1. Coverage; Exclusions; Dependents; Beneficiaries; Benefits

B. GSIS Law (R.A. No. 8291)

• Benefits; Coverage and Exclusions
• Dependents and Beneficiaries

Government Service Insurance System Law (R.A. No. 8291)

Purpose

R.A. No. 7699 was enacted to enable those from the private sector who transfer to the government service or from the government service to the private sector to combine their years of service and contributions which have been credited with the SSS or GSIS, as the case may be, to satisfy the required number of years of service for entitlement to the benefits under the applicable laws. (Chan, 2019)

Coverage

R.A. No. 7699 was enacted to enable those from the private sector who transfer to the government service or from the government service to the private sector to combine their years of service and contributions which have been credited with the SSS or GSIS, as the case may be, to satisfy the required number of years of service for entitlement to the benefits under the applicable laws. (Chan, 2019)

Exclusions from coverage

R.A. No. 7641, "The Retirement Pay Law," only applies in a situation where:

• There is no collective bargaining agreement or other applicable employment contract providing for retirement benefits for an employee; or
• There is a collective bargaining agreement or other applicable employment contract providing for retirement benefits for an employee, but it is below the requirements set for by law.

The reason for the first situation is to prevent the absurd situation where an employee, who is otherwise deserving, is denied retirement benefits by the nefarious scheme of employers in not providing for retirement benefits for their employees. The reason for the second situation is expressed in the Latin maxim pacta private juri public derogare non possunt. Private contracts cannot derogate from the public law. (Oxales vs Unilab, G.R. No. 152991, 2008)

State Insurance Fund

The State Insurance Fund (SIF) is built up by the contributions of Ers based on the salaries of their Ees as provided under the Labor Code. (Chan, 2019)

The State Insurance Fund pays the Ee’s compensation benefits; administrative expenses of the Employees’ Compensation Commission and the administering Systems may also be charged against it as authorized by law. (Art. 185, LC)

Primary

• Legal dependent spouse until he/she remarries
• Dependent children

EXCEPT:

• Government employees, whether employed by the National Government or any of its political subdivisions, including those employed in government-owned and/or controlled corporations with original charters or created under special laws;
• House helpers and persons in the personal service of another;
• Managerial employees, if they meet all of the following conditions.
• Their primary duty is to manage the establishment in which they are employed or of a department or subdivision thereof;
• They customarily and regularly direct the work of two or more employees therein;
• They have the authority to hire or fire other employees of lower rank; or their suggestions and recommendations as to hiring, firing, and promotion, or any other change of status of other employees are given particular weight.
• Field personnel and those whose time and performance is unsupervised by the employer;
• Those already enjoying this benefit;
• Those enjoying vacation leave with pay of at least five (5) days; and
• Those employed in establishments regularly employing less than ten (10) employees. (IRR Labor Code, Sec. 1, Rule V, Book III)

Totalization

Totalization refers to the process of adding up the periods of creditable services or contributions under each of the Systems, SSS or GSIS, for the purpose of eligibility and computation of benefits. (Sec. 2(e), R.A. No. 7699)

All services rendered or contributions paid by a member personally or paid by the Ers to either System shall be considered in the computation in the computation of benefits, which may be claimed from either or both Systems. (Sec. 2, Rule V, IRR, R.A. No. 7699)

NOTE: The amount of benefits to be paid by one System shall be in proportion to the services rendered/periods of contribution made to that System. (Sec. 2, Rule V, IRR, R.A. No. 7699)

II. Secondary beneficiaries

• The legitimate parents wholly dependent upon the Ee for regular support; and
• The legitimate descendants and illegitimate children who are unmarried, not gainfully employed, and not over 21 years of age, or over 21 years of age provided that he is incapacitated and incapable of self- support due to physical or mental defect which is congenital or acquired during minority. (Sec. 1(c), Rule VX, Amended Rules on EC)

Totalization shall apply in the following instances:

• If a worker is not qualified for any benefits from both System;
• If a worker in the public sector is not qualified for any benefits in the GSIS; or
• If a worker in the private sector is not qualified for any benefits from the SSS.

NOTE: For purposes of computation of benefits, totalization shall apply to all cases so that the contributions made by the worker-member in both Systems shall provide maximum benefits which otherwise will not be available. In no case shall the contribution be lost or forfeited. (Sec 3, Rule V, IRR, R.A. N. 7699)

Overlapping periods of creditable service in both Systems shall be credited only once for purposes of totalization. (Sec. 7, Rule V, IRR, R.A. 7699)

If after the totalization, the worker-member still does not qualify for any benefit, the member will then get whatever benefits correspond to his/her contributions in either or both Systems. (Sec. 4, Rule V, IRR, R.A. No. 7699)

Primary

• The dependent spouse until he or she remarries
• The dependent legitimate, legitimated or legally adopted, and illegitimate children
• Entitled to fifty percent (50%) of the share of the legitimate, legitimated or legally adopted children.
• If there are no legitimate children, they shall be entitled to one hundred percent (100%) of the benefits.

Basic Monthly Pension Computation

37.5% x [revalued average monthly compensation] Plus 2.5% x [revalued average monthly compensation] x [years in service in excess of 15 years], subject to the statutory ceiling.

Paid to each dependent child conceived on or before the date of the contingency beginning with the youngest.

• Not exceeding 5
• Legitimate shall be preferred over illegitimate children

In Case of Death of Member

• Primary beneficiaries as of the date of retirement shall be entitled to receive the monthly pension; or
• If no primary beneficiaries and he dies within 60 months from the start of monthly pension, secondary beneficiaries shall be entitled to a lump sum benefit equivalent to the total monthly pensions corresponding to the balance of the five-year guaranteed period, excluding the dependents’ pension.

Lump Sum Eligibility

A 60-year-old member with less than 120 monthly contributions who is no longer employed or self-employed, and who is not continuing contributions independently, is entitled to a lump sum equal to his total contributions paid.

The monthly pension of a member who retires after reaching age 60 shall be the higher of either:

• The monthly pension computed at the earliest time he could have retired had he been separated from employment or ceased to be self-employed + all adjustments thereto;
• The monthly pension computed at the time when he actually retires.

Death Benefits [Sec. 13]

Disabilities Deemed Total and Permanent

• Complete loss of sight of both eyes;
• Loss of 2 limbs at or above the ankle or wrist
• Permanent complete paralysis of 2 limbs
• Brain injury resulting in incurable imbecility or insanity
• Other cases as determined by the GSIS

Lump Sum Alternative

A member is entitled to a lump sum benefit equivalent to the monthly pension times the number of monthly contributions paid to the SSS or 12 times the monthly pension, whichever is higher.

Disabilities Deemed Partial and Permanent

Complete and permanent loss of the use of:

• Any finger
• Any toe
• One arm
• One hand
• One foot
• One leg
• One or both ears
• Hearing of one or both ears
• Sight of one eye

Other cases as determined by the GSIS

Eligibility Requirements and Other Conditions

• Inability to work due to sickness or injury;
• Confined for at least 4 days either in a hospital or elsewhere with SSS approval;
• At least 3 months of contributions in the 12-month period immediately before the semester of sickness or injury has been paid;
• All company sick leaves with pay for the current year have been used up;
• Maximum of 120 days per calendar year [i.e. maximum permissible for the same sickness and confinement is 240 days for 2 consecutive years];
• The employer has been notified, or, if a separated, voluntary or self-employed member, the SSS directly notified within 5 days of confinement;
• Notice to employer or SSS not needed when confinement is in a hospital; notice to employer not required as well when Employee became sick or injured while working or within premises of the employer.

Entitled to daily cash allowance paid for the number of days a member is unable to work due to sickness or injury equivalent to 90% x [average daily salary credit]

• 100% of the daily benefits provided shall be reimbursed by the SSS to said employer upon receipt of satisfactory proof of such payment and legality thereof if the following conditions are met:
• The employer notified the SSS of the confinement within five calendar days after receipt of the notification from the employee member
• If the notification to the SSS is made by the employer beyond five calendar days after receipt of the notification from the employee member, he shall be reimbursed only for each day of confinement starting from the tenth calendar day immediately preceding the date of notification to the SSS
• SSS shall reimburse the employer or pay the unemployed member only for confinement within the one-year period immediately preceding the date the claim for benefit or reimbursement is received by the SSS, except confinement in a hospital in which case the claim for benefit or reimbursement must be filed within one year from the last day of confinement

Maternity Leave Benefits [Sec. 14-A]

Optional Insurance

Member may apply for insurance and/or pre-need coverage embracing life, health, hospitalization, education, memorial plans, and such other plans.

Employer may also apply for group insurance.

The payment of the premiums/installments for optional insurance may be made by:

• The insured or
• His employer and/or
• Any person acceptable to the GSIS