Limitation on the Right to Benefits.
Article 242
ART. 242. Limitation on the Right to Benefits. - (a) No employee shall be entitled to the benefits herein granted unless he shall have paid at least three (3) monthly contributions during the last twelve (12) months prior to the first day of the single period of confinement. In case of sickness on which surgery may be deferred at the election of the employee in such cases as herniotomy, hemorrhoidectomy, tonsillectomy, adenotomy and the like, the required monthly contributions paid immediately prior to the operation shall be at least for twelve (12) consecutive monthly installments. Until such time that such an employee is entitled to the benefits under Program I, he shall be covered by Program II. When the SSS or GSIS, as the case may be, has not been duly notified by the hospital in the manner prescribed under Article 240 no claim for any of the benefits of the Title shall be paid to the hospital concerned and said hospital shall further pay to the medical practitioner damages equivalent to the benefits which said medical practitioner would have received had there been due notification. In no case may a claim for benefit filed after the lapse of sixty (60) days from the last day of confinement be paid. The SSS or GSIS may deny or reduce any benefits provided under Chapter 2 of this Title when an employee, hospital or medical practitioner, as the case may be: Fails without good cause or legal ground to comply with the advice of the medical practitioner with respect to hospitalization; Furnishes false or incorrect information concerning the matter; Is guilty during his confinement or illness of gross negligence with regard to his health; Refuses to be examined by or fails to comply with the advice of the medical practitioner appointed for supervision purposes by the SSS or GSIS; and Fails to comply with any provisions of this Chapter or rules and regulations of the SSS or GSIS required for entitlement to the benefits provided in this Title.