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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.
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
meeting that is actually
(e) Interim disbursements of attended by him, exclusive of
accumulated values to actual, ordinary and necessary
members of ameliorative travel and representation
and similar purposes; expenses. In his absence, any
Member may designate an
(f) Housing and other loan official of the institution he
assistance programs for serves on full-time basis as his
members; representative to act in his
behalf. (As amended by Sec. 2,
(g) Adjudication and P.D. 1368).
settlement of claims and
disputes and the procedures (c) The general conduct of the
for the same on any matters operations and management
involving the interests of functions of the GSIS or SSS
members in the Fund; under this Title shall be vested in
its respective chief executive
(h) Optimize the officer, who shall be
effectiveness of the initial immediately responsible for
coverage drive through carrying out the policies of the
phased implementation Commission.
based on reasonable
classifications of employers (d) The Commission shall have
and/or employee groups; the status and category of a
and government corporation, and it
is hereby deemed attached to
(i) Other matters that, by the Department of Labor for
express or implied policy coordination and
provisions of this Act, shall guidance.
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 ART. 180. Settlement of claims. -
Resolution have original and with respect to Procedures. A member, a and exclusive jurisdiction The System shall have original
exclusive coverage, benefits, dependent, or a health care over all claims and disputes and exclusive jurisdiction to
jurisdiction to contributions and provider may file a complaint on any other matter relative settle any dispute arising from
settle any dispute penalties shall be for grievance based on any of to the implementation of this Title with respect to
arising under this heard by the the above grounds, in the provisions of RA 9679 coverage, entitlement to
Act and any other Commission. accordance with the following and these Rules affecting benefits, collection and payment
laws administered 2. The decision of procedures: the rights and interest of the of contributions and penalties
by the GSIS. the Commission (a) A complaint for grievance members. The decision of thereon, or any other matter
2. Appeals from upon any disputed must be filed with the the Chief Executive Officer related thereto, subject to
any decision or matter may be Corporation which shall refer of the Fund shall final and appeal to the Commission,
award of the Board reviewed both upon such complaint to the executory, unless appealed which shall decide appealed
shall be governed the law and the Grievance and Appeal Review to the Board, after the lapse cases within twenty working
by Rules 43 and 45 facts by the Court of Committee. The Grievance and of 30 days from receipt by days from the submission of the
of the 1997 Rules Appeals. Appeal Review Committee shall the aggrieved party of such evidence.
of Civil Procedure. rule on the complaint through decision. The decision of the
a notice of resolution within Board shall, unless appealed ART. 181. Review. - Decisions,
sixty (60) calendar days from to a competent court, orders or resolutions of the
receipt thereof. become final and executory Commission may be reviewed
(b) Appeals from the decision after 15 days from receipt of on certiorari by the Supreme
of the Grievance and Appeal such decision. Court on questions of law upon
Review Committee must be petition of an aggrieved party
filed with the Board within within ten days from notice
thirty (30) calendar days from thereof.
receipt of the notice of
resolution. 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.
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.
(b) SSS law? No. A is not qualified as dependent of his 21-year old son working in a big firm.