Definition

Sickness benefit is a daily cash allowance paid for the number of days a member is unable to work due to sickness or injury.

Qualifying Conditions

A member is qualified to avail of this benefit if he/she:

1. Is unable to work due to sickness or injury and is confined either in a hospital or at home for at least four (4) days
2. Has paid at least three (3) months of contributions within the 12-month period immediately preceding the semester of sickness or injury
3. Has duly notified the SSS directly of the fact of sickness or injury.

Benefit Details

Amount of Benefit

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

Benefit Computation

1. Exclude the semester of contingency.

• • A semester refers to two (2) consecutive quarters ending in the quarter of sickness.
  • A quarter refers to three (3) consecutive months ending in March, June, September, or December.

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

3. Select the six (6) highest monthly salary credits within the 12-month period to arrive at the total monthly salary credit.

• • Monthly salary credit (MSC) refers to the compensation base for contributions and benefits related to the total earnings for the month.

Refer to the SSS Contribution Table

4. Divide the total monthly salary credit by 180 days to get the average daily salary credit (ADSC).

5. Multiply the ADSC by ninety percent (90%) to get the daily sickness allowance.

6. Multiply the daily sickness allowance by the approved number of days to arrive at the amount of benefit due.

Limitations in Granting the Sickness Benefit

A member can be granted sickness benefit for a maximum of 120 days in one (1) calendar year. Any unused portion cannot be carried forward/added to the total number of allowable compensable days for the following year.

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

Prescriptive Period

For contingencies starting 01 March 2020 until the lifting of the Enhanced Community Quarantine/General Community Quarantine (ECQ/GCQ), the filing of Sickness Benefit Application (SBA) shall be:

NOTE: Sickness claims shall not be reduced or denied if the deadline of the filing period falls on 01 March 2020 until the last day of the ECQ/GCQ for home and hospital confinement of SE/VM/OFW.

Whenever the last day to notify the SSS of a member’s sickness or injury falls on a Saturday, Sunday, or holiday, the sickness benefit application may be filed on the immediately succeeding working day without the penalty of delay.

• Holiday refers to the legal, regular, or special non-working day declared by the government, both national and local.

The same rule shall also be applied for hospital confinement, if the deadline of the one-year prescriptive period falls on a Saturday, Sunday, or a holiday.

Implications of Late Filing

Failure to observe the rule on notification shall be a ground for the reduction or denial of the sickness claim application. If the member notifies the SSS beyond the prescribed five-day period, the confinement shall be deemed to have started not earlier than the fifth (5th) day immediately preceding the date of notification.

Benefit Payment

The sickness benefit claims shall be mandatorily disbursed through the qualified payee’s Unified Multi-Purpose Identification (UMID) card enrolled as Automated Teller Machine (ATM) card. In the absence of this, payment shall be made thru participating banks under the Development Bank of the Philippines (DBP) Disbursement Facility via the Philippine Electronic Fund Transfer System and Operations Network (PESONet), electronic wallets (E-Wallets), or accredited remittance transfer companies (RTCs)/cash payout outlets (CPOs).

Hence, qualified payees shall be required to enroll the following details in the Disbursement Account Enrollment Module (DAEM) and upload proof of account (POA), government-issued ID card/document in JPEG of PDF format, and selfie photo holding ID card/document and the uploaded POA of the disbursement account being enrolled in the My.SSS Facility in the SSS website:

See also How to enroll an account in the Disbursement Account Enrollment Module

Members shall be notified by SSS thru email or SMS upon crediting of their sickness benefit claims to their PESONet bank/E-wallet accounts, or if payment is already available through RTCs/CPOs. Member may also view the status of the disbursement through the Inquiry Module of the My.SSS account.

Crediting of benefit payments shall be made within five (5) banking days from date of settlement.

How to Apply

SBAs are filed online through the member’s My.SSS account. Before filing an SBA, an individual member needs to prepare the following:

• A registered My.SSS account in the SSS website
• An approved disbursement account in the Disbursement Account Enrollment Module (DAEM) of the My.SSS portal in the SSS website.

All initial or new claims and the following cases for adjustment shall be filed online through the member’s My.SSS account:

• SSS system computation is higher than employer’s computation
• Additional posted contributions will increase the amount of sickness benefit.

Steps for Online Filing

For Employed Members and Employers

The member who got sick or injured shall immediately notify his/her employer of such fact and submit the following proof of illness or injury:

1. Medical Certificate
   • Complete diagnosis
   • Recommended number of days of sick leave including recuperation
   • Clinic Address
   • Contact Number
   • License number written legibly
2. Certified true copy of supporting medical documents

Upon receipt of above documents, the employer shall in turn notify SSS online through its My.SSS account. Submission of documents over the counter is no longer necessary.

For Self-Employed, Voluntary, OFWs, NWS and Members Separated from Employment

1. Log in to your My.SSS account.
2. Click “Submit Sickness Benefit Application” under the E-Services tab.
3. Read the important reminders, then click “Proceed” to continue.
4. Supply all required information, then click “Proceed” for SSS validation of provided information and confirmation of eligibility to Sickness Benefit, such as the following:

• • Start of Sickness
  • Confinement Location
  • Date of Discharge (if hospital confinement)
  • Number of days claimed
  • License Number of attending physician
  • Work related (Yes/No)
  • Disbursement account
  • Employed at the time of sickness (Yes/No)

5. Click the i to see list of documentary requirements and important reminders.
6. Upload the required supporting document/s. Read and understand the Certification portion, then click “I Certify and Submit” to proceed. Then click “OK” to confirm the transaction.
7. The System will display a notification message. Click “View” and then take note of your transaction details. Also check your inbox for the email notification from SSS.

Important Reminders:

1. The filer shall upload the required supporting document/s corresponding to the type of claim/adjustment being filed to proceed with the submission of SBA. Uploaded documents shall be reviewed by SSS.
2. All sickness claims shall be subject to medical evaluation and approval prior to payment.
3. The filing date of the sickness benefit claim shall be on the date of successful submission of the claim.
4. Claims that have been previously submitted but were not accepted based on SSS’ evaluation may be refiled online by the member as a new transaction upon compliance with SSS’ requirements.

See also How to enroll an account in the Disbursement Account Enrollment Module (DAEM)

Documentary Requirements

1. Medical Certificate
2. Supporting medical documents for prolonged confinement/sickness, if any:

• • Laboratory, X-ray, ECG, and other diagnostic results
  • Operating room/clinical record that will support diagnosis

Additional Requirements for Self-Employed/Voluntary Member who were previously employed

If confinement period applied for is within the period of employment or prior to date of separation:

• Certificate of separation from employment with effective date of separation and no advance payment was granted (signed by the employer’s Human Resource Manager)

If confinement period applied for is after the date of separation:

• Certificate of separation from employment with effective date of separation (signed by the employer’s Human Resource Manager)

NOTE: Certificate of separation is not required for self-employed and voluntary members (previously employed) or those separated from employment under any of the following conditions in which other supporting document/s shall be required to be submitted as follows:

If company is on strike:

• Notice of strike duly acknowledged by the Department of Labor and Employment (DOLE); and
• Duly notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted

If company has been dissolved or has ceased operation:

• Duly notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted and with indicated effective date of separation

If there is a case pending before a court regarding separation of member:

• Certification from DOLE; and
• Duly notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted and with indicated effective date of separation

If separated from employment due to absence without leave (AWOL) or with strained relations with the employer:

• Duly notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted and with indicated effective date of separation

Exemptions from Online Filing

The following sickness benefit claims, however, are exempted from the online filing, and must be submitted over the counter at any SSS branch office/Foreign Representative Office:

• Denied claim reconsidered from payment
• Unclaimed benefit of deceased member

See also Sickness Benefit Reimbursement Application online