Are Illegal Abortions Covered by SSS Maternity Benefits?

The Social Security System (SSS) provides maternity benefits for childbirth, miscarriage, and emergency pregnancy terminations. But one sensitive and often controversial question is:

“Kung illegal abortion ang nangyari, pwede bang makakuha ng SSS maternity benefits?”

This is an important topic because many members are unsure about the legal, medical, and SSS policy implications. Misunderstanding this can lead to denied claims, legal trouble, and wasted effort.

Let’s clarify how SSS treats illegal abortions, what the rules say, and what you should do if you’re in a complicated situation.

Understanding the SSS Rule on Abortions

Legal vs. Illegal Pregnancy Terminations

In the Philippines, abortion is generally illegal under the Revised Penal Code, except in cases where it is medically necessary to save the life of the mother (therapeutic abortion).

SSS Maternity Benefit Policy:

SSS covers miscarriage and emergency pregnancy terminations that are natural or medically necessary.
Illegal abortions—those performed in violation of the law—are NOT covered.

Why Illegal Abortions Are Not Covered

The SSS is a government institution bound by Philippine laws. If a pregnancy termination violates criminal law, SSS cannot process it as a valid contingency for maternity benefits.

Potential causes of claim denial:

Medical records indicating “induced abortion” without lawful justification.
No supporting legal/medical proof that it was a therapeutic or spontaneous miscarriage.
Conflicting statements in hospital and SSS submissions.

Example Scenario

Case 1 – Covered:
Maria had severe pregnancy complications, and her doctor performed a medically necessary procedure to save her life. She provided complete hospital records and a doctor’s affidavit.
→ SSS approved the claim.
Case 2 – Not Covered:
Anna underwent a procedure outside a medical facility to end her pregnancy without medical necessity. Records showed “illegal induced abortion.”
→ SSS denied the claim.

What to Do If Your Case Is a Miscarriage but Is Being Questioned

Sometimes, a natural miscarriage may be mistaken for an induced abortion in medical records. This can happen if:

Documentation is incomplete.
There’s vague or inconsistent wording in hospital reports.

Steps to solve this:

Request detailed medical certification from your attending physician clearly stating it was a natural miscarriage.
Ensure hospital records are consistent across all documents.
File maternity notification through My.SSS with complete proof.

Self-Help Options Before Filing

If you want to prepare everything yourself:

Gather OB-GYN’s certification stating cause of pregnancy loss.
Keep all receipts, lab results, and ultrasound records.
Verify your contributions and benefit amount in advance using the SSS Maternity Benefits Calculator for Miscarriage.

If the Claim Still Gets Denied

If SSS rules that it was an illegal abortion:

You cannot appeal on the basis of sympathy alone—you must present legal and medical proof that it was lawful.
If no proof is available, the decision is final, and no benefits will be released.
Focus on compliance in future pregnancies—timely SSS contributions and proper medical documentation are key.

TL;DR (Too Long; Didn’t Read)

Illegal abortions are NOT covered by SSS maternity benefits.
SSS only covers miscarriages and medically necessary terminations.
Complete, consistent medical documentation is crucial.
If SSS denies your claim for being “illegal abortion,” you need strong legal/medical proof to overturn it.