injury, he shall be provided by
upon separation, monthly the first day of availment, total accumulated savings the System during the
whichever comes contributions prior including those of the (TAV), which consists of the subsequent period of his
later: Provided, to the semester of dependents, shall be entitled to member's accumulated disability with such medical
That the member retirement and who the benefits of the contributions, the employer services and appliances as the
resigns or (1) has reached the Program:Provided, That such counterpart contributions, if nature of his sickness or injury
separates from the age of 60 years and member can show that any, and the dividend and progress of his recovery may
service after he has is already separated contributions have been made earnings credited to the require, subject to the expense
rendered at least 3 from employment with sufficient regularity: member's account upon limitation prescribed by the
years of service but or has ceased to be Provided, further, That the occurrence of any of the Commission.
less than 15 years. selfemployed or (2) member is not currently following grounds for ART. 191. Temporary total
2. Unemployment has reached the age subject to legal penalties as withdrawal: disability.
benefits - paid to a of 65 years, shall be provided for in Section 44 of 1. Membership maturity. (a) Under such regulations as the
permanent entitled for as long this Act. The member must have Commission may approve, any
employee who is as he lives to the The following need not pay remitted at least 240 employee under this Title who
involuntarily monthly pension: the monthly contributions to monthly membership sustains an injury or contracts
separated from the Provided, That he be entitled to the Programs contributions with the Fund. sickness resulting in temporary
service due to the shall have the benefits: For Pag-IBIG Overseas total disability shall for each day
abolition of his option to receive his (a) Retirees and pensioners of Program (POP) members, of such a disability or fraction
office or position first 18 monthly the SSS and GSIS prior to the membership with the Fund thereof be paid by the System
usually resulting pensions in lump effectivity of this Act; and shall be at the end of five an income benefit equivalent to
from sum discounted at a (b) Lifetime members. (5), ten (10), fifteen (15), or ninety percent of his average
reorganization: preferential rate of twenty (20) years depending daily salary credit, subject to the
Provided, That he interest to be on the option of the following conditions: The daily
has been paying determined by the member upon membership income benefit shall not be less
integrated SSS. registration. than Ten Pesos nor more than
contributions for at 2. Death Benefits 2. Retirement. The member Ninety Pesos, nor paid for a
least one (1) year Upon the death of a shall be compulsorily retired continuous period longer than
prior to separation. member who has upon reaching age 65. He one hundred twenty days,
3. Retirement paid at least 36 may however, opt to retire except as otherwise provided for
Benefits (1) Such monthly upon the occurrence of any in the Rules, and the System
member has contributions prior of the following: shall be notified of the injury or
rendered at least to the semester of a. Actual retirement from sickness.
15 years of service; death, his primary the SSS, the GSIS or a
(2) he is at least 60 beneficiaries shall separate employer ART. 192. Permanent total
years of age at the be entitled to the provident/retirement plan, disability.
time of retirement; monthly pension: provided the member has at
and (3) he is not Provided, That if he least reached age 45. (a) Under such regulations as the
receiving a monthly has no primary b. Upon reaching age 60. Commission may approve, any
pension benefit beneficiaries, his 3. Permanent and Total employee under this Title who
from permanent secondary Disability or Insanity. The contracts sickness or sustains an
total disability. beneficiaries shall following disabilities shall be injury resulting in his permanent
4. Permanent be entitled to a deemed total and total disability shall, for each
Disability Benefits lump sum benefit permanent: month until his death, be paid
A member who equivalent to 36 a. Temporary total disability by the System during such a
suffers permanent times the monthly lasting continuously for disability, an amount equivalent
disability for pension. more than 120 days; to the monthly income benefit,
reasons not due to 3. Permanent b. Complete loss of sight of plus ten percent thereof for
his grave Disability Benefits both eyes; each dependent child, but not
misconduct, Upon the c. Loss of two limbs at or exceeding five, beginning with
notorious permanent total over the ankle or wrist; youngest and without
negligence, disability of a d. Permanent complete substitution: Provided, That the
habitual member who has paralysis of two limbs; monthly income benefit shall be
intoxication, or paid at least 36 e. Brain injury resulting in the new amount of the monthly
willful intention to monthly incurable imbecility or benefit for all covered
kill himself or contributions prior insanity; and pensioners, effective upon
another. to the semester of f. Such other cases which approval of this Decree.
5. Survivorship disability, he shall are adjudged to be total and
Benefits (1) be entitled to the permanent disability by a ART. 193. Permanent partial
basic survivorship monthly pension: duly licensed physician and disability.
pension is 50% of Provided, That if he approved by the Board of
the basic monthly has not paid the Trustees. (a) Under such regulation as the
pension required 36 monthly 4. Separation from the Commission may approve, any
(2) dependent contributions, he service due to health reason employee under this Title who
children's pension shall be entitled to a 5. Permanent departure contracts sickness or sustains an
not exceeding 50% lump sum benefit from the country injury resulting in permanent
of the basic equivalent to the 6. Death. In case of death, partial disability shall for each
monthly pension. monthly pension the Fund benefits shall be month not exceeding the period
6. Funeral Benefit times the number of divided among the designated herein be paid by the
The amount of monthly member's legal heirs in System during such a disability
funeral benefit contributions paid accordance with the New an income benefit equivalent to
shall be P12,000 - to the SSS or 12 Civil Code as amended by the income benefit for
P18,000. times the monthly the New Family Code. permanent total disability.
7. Life Insurance pension, whichever
Benefits is higher. ART. 194. Death.
4. Funeral Benefit
A funeral grant (a) Under such regulations as the
equivalent to Commission may approve, the
Twelve thousand System shall pay to the primary
pesos (P12,000.00) beneficiaries upon the death of
shall be paid, in cash the covered employee under
or in kind, to help this Title an amount equivalent
defray the cost of to his monthly income benefit,
funeral expenses plus ten percent thereof for
upon the death of a each dependent child, but not
member, including exceeding five, beginning with
permanently totally the youngest and without
disabled member or substitution, except as provided
retiree. for in paragraph (j) of Article 167
5. Sickness benefit. hereof: Provided, However, That
(a) A member who the monthly income benefit
has paid at least 3 shall be guaranteed for five
monthly years: Provided, Further, That if
contributions in the he has no primary beneficiary,
twelvemonth the System shall pay to his
period immediately secondary beneficiaries the
preceding the monthly income benefit but not
semester of sickness to exceed sixty months:
or injury and is Provided, Finally, That the
confined therefor minimum death benefit shall not
for more than 3 be less than P15,000.
days in a hospital or
elsewhere with the
approval of the SSS,
 shall, for each day of
compensable
confinement or
fraction thereof, be
paid by his
employer, or the
SSS, if such person is
unemployed or self
employed, a daily
sickness benefit
equivalent to 90% of
his average daily
salary credit.
6. Maternity Leave
Benefit A female
member who has
paid at least 3
monthly
contributions in the
twelvemonth
period immediately
preceding the
semester of her
childbirth or
miscarriage shall be
paid a daily
maternity benefit
equivalent to 100%
of her average daily
salary credit for 60
days or 78 days in
case of caesarean
delivery.
5. Procedures Claims for benefits Compulsory SEC. 25. Reimbursement and The Fund shall be private in No claim for compensation shall
of Availment under this Act coverage of the Period to File Claims. All character, owned wholly by be given due course unless said
except for life and employer shall take claims for reimbursement or the members, administered claim is filed with the System
retirement shall effect on the first payment for services rendered in trust and applied within three years from the time
prescribe after 4 day of his operation shall be filed within a period of exclusively for their benefit. the cause of action accrued.
years from the and that of the sixty (60) calendar days from All the personal and
date of employee on the the date of discharge of the employer contributions shall ART. 201. Prescriptive period. -
contingency. first day of his patient from the health care be fully credited to each No claim for compensation shall
employment: provider. member, accounted for be given due course unless said
Provided, That the The period to file the claim individually and transferable claim is filed with the System
compulsory may be extended for such in case of change of within three years from the time
coverage of the self reasonable causes determined employment. They shall the cause of action accrued.
employed person by the Corporation. earn dividends as may be
shall take effect provided for in the ART. 292. Money claims. - All
upon his registration implementing rules. The money claims arising from
with said amounts shall employer-employee relations
the SSS. constitute the provident accruing during the effectivity of
fund of each member, to be this Code shall be filed within
paid to him, his estate or three (3) years from the time the
beneficiaries upon cause of action accrued;
termination of membership, otherwise, they shall be forever
or from which peripheral barred.
benefits for the member
may be drawn. All money claims accruing prior
to the effectivity of this Code
shall be filed with the
appropriate entities established
under this Code within one year
from the date of such effectivity,
and shall be processed or
determined in accordance with
the implementing rules and
regulations of the Code;
otherwise, they shall be forever
barred.

Workmens compensation
claims accruing prior to the
effectivity of this Code and
during the period from
November 1, 1974 up to
December 31, 1974, shall be
filed with the appropriate
regional offices of the
Department of Labor not later
than March 31, 1975; otherwise,
they shall be forever barred.
6. The GSIS shall The SSS shall submit The Corporation shall have the Section 13. Rule-Making ART. 176. Employees'
Administratio formulate, adopt, annually not later following powers and Power. The Board of Compensation Commission.
n amend and/or than April 30, a functions: Trustees is hereby (a) To initiate, rationalize and
rescind such rules public report to the a) to administer the National authorized to make and coordinate the policies of the
and regulations as President of the Health Insurance Program; change needful rules and employees' compensation
may be necessary Philippines and to b) to formulate and promulgate regulations, which shall be program, the Employees'
to carry out the the Congress of the policies for the sound published in accordance Compensation Commission is
provisions and Philippines covering administration of the Program; with law or at least once in a hereby created to be composed
purposes of this its activities in the c) to set standards, rules, and newspaper of general of five ex-officio members,
Act, as well as the administration and regulations necessary to ensure circulation in the namely: the Secretary of Labor
effective exercise enforcement of this quality of care, appropriate Philippines, to provide for, and Employment as Chairman,
of the powers and Act during the utilization of but not limited to the the GSIS General Manager, the
functions, and the preceding year services, fund viability, member following matters: SSS Administrator, the Chairman
discharge of duties including satisfaction, and overall (a) The effective of the Philippine Medical Care
and responsibilities information and accomplishment of Program administration, custody, Commission, and the Executive
of the GSIS, its recommendations objectives; development, utilization and Director of the ECC Secretariat,
officers and on broad policies for d) to formulate and implement disposition of the Fund or and two appointive members,
employees. the development guidelines on contributions and parts thereof, including one of whom shall represent the
and perfection of benefits; portability of benefits, payment of amounts employees and the other, the
the program of the cost credited to members or to employers, to be appointed by
SSS. containment and quality their beneficiaries or the President of the Philippines
assurance; and health care estates; for a term of six years. The
provider arrangements, appointive member shall have at
payment, methods, and (b) Extension of Fund least five years experience in
referral systems; coverage to other working workmen's compensation or
xxx groups, and waiver or social security programs. All
suspension of coverage or vacancies shall be filled for the
its enforcement for reasons unexpired term only. (As
herein stated; amended by Sec. 19(c), E.O.
126).
(c) Grounds for and effects
of termination of (b) The Vice Chairman of the
membership other than by Commission shall be alternated
completion of term; each year between the GSIS
General Manager and the SSS
(d) Fund earnings and their Administrator. The presence of
distribution, investment four Members shall constitute a
and/or plowing back for the quorum. Each Member shall
exclusive benefit of the receive a per diem of two
members; hundred pesos for every

(e) Interim disbursements of
accumulated values to
members of ameliorative
and similar purposes;
(f) Housing and other loan
assistance programs for
members;
(g) Adjudication and
settlement of claims and
disputes and the procedures
for the same on any matters
involving the interests of
members in the Fund;
(h) Optimize the
effectiveness of the initial
coverage drive through
phased implementation
based on reasonable
classifications of employers
and/or employee groups;
and
(i) Other matters that, by
express or implied
provisions of this Act, shall
require implementation by
appropriate policies, rules
and regulations.
7. Despute- 1. The GSIS shall 1. Dispute arising Grievance and Appeal The Fund shall have original
Resolution have original and with respect to Procedures. A member, a and exclusive jurisdiction
exclusive coverage, benefits, dependent, or a health care over all claims and disputes
jurisdiction to contributions and provider may file a complaint on any other matter relative
settle any dispute penalties shall be for grievance based on any of to the implementation of
arising under this heard by the the above grounds, in the provisions of RA 9679
meeting that is actually
attended by him, exclusive of
actual, ordinary and necessary
travel and representation
expenses. In his absence, any
Member may designate an
official of the institution he
serves on full-time basis as his
representative to act in his
behalf. (As amended by Sec. 2,
P.D. 1368).
(c) The general conduct of the
operations and management
functions of the GSIS or SSS
under this Title shall be vested in
its respective chief executive
officer, who shall be
immediately responsible for
carrying out the policies of the
Commission.
(d) The Commission shall have
the status and category of a
government corporation, and it
is hereby deemed attached to
the Department of Labor for
policy coordination and
guidance.
ART. 180. Settlement of claims. -
The System shall have original
and exclusive jurisdiction to
settle any dispute arising from
this Title with respect to
coverage, entitlement to
Act and any other Commission. accordance with the following
laws administered 2. The decision of procedures:
by the GSIS. the Commission (a) A complaint for grievance
2. Appeals from upon any disputed must be filed with the
any decision or matter may be Corporation which shall refer
award of the Board reviewed both upon such complaint to the
shall be governed the law and the Grievance and Appeal Review
by Rules 43 and 45 facts by the Court of Committee. The Grievance and
of the 1997 Rules Appeals. Appeal Review Committee shall
of Civil Procedure. rule on the complaint through
a notice of resolution within
sixty (60) calendar days from
receipt thereof.
(b) Appeals from the decision
of the Grievance and Appeal
Review Committee must be
filed with the Board within
thirty (30) calendar days from
receipt of the notice of
resolution.
and these Rules affecting
the rights and interest of the
members. The decision of
the Chief Executive Officer
of the Fund shall final and
executory, unless appealed
to the Board, after the lapse
of 30 days from receipt by
the aggrieved party of such
decision. The decision of the
Board shall, unless appealed
to a competent court,
become final and executory
after 15 days from receipt of
such decision.
benefits, collection and payment
of contributions and penalties
thereon, or any other matter
related thereto, subject to
appeal to the Commission,
which shall decide appealed
cases within twenty working
days from the submission of the
evidence.
ART. 181. Review. - Decisions,
orders or resolutions of the
Commission may be reviewed
on certiorari by the Supreme
Court on questions of law upon
petition of an aggrieved party
within ten days from notice
thereof.
ART. 182. Enforcement of
decisions.
(a) Any decision, order or
resolution of the Commission
shall become final and executory
if no appeal is taken therefrom
within ten days from notice
thereof. All awards granted by
the Commission in cases
appealed from decisions of the
System shall be effected within
fifteen days from receipt of
notice.
(b) In all other cases, decisions,
orders and resolutions of the
Commission which have become
final and executory shall be
enforced and executed in the
same manner as decisions of the
Court of First Instance, and the
 Commission shall have the
power to issue to the city or
provincial sheriff or to the sheriff
whom it may appoint such writs
of execution as may be
necessary for the enforcement
of such decisions, orders or
resolutions, and any person who
shall fail or refuse to comply
therewith shall, upon application
by the Commission, be punished
by the proper court for
contempt.

8. Strengths The lack of a PhilHealth

identification card will not be a
reason to deny medical service
to anyone.
9. Its actuarial life is There are lots of complaints
Weaknesses only estimated to about the implementation
last until 2036. this program.

10. It must include the The commission Voluntary, not compulsory,

Recommenda legitimate surviving must be lenient in membership would give
tions for spouse of the GSIS approving the leeway to OFW families to
Improvement member or claims of the choose between getting a
(Proposed pensioner as a members who have housing loan or simply
Amendment) dependent proven to have building their own home at
together with a contributions. a lower cost.
legally-adopted
child, illegitimate
child, and natural
or adoptive parents
as beneficiaries.
B. Question

A, a female, married government employee is also teaching in a private university. She delivered a baby by Caesarean section. She was later diagnose
with cancer of the ovary and had to undergo an ovorectomy. She is a solo parent but is named as dependent of her 21-year old son working in a big firm.

1. What are the benefits that she is entitle to?

2. Is she entitled to claim benefits from

(a) GSIS law? Yes. A is a government employee.

(b) SSS law? No. A is not qualified as dependent of his 21-year old son working in a big firm.

(c) PhilHealth law?

(d) Labor Code Book 4?

(e) Other laws? A is entitled to claim Maternity leave benefits.