SSS Sickness Benefits
What is the sickness benefit?
The sickness benefit is a daily cash allowance paid for the number of days a member is unable to work due to sickness or injury.
How does an SSS member qualify for the sickness benefit?
A member is qualified to avail of this benefit if:
unable to work due to sickness or injury and confined either in a hospital or at home for at least four days;at least three months of contributions within the 12 month period immediately before the semester of sickness has been paid;all company sick leaves with pay for the current year has been used up;
the employer has been notified, or, if a separated, voluntary or self-employed member, the SSS directly.
How much sickness benefit is a member entitled to receive?
The amount of a member’s sickness benefit per day is equivalent to ninety percent (90%) of the member’s average daily salary credit.
How is the sickness benefit computed?
- 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 12 months backwards starting from the month immediately before the semester of sickness.
- 3.Identify the six highest monthly salary credits within the 12-month period.
Monthly salary credit means the compensation base for contributions and benefits related to the total earnings for the month. (The maximum covered earnings or compensation is P15,000 effective Jan 1, 2002).
Please refer to the following table:
- Add the six highest monthly salary credits to get the total monthly salary credit.
- Divide the total monthly salary credits by 180 days to get the average daily salary credit.
- Multiply the average daily salary credit by 90 percent to get the daily sickness allowance.
- Multiply the daily sickness allowance by approved number of days to arrive at the amount of benefit due.
For example, let us say that an SSS member gets sick or injured in October 2004 for 20 days:
- The semester of sickness would be from July 2004 to December 2004.
- The 12-month period would be from July 2003 to June 2004 within which the six highest monthly salary credits will be chosen.
- Let us assume that the six highest monthly salary credits are P15, 000 each. The total monthly credit would be P90, 000 (P15, 000 x 6).
- The total monthly salary would be divided by 180 to get the average daily salary credit or P500 (P90, 000/180).
- The sickness benefit due is P9,000 (P450 x 20 days).
How many days in a year can a member avail himself of the sickness benefit?
A member can be granted sickness benefit for a maximum of 120 days in one calendar year. Any unused portion of the allowable 120 days sickness benefit cannot be carried forward and added to the total number of allowed 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 still persists after 240 days, his claim will be considered a disability claim.
Who should an employee notify regarding his sickness or injury?
A member should notify the employer within five (5) calendar days after the start of sickness or injury. The employer, in turn, must notify the SSS of the confinement within (5) calendar days after receipt of the notification from the employee member.
Notification to the employer is not necessary if the member’s confinement is in a hospital or if the member got sick or was injured while working or was within the company premises. In this case, the employer must notify the SSS within five (5) calendar days from the start of the employee’s sickness or injury while working or was within the company premises.
What is the procedure for notification 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 the hospital,in which case, notification is not necessary.
What are the effects of failure or delay in notification?
- If the employee notifies the employer, or the SSS, in the case of an unemployed, self-employed or voluntary paying member, 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.
- If the employer notifies the SSS beyond the five (5) calendar days after the 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 the SSS.
- If the employee has given the required notification to the employer, but the employer 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 employer shall have no right to recover the daily sickness allowance advanced to the employee.
How would an employed member be paid his sickness benefit?
The payment of the daily sickness allowance is advanced by the employer every regular payday. The SSS will then reimburse the employer of the amount legally advanced upon receipt of satisfactory proof of such payment and legality thereof.
The SSS will reimburse the employer only for confinements within the one year period immediately preceding and the date the claim for benefit or reimbursement is received by the SSS, except for confinements in hospital (i.e. SSS receives the employer’s reimbursement claim on Oct. 3, 2004 for the sickness period September 23 to Oct. 14, 2003. The employer will be reimbursed for the period Oct. 4 to 14,2003 only as Sept. 23 to Oct. 3, 2003 falls outside the prescribed one-year period for reimbursement claim.
How about the unemployed, self-employed or voluntary member?
The sickness benefit will be paid directly by the SSS to the unemployed, self-employed or voluntary members.
What is the prescribed period of filing for a member who is confined in a hospital?
For hospital confinement, the claim for benefit must be filed within one (1) year from the last day of confinement from the hospital. For home confinement, the claim for reimbursement by the employer must be filed within one (1) year from the start of illness. Failure to file the claim within the prescribed period will result to denial of the claim.
What forms are needed in filing for sickness benefit?
For the employed member
- SSS Form CLD-9N (Sickness Notification).
For the employer
- b. SSS Form B-304 (Sickness Benefit Reimbursement Application).
For the unemployed/self-employed/voluntary member
- SSS Form CLD-9A (Sickness Benefit Claim for Unemployed/Self-employed/Voluntary Members)
- SSS Form MMD-102 (Medical Certificate)
For unemployed members
- Certification from last employer showing the effective date of separation from employment or notice of the company’s closure/strike or certification from the Department of Labor and Employment that the employee or employer has a pending labor case.
- Certification that no advance payment was granted, if the date of separation form employment is within the confinement period being applied for.
- Presentation of the SS Digitized ID/SSS Form E-6 (acknowledgment stub) with 2 valid Ids, one of which with the recent photo. To ensure receipt of benefits by members, authorized company representatives who file sickness benefit claims shall present the members’ SS digitized ID or E-6 (acknowledgement stub) with two valid Ids (at least one with photo). This requirement is in addition to the presentation by the company representative’s own SSS digitized ID and blue card.
Where does the member file his claim for sickness benefit?
For the employed/separated member - claims may be filed at the nearest SSS office. However, processing will be done at the branch where the employer and employee records are based.
For the voluntary/self-employed member - claims may be filed at the SSS office nearest the members residence. However, processing will be done at the branch where the record is based.