You’re sick and you got injured recently. What are the steps you need to take to avail the Social Security System (SSS) Sickness Benefit?

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Each person who are currently employed and at the same time a member of the SSS are entitled to a package of benefits under the SS and EC Programs. These are in the events of sickness, maternity, disability, old age, and death.

Those who’re self-employed and considered voluntary members can get the same benefits like employed members; except for the benefits under the EC program. The SSS mostly provides for a partial replacement of income lost on account of the above mentioned contingencies; or what is known as unforeseen events.

Read: How to apply for SSS Housing Loan for Repairs and/or Improvements

What does the Sickness Benefit mean?

The sickness benefit is the amount or the daily cash allowance paid for the number of days a member is unable to work due to sickness or injury. It’s equivalent to 90% of the member’s average daily salary credit.

Read: How to Reimburse SSS Maternity Benefits

What are the Qualifying Conditions an SSS Member must have to avail the Sickness Benefit?

A member is eligible of this benefit if:

1. He/she is unable to work due to sickness or injury; confined either in a hospital or at home for at least four (4) days;

2. The member was able to pay at least three (3) months of contributions within the 12-month period immediately before the semester of sickness or injury;

3. A member used up all current company sick leaves with pay; and

4. Lastly, if a member was able to notify the employer regarding his sickness or injury by filing the sickness benefit application; if he/she is unemployed, voluntary or self-employed member. The sickness notification should be submitted directly to SSS.

What forms and documents needed for the sickness benefit?

If the member personally files it:

1. Sickness Notification (SN) Form

Sickness Notification Form

2. ID card/s and/or document/s

  • Medical documents, if any In case of work-related claims, all the above-listed documents, plus the following:
  • Accident/Sickness Report from EMPLOYER, if work-connected; and
  • Police Report (for vehicular accident with third party involvement), if work-related; and
  • Photocopy of EMPLOYER’s logbook In case of prolonged confinements or sickness, original/certified true copy of the following:
  • –> Laboratory, X-ray ECG and other diagnostic results
  • –> Operating room/clinical records that will support diagnosis. In case of sickness that occurred while on strike/shutdown, original/certified true copy of the following:
  • —-> Certificate of Notice of Strike issued by DOLE
  • —-> Certificate of Foreclosure
  • —-> Certification from the DOLE that the employee or employer has a pending labor case
  • —-> Certificate of Non-advancement of Payment from Employer

For Unemployed/Self-Employed/Voluntary Member:

1. Sickness benefit application form for unemployed/self-employed/voluntary member

Sickness Benefit form for Voluntary Members

2. Medical Certificates

SSS Medical Certificate Form

Remember that a Medical Specialist shall determine other required medical documents. For sickness or injury acquired abroad, documents issued by the foreign country should be in English translation and must be authenticated by the Philippine Embassy or Consulate Office; or duly notarized by a notary public from the host country.

If filed through Company Representative:

1. System-generated Transmittal List (TL) or System-generated Acknowledgment Letter, if filed through Electronic Notification; or Employer TL

2. Sickness Notification (SN) Form

3. Member’s ID card/s and/or document/s (photocopy)

4. Medical documents, if any In case of work-related claims, all the above-listed documents, plus the following:

  • Accident/Sickness Report from EMPLOYER, if work-connected; and
  • Police Report (for vehicular accident with third party involvement), if work-related; and
  • Photocopy of EMPLOYER’s logbook In case of prolonged confinements or sickness, original/certified true copy of the following:
  • –> Laboratory, X-ray, ECG and other diagnostic results
  • –> Operating room/clinical records that will support diagnosis In case of sickness that occurred while on strike/shutdown, original/certified true copy of the following:
  • —-> Certificate of Notice of Strike issued by DOLE
  • —-> Certificate of Foreclosure
  • —-> Certification from the DOLE that the EMPLOYEE or EMPLOYER has a pending labor case
  • —-> Certificate of Non-advancement of Payment from EMPLOYER

Again, take note that a Medical Specialist shall determine other required medical documents. In addition, for sickness or injury acquired abroad, documents issued by the foreign country should be in English translation and must be authenticated by the Philippine Embassy or Consulate Office, or duly notarized by a notary public from the host country.

In filing for Sickness Benefit Reimbursement Application (For Employed Members)

1.  Sickness Benefit Reimbursement Application (SBRA) Form

Sickness Benefit Reimbursement form

2. Approved SN Form or Certificate of Medical Approval issued by the SSS Medical Evaluation Section

3. Copy of page of ER’s Logbook (manual logbook or electronic filing) for approved EC claim

4. Member or Filer’s SS card or other valid ID cards/documents as listed below:

  • SSS card
  • UMID card
  • Passport
  • PRC card
  • Seaman’s Book (Seafarer’s Identification &Record Book)

For the secondary IDs, kindly see the full list here.

How much Sickness Benefit is a member entitled to receive?

The amount of sickness benefit per day is equivalent to ninety percent (90%) of the member’s average daily salary credit (ADSC).

For how many days in a year can a member avail of the sickness benefit?

A member can have sickness benefit for a maximum of 120 days in one (1) calendar year. Any unused portion of the allowable 120 days sickness benefit cannot be carried forward nor added to the total number of allowed compensable days for the following year.

The sickness benefit shall be paid for not more than 240 days on account of the same illness. If the sickness or injury still persists after 240 days, the claim will be considered a disability claim.

How is the Sickness Benefit Computed?

1. Exclude the semester of sickness.

  • A semester – refers to two consecutive quarters ending in the quarter of sickness.
  • A quarter – refers to three consecutive months ending March, June, September, or December.

2. Count twelve (12) months backwards starting from the month immediately before the semester of sickness.

3. Identify the six (6) highest MSCs within the 12-month period. Monthly salary credit (MSC) means the compensation base for contributions and benefits related to the total earnings for the month. The maximum covered earnings or compensation is P16,000, effective January 1, 2014.

Kindly refer to the following table:

Range of Compensation MSC Range of Compensation MSC
P 1,000 – P 1,249.99 1,000 P 8,750 – P 9,249.99 9,000
P 1,250 – P 1,749.99 1,500 P 9,250 – P 9,749.99 9,500
P 1,750 – P 2,249.99 2,000 P 9,750 – P 10,249.99 10,000
P 2,250 – P 2,749.99 2,500 P 10,250 – P 10,749.99 10,500
P 2,750 – P 3,249.99 3,000 P 10,750 – P 11,249.99 11,000
P 3,250 – P 3,749.99 3,500 P 11,250 – P 11,749.99 11,500
P 3,750 – P 4,249.99 4,000 P 11,750 – P 12,249.99 12,000
P 4,250 – P 4,749.99 4,500 P 12,250 – P 12,749.99 12,500
P 4,750 – P 5,249.99 5,000 P 12,750 – P 13,249.99 13,000
P 5,250 – P 5,749.99 5,500 P 13,250 – P 13,749.99 13,500
P 5,750 – P 6,249.99 6,000 P 13,750 – P 14,249.99 14,000
P 6,250 – P 6,749.99 6,500 P 14,250 – P 14,749.99 14,500
P 6,750 – P 7,249.99 7,000 P 14,750 – P 15,249.99 15,000
P 7,250 – P 7,749.99 7,500 P 15,250 – P 15,749.99 15,500
P 7,750 – P 8,249.99 8,000 P 15,750 and over 16,000

4. Add the six (6) highest MSCs to get the total MSC.

5. After doing so, divide the total MSC by 180 days to get the ADSC.

6. Then, multiply the ADSC by ninety percent (90%) to get the daily sickness allowance.

7. Lastly, multiply the daily sickness allowance by the approved number of days to arrive at the amount of benefit due.

For example, an SSS member got sick or was injured in October 2015 for 20 days:

  • The semester of sickness would be from July 2015 to December 2015.
  • The 12-month period would be from July 2014 to June 2015, within which the six (6) highest MSC will be chosen.
  • Let us assume that the six (6) highest MSC are P15,000 each. The total MSC would then be P90,000 (P15,000 x 6).
  •  Divide the total MSC by 180 to get the ADSC, or P500 (P90,000 ÷ 180).
  • The daily sickness allowance is 90% of the ADSC (P500 x 90%), or P450.
  • Multiply the daily sickness allowance by the number of sick days (P450 x 20 days), Thus, the member will have a sickness benefit due of P9,000.

How would an SSS Member be paid of the Sickness Benefit?

The payment of the daily sickness allowance is advanced by the employer every payday. The SSS will then reimburse the employer of the amount legally advanced upon receipt of satisfactory proof of such payment and legality. Since this is the case, all employers are required to enroll in the “Sickness and Maternity Benefits Payment thru-the-Bank Program” (SMB-PTB); wherein SSS reimbursements will be deposited directly to the existing savings/current account of the employer in an SSS-accredited bank.

The payment advice containing the payment details of the Sickness-Maternity reimbursement will be sent to the employer through his/her My.SSS account in the SSS website. The SSS will reimburse the employer  only for confinements within the one-year period immediately preceding the date the claim for benefit or reimbursement is received by the SSS; except for confinements in hospital.

To give you an example, the SSS received the employer’s reimbursement claim on October 3, 2015 for the employee’s sickness period of September 23 to October 14, 2014. The employer will be reimbursed for the period October 3 to 14, 2014 only, as September 23 to October 2, 2014 already falls outside the prescribed one-year period for reimbursement claim.

What if the member was separated from employment, how are they paid?In addition, what about the self-employed? 

The sickness benefit will be paid directly by the SSS to the member separated from employment, SELF EMPLOYED (SE) and VOLUNTARY MEMBER (VM) through their single savings/current/cash card/prepaid account in SSS-accredited banks under the SMB-PTB.

For this purpose, the member, whose approved benefit amount is more than P1,000 and whose address is within thirty (30) kilometers to the nearest SSS-accredited bank, is required to open a single savings or current account, or to use their existing one with an SSS-accredited bank to which the benefit payment will be remitted. If the member does not have an existing bank account, the SSS shall issue a Letter of Introduction (LOI) form. They need to present that to the SSS-accredited bank chosen by the member for the purposes of opening a single savings account or cash card account. SSS shall then notify the member via email or text of their benefit payment.

How does one notify the SSS about the sickness/injury?

For Employed Members

Employees must notify their employer about the sickness/injury within five (5) calendar days after the start of the mishap. The employer must then notify the SSS about the sickness/injury. Actually, notifying or informing your employer is not necessary if you were confined in a hospital or you have acquired the injury while working or if he is aware of your current condition because this will be automatic.

To add to that, the following should be taken into consideration:

  • Take note that if an employee fails to notify their employer within the five-day rule, the confinement will be considered to have started five days before you notified them.
  • If the employer fails to notify the SSS within the five-day rule, then the employer will be reimbursed only for each day of confinement from the 10thcalendar day before he notified SSS.
  • If the employee had successfully notified their employer but then the ER fails to notify the SSS causing the denial of the benefit claim, your employer will have NO RIGHT to recover your daily sickness allowance.

For Unemployed, Self-employed, and Voluntary Members

Unemployed, self-employed, or voluntary paying members should notify the SSS directly within five (5) calendar days after the start of confinement. Unless such confinement is in a hospital, notification should be made within one (1) year from start of confinement.

What are the possible effects of failure or delay in notification? 

If the employee notifies the employer, or the SSS (in the case of a member separated from employment, SE or VM), beyond the prescribed five-day period, the confinement shall be deemed to have started not earlier than the fifth day immediately preceding the date of notification.

To give you a concrete example:

The member is employed – Home confinement period was from March 1 to March 31, 2014 (31 days).

Notifications made:

EE to ER – March 8, 2014 (must be within March 2 to 6)
ER to SSS – March 13, 2014 (must be within March 9 to 13)
Compensable period: March 3 to March 31, 2014 only (29 days)

SE/VM/Member separated from employment – Home confinement period was from March 1 to March 31, 2014 (31 days).

Notifications made:

Member to SSS – March 8, 2014 (must be within March 2 to 6)
Compensable period: March 3 to 31, 2014 only (29 days)

If the employer notifies the SSS beyond five (5) calendar days after receipt of the notification from the EMPLOYEE, the employer shall be reimbursed only for each day of confinement starting from the 10th calendar day immediately preceding the date of notification to SSS.

Member is employed – Home confinement period was from March 1 to March 31, 2014 (31 days).

Notifications made:

EE to ER – March 5, 2014 (must be within March 2 to 6)
ER to SSS – March 15, 2014 (must be within March 7 to 11)
Compensable period: March 5 to March 31, 2014 only (31 days applied by ER will be reduced to only 27 days for the ER’s reimbursement)

If the employee has given the required notification to the employer, but the latter fails to notify the SSS of the confinement within the prescribed period resulting in the reduction of the benefit or denial of the claim, the ER shall have no right to recover the daily sickness allowance advanced to the EE.

What  to do if the last day for filing of sickness notification or for filing for sickness benefit reimbursement falls on a Saturday, Sunday or holiday?

Effective November 9, 2016, whenever the last day to either:

A. Notify the employer or SSS of an employee’s/member’s sickness or injury or;

B. File a claim for reimbursement for sickness benefit falls on a Saturday, Sunday or holiday, the sickness notification or claim for reimbursement may be filed on the immediately succeeding working day, without the penalty of delay, under the following guidelines:

  • “Holiday” shall mean legal, regular, or special non-working day declared by the national government or local government units.
  • The five (5)-calendar-day notification period of the employee to the employer and the employer to SSS, respectively, may be done on the next working day if the last day of filing the sickness notification falls on Saturday, Sunday or holiday.
  • The determination of the compensable period shall exclude the Saturday, Sunday or holiday in which the deadline falls, as in the following cases:
  • –> 10-calendar day period immediately before the date of notification to the SSS by the employer;
  • –> One-year period immediately before the date the claim for benefit or reimbursement is received by the SSS; and
  • –> One-year period from the last day of confinement in a hospital.
  • Should the member or the employer fail to notify or file the reimbursement claim on the immediately succeeding or next working day, the usual procedure shall be applied in the evaluation based on the actual date the notification or reimbursement was received by SSS.
  • Members who are Overseas Filipino Workers (OFWs) shall continue to have a 30-day grace period beyond the existing five-day prescriptive period in the initial filing of sickness benefit application for cases that do not require hospital confinement.
  • For hospital confinement, if the deadline of the one-year prescriptive period falls on a Saturday, Sunday or holiday, the claim may be filed on the immediately succeeding working day, without the penalty of delay.

I think all of the questions that might pop up revolving around the SSS Sickness Benefit topic is here. If you have further questions, never hesitate to contact US or the SSS directly if you want direct and more precise answers.

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