SSS Maternity Benefits Claim Denied: Here Are The Explanations Why Some Women Are DENIED

One of the programs that SSS offering is Maternity Benefits Reimbursement, hearing all the good news regarding this program makes a mother feel financially secured because it can be a big help when it comes to their delivery expenses.

As we all know, the prerequisite in order to avail this program is to be a member of SSS. With that, there are some factors you need to comply as well.

But why there are some women got denied to avail the Maternity Benefits Reimbursement even they are already member?

So, here are the explanations and concerns base from several women’s personal experiences that needs to consider why SSS Maternity Benefits are being denied:

DENIED DUE TO INCOMPLETE OR INCORRECT DOCUMENTS

1. Documents not submitted by a member who recently resigned from his job

-If you are applying for SSS maternity benefit, and you just resigned from your recent job, make sure you submit these additional documents:
-Certificate of Separation – must indicate the date of separation from employment
-Certificate of Non-Advancement of Maternity Benefit – to certify that your employer did not advance any amount of maternity benefit to you
-2 copies of SSS Form L-501 – specimen signature card
-You can request for these documents from your previous employer and you need to submit these if your date of separation from employment is within 6 months of your date of delivery.
-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.
-To be safe, you personally inquire at the SSS branch whether you should submit these documents or not especially if you resigned from your company within 1 year.

2. Documents submitted have errors or discrepancies

A. For example, if 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, your maternity benefit claim may be denied.

B. Another common mistake is that some members submit the Certificate of Employment and not the Certificate of Separation. The content may look the same but they are different documents. Make sure to submit the Certificate of Separation.

C. 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 indicate 2nd pregnancy, but the Birth Certificate shows 3rd in Birth Order.

Or it’s 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.

D. Member did not submit complete requirements to claim maternity benefit.
Member delivered her child by CS, but did not submit Operating Room Record
Member had Miscarriage, but did not submit Histopathology Report and Medical Certificate

E. Birth Certificate of Child is not Authenticated by the local registrar or NSO.
To avoid this, 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.

F. Questions about the Child’s Middle Name and Surname
An example of this is if the child’s middle name is different from the mother’s surname, and the child’s surname is different from the father’s surname.

To avoid issues related to this, make sure to submit an Affidavit to explain the Discrepancy in Names.
DENIED DUE TO MAT1 / MAT2 FORMS

3. MAT1 was not submitted to SSS before delivery of the child.

As soon as you learned that you’re pregnant, you must notify the SSS of your pregnancy by submitting the MAT1.

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

Please bear in mind that not all explanations or reasons for nonsubmission of MAT1 may be accepted. It is still subject to an evaluation by the SSS officer.

4. Your signatures don’t match in MAT1 and MAT2

Your signature in MAT1 may be different from your signature in MAT2 because you may have used your maiden name and signature when you submitted your MAT1, whereas you used your married name and signature when you submitted your MAT2.

To avoid this, make sure you update/inform SSS of your change in civil status and/or name using the SSS E4 form. You may login to your My.SSS account to see if your personal information details are already updated before you submit any documents or requirements to SSS.
DENIED DUE TO MEMBERSHIP / COVERAGE STATUS

4. Your Coverage Status in your Claim is different from your Record in SSS

An example of this is if you checked VOLUNTARY in your MAT1 or MAT2 form, but your status in your SSS account is EMPLOYED.

To avoid this, make sure you check your SSS account online or inquire at the SSS branch about your current membership status and coverage.

5. Member has NO Date of Coverage

There are two types of coverages under the Social Security Program:
Compulsory Coverage – including Employers, Employees, and Self-Employed Persons
Voluntary Coverage – including Separated Members, Overseas Filipino Workers (OFWs), and Non-Working Spouse of SSS Members

If your maternity benefit claim was denied due to No Date of Coverage (DOC), you may have been paying your contributions to the SSS as a Voluntary Member without proper registration. Meaning, you are not a separated member or previously employed, you’re not an OFW, or a non-working spouse member. Making your FIRST payment to SSS as Voluntary is not allowed.

Usually, a member discovers that she has no Date of Coverage upon submission of MAT1. To avoid this, always make sure to verify your membership coverage status before paying your contributions. You can do this by logging in to your My.SSS account or by visiting the nearest SSS branch.
DENIED DUE TO SSS CONTRIBUTIONS

6. Your SSS Contributions are not yet Posted on your SSS Account

This is the most common reason why SSS benefit claims are denied. To address this issue, the SSS has recently implemented the PRN-based system wherein all members are now required to use their PRN or Payment Reference Number when paying SSS contributions for real-time posting of contribution.

7. Your SSS Contributions have not yet been remitted by your Employer

It is very important that you are aware of your SSS contributions. To know this, you must be registered to My.SSS so that you can access your SSS account and view your SSS contributions. You may also inquire from your HR Personnel about this. This way, you’ll find out if your employer is remitting the correct amount of your contribution payments and if they remit it on time.

As suggestions, do these before you file your SSS maternity benefit so that if there are any issues with the posting of your SSS contributions, it will be addressed/solved first.

If you found out that your employer has not remitted your contribution payments but you were deducted from your salary for the applicable months, then talk to your HR Personnel. Don’t be afraid to ask. If they don’t give you a valid answer or they simply don’t want to assist you, report them to the SSS. Make sure to bring supporting documents including your pay slip, company ID, and SSS number.

8. You are not eligible for SSS maternity benefit

You may be a member of the SSS but you have not paid at least 3 months (of the 12 months) BEFORE the semester of contingency.

You are also not eligible to claim SSS maternity benefit for the 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.

OTHERS: DENIED REMARKS
Based on our research, some members got denied with the following remarks.
DENIED: Wrong Key Encoding
DENIED: No Medical Approval

It is better to clarify these remarks into a SSS official.

Final Thought:

By logging in to My.SSS from time to time, it is important that we are aware and updated with our SSS contributions, benefit claims, or loan status. Moreover, we need to submit all the required documents when filing for claims for faster processing and higher chance of approval.

Lastly, as SSS members, we are eligible to the benefits that the SSS provides, but it is always comes with a responsibility and awareness. We should pay our contributions properly and timely so that we won’t have any issues when claiming benefits.

Source: Master Citizen
SSS Maternity Benefits Claim Denied: Here Are The Explanations Why Some Women Are DENIED SSS Maternity Benefits Claim Denied: Here Are The Explanations Why Some Women Are DENIED Reviewed by Admiin Artikulo on June 30, 2019 Rating: 5
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