MPSTA | MBS-IRR

Death Benefit

Upon death of the member, the designated
beneficiary/ies will be indemnified according to the Insurance Benefits
Schedule. It is understood that upon death of the member, his/her certificate
of membership is automatically terminated.

Accidental Death Benefit

Upon accidental death of the member, the
designated beneficiary/ies will be indemnified according to the Insurance
Benefits Schedule.

Accidental death is defined as loss of life
as a direct result, independently and exclusively of all other causes, of
bodily injury affected solely by external, violent and accidental means of
which, except in the case of drowning or if internal injury is revealed by an
autopsy, there is evidence of a visible contusion or wound on the exterior of
the body, occurring within one hundred eighty (180) days from the date of such
injury.

Hospital Confinement Daily Benefit

A member, who incurred hospital confinement
in a legally constituted hospital of not less than 24 hours, requires treatment
by a legally qualified physician or surgeon, MPSTA-MBS shall, subject to the
exclusions and provisions hereunder and the certificate of membership, pay the
member’s hospital confinement daily benefit as stipulated in the Insurance
Benefits Schedule. The following conditions and definitions apply:

a)     A physician or surgeon is defined as a person legally registered to practice medicine in the geographical location where the services to the patient have been rendered;

b)     Hospitalization for the purpose of cosmetic surgery or childbirth is not applicable.

Member’s Equity Value / Maturity Benefit

A member shall be entitled to an equity value equal to at least FIFTY PER CENTUM (50%) of the total membership contributions collected from him/her. This is payable upon termination of his/her membership from MPSTA-MBS including death. A termination charge of not more than 30% of the total contributions collected from the member may however be imposed by MPSTA-MBS for termination occurring within three (3) years of membership.  Upon attaining the age of 65, a member is entitled to maturity benefit.

            B.     Members Eligibility

Any person satisfying all of the following conditions shall be eligible for membership under MPSTA-MBS :

a)     Applicants must be either a permanent teacher or an employee of a public school in the Division City Schools, Manila.

b)     Applicants must be at least eighteen (18) years old but not more than sixty five (65) years old as of the enrollment date.  Only those applicants who can meet  all of the requirements stated on the prescribed application form shall be eligible for membership.

C.   Effectivity of Membership

a)     Membership in MPSTA-MBS shall take effect upon payment of the first     contribution and approval of the application for membership by the Board of Trustees or the official so delegated by the Board.    

b)     A certificate of membership containing the date of effectivity of membership, a summary of benefits and excerpts of the Implementing Rules and Regulations of MPSTA-MBS shall be issued to each and every member of MPSTA-MBS upon approval of the application for membership.

D.  Misstatement of Age

Any willful misstatement of age in the application that would render a person eligible for coverage when he/she would otherwise be ineligible shall be sufficient cause for the cancellation of one’s membership in the MPSTA-MBS at any time such misstatement is known. MPSTA-MBS will only refund all contributions paid by the disqualified member without interest.

E.   Beneficiary

The beneficiary is the person designated to
receive the proceeds of this Certificate of Membership upon the death of the member,
unless otherwise changed and provided that they are not disqualified under the
law.

a)    The right to designate beneficiaries is reserved to every member of the MPSTA-MBS, who may, at anytime, designate a new beneficiary/ies. Such request for change of beneficiaries must be made in writing and signed by the member under oath, then submitted to the MPSTA-MBS Office.

b) When a member dies without any designated beneficiary/ies, the benefits shall be awarded to the legal heirs based on law.

c)    In case of multiple overlapping applications for membership, only the initial application shall be considered valid. Upon discovery of multiple overlapping membership of one person, the additional certificates of membership shall be automatically cancelled and the contributions for these overlapping memberships shall be refunded. In case of multiple claims for a single event by one member, benefits will be paid only once as defined and due under the initial membership.

d)    The member’s legal beneficiaries shall be defined as follows :

·      Legal spouse

·      Biological or legally adopted children and;

·      If single, parents, brothers or sisters may be designated.

F.   Fees and Contributions

a)    Members shall be charged ONE HUNDRED PESOS
(Php 100.00) monthly contributions.

b)    Members shall be charged an entrance fee of
FIFTY PESOS (Php 50.00) in order to cover the expenses incurred in processing
the application. This fee is not refundable, nor will it be included for
purposes of determining the member’s accumulated and refundable contributions.

c)    The fees and contributions may be adjusted
by the Board of Trustee as may be necessary to maintain the funds of MPSTA-MBS
at a level adequate to meet its benefit obligations or commitments under the
insurance program.  Any change in the
contributions or fee is subject to approval by the Insurance Commission.

d)    Members’ contributions may be paid by direct
remittance to the MPSTA-MBS Office or designated authorized collection centers
and are considered paid on the date of receipt of MPSTA-MBS Office or
authorized collection center.

G.  Payment of Contributions

Subject to the grace period herein provided,
all contributions are payable by the member on or before the due dates at the
duly designated offices or authorized representatives.

H.  Maximum Benefit

The maximum amount of guaranteed benefits
excluding the TPD benefit for each certificate issued under this insurance plan
shall not be more than five hundred (500) times the current daily minimum wage
rate for non-agricultural workers in Metro Manila.  The maximum amount of TPD benefit for each
certificate shall be in accordance with the Insurance Benefits Schedule.

I .   Maximum Contributions

The maximum amount of contributions computed
on a daily basis shall not exceed five percent (5%) of the current daily
minimum wage rate for non-agricultural workers in Metro Manila.

J.    Fund Management

MPSTA-MBS shall disaggregate the
contributions from the members and administer them into four (4) separate and
distinct funds, namely: Benefit Fund, Equity Fund, General Fund and Guaranty
Fund.

a)    Benefit Fund

The Benefit Fund shall not exceed more than
40% of the contribution. It shall cover all the contractual benefits in the
insurance plan.

b)    Equity Fund

The Equity Fund representing 50% of the
contribution shall support the member’s equity or termination value and any
other promised accrued interest earnings on the equity value.

c)    General Fund

The General Fund shall not exceed more than 5% of the contribution.  It shall finance the general and operating
expenses in administering the insurance program.

d)     Guaranty Fund

The Guaranty Fund
comprising 5% of the contribution shall ensure the timely and properly payment
of annual contribution to the Guaranty Fund as mandated by the Insurance
Commission (IC).  If the Guaranty Fund
has been fully complied with as required by Law, the allocation for the
Guaranty Fund shall be utilized to increase the member’s benefits or reduce the
contribution or may be lumped under the General Fund Account.

K.   Grace Period

A grace period of sixty (60) days from due
date of the contribution payment is allowed, after which if the contribution is
not paid, the Certificate of Membership shall automatically terminate.  Equity value is payable upon termination of
the Certificate of Membership.

In case of natural death, accidental death,
or hospital confinement of the insured member during the said grace period, the
unpaid contributions shall automatically be deducted from the benefits payable.

L.   Contestability

An individual coverage can be contested by
the MPSTA-MBS within one (1) year from the effective date of his/her coverage
or the date of last reinstatement of his/her coverage.

M. Suicide

      MPSTA-MBS will not be liable if the member dies by suicide within one (1) year after the  effective date or last reinstatement of the Certificate of Membership, provided however, that      suicide committed in a state of insanity will be compensable regardless of the date of commission. Where   suicide is not compensable, MPSTA-MBS’s liability shall be limited to the return of all contributions paid.

N.  Termination of Coverage

A member’s coverage automatically terminates
under the following conditions whichever comes first:

a)    Upon death of the member;

b)    Upon voluntary surrender / termination fro MPSTA-MBS;

c)    Upon expiration of the grace period if no paymen is received by then;

d)     Upon withdrawal of the equity value on the Certificate of Membership;

e)     If the member is terminated with cause by MPSTA-MBS;

f)    Upon reaching the termination age of 65 The termination of coverage shall be without

prejudice to any claim arising prior to such termination.

           O.    Reinstatement of Membership and Coverage

a)   Membership may be reactivated provided the teacher/employee is in the service and in good health as certified to by a government physician.  The reactivity shall take effect upon payment of the required installment fee of the contributions in arrears with interest at the rate of six percent (6%) per annum upon payment of arrears. 

a)    Reactivation shall be made within a period of three (3) years from the date of cancellation of membership.

b)    The required fees and contributions in arrears with interest may be paid in full or
in monthly installment to be determined by the Board.

c)    In case of death during the installment period, the balance of the contributions
in arrears with interest shall automatically be deducted from the benefits.

P.   Notice and Proof of Claim

Notice of claim must be submitted to the MPSTA-MBS within thirty (30) days and proof of claim within ninety (90) days from the date of death and two (2) weeks for hospitalization claim after the discharge from the hospital, except when it can be shown that failure to submit the notice and proof within such time is due to valid reason.

Q.   Claims Settlement

Claims under this Certificate of Membership shall be settled within ten (10) working days upon receipt of complete documents.

R.   Dispute Resolution

All disputes arising in connection with Certificate of Membership shall be initially settled through alternative dispute resolution mechanism.

S.   Mutual Benefit System Review Committee

The Mutual Benefit System Review Committee (MBS-RC) which is composed of five (5) members shall be the body to provide resolutions for all disputes.  In case of indecision, the result of the evaluation of cases and recommendation must be submitted to the MPSTA President for a decision.  However, if the President cannot make a decision, the case or dispute shall be referred to the Board of Trustees for final decision.

T.   Board of Trustees

The Board of Trustees shall adopt a prudent cash management program to invest profitably all cash in excess of current disbursements.  MPSTA-MBS shall utilize not more than FIVE PER CENTUM (5%) of the monthly contribution from its members as administrative expenses (in addition to the membership fees).  The balance shall be used for paying benefits as outlined in Section A above. The Board of Trustees shall set up each year sufficient reserves for the payment of claims and other obligations in accordance with actuarial procedures approved by the Insurance Commission and per the recommended calculations and procedures specified by Consulting Actuary. If the reserves become impaired, the Board of Trustees shall requireall members to pay MPSTA-MBS the amount of the member’s equitable proportion of such deficiency as ascertained by the Board of Trustees. If the payment is not

made, it shall stand as an indebtedness against the members and draw interest not exceed five per centum (5%) per annum compounded annually.

U. Availability of Implementing Rules and Regulations (IRR)

The Implementing Rules and Regulations of MPSTA-MBS embodies the terms and conditions of the insurance described above.  A copy of the IRR of MPSTA-MBS is kept in the office and is available to the member for inspection during its regular office hours.

IMPORTANT NOTICE

The Insurance Commission, with offices in Manila, Cebu and Davao, is the government office in charge of the enforcement of all laws related to insurance and has supervision over mutual benefit associations and intermediaries.  It is ready at all times to assist the general public in matters pertaining to insurance.  For any inquiries or complaints, please contact the Public Assistance and Mediation Division (PAMD) of the Insurance Commission at 1071 United Nations Avenue, Manila, with the telephone numbers +632-5238461 to 70 with email address pubassist@insurance.gov.ph. The official website of the Insurance Commission is www.insurance.gov.ph.