SSS Sickness Benefit: Everything You Need to Know

Getting sick is inevitable.  Whether you are an employee, a business person, or a stay-at-home parent, you will eventually have to take some rest to recuperate from a viral or bacterial infection.  Other times, you might get injured at work and will need some time off to heal and rehabilitate before you are able to go back to your normal daily routine.

The good news is, if you are a member of the SSS, you are entitled to sickness benefits to help you defray expenses when your capacity to earn is lessened due to being confined in bed, a wheelchair, or a hospital.

How to know if you are qualified for SSS Sickness Benefits?

1. You have to be an SSS member.
2. You have been sick or are injured and unable to work; you have been confined in a hospital or at home for at least 4 days.
3. Your contributions are updated or have at least paid three months of monthly contributions before your illness or injury.
4. All your “leave with pay” credits have been used up.
5. Your employer is duly notified of your sickness or injury; if unemployed, voluntary, or self-employed, you must have notified SSS prior to claiming.

If your answer to all five qualifiers is “yes”, you can proceed to the nearest SSS branch to apply for the sickness benefit.

How do I notify the SSS about my illness or injury?

For EMPLOYED members:

An employed member must advise his or her employer within five calendar days of his sickness or injury.  It is the employer’s obligation to advise SSS of the employee’s condition.

• Should you fail to notify your employer within the five-day timeframe, your confinement will be considered to have started five days before you notified him.
• If the employer fails to notify the SSS within the five-day timeframe, your employer will be compensated only for each day of confinement from the 10^th calendar day prior to notifying SSS.
• If you notified your employer but he failed to notify the SSS and as a result, your benefits were denied, he or she must not be able to recover your daily sickness allowance.

For SELF-EMPLOYED members:

You must notify the SSS within five days after getting sick or injured.  If you are confined in a hospital, you have one year to notify the SSS.

What are the requirements when filing?

For EMPLOYED members:

Submit the following to your HR or to your company’s representative to SSS:

1. Duly accomplished sickness notification.
2. Identification card/s and documents (ex: PSA birth certificate)
3. Medical documents, if any.

If the claim is work-related (or if you incurred the sickness or injury at work):

1. Accident/sickness report from the employer, if work-connected; and
2. Police Report (for a vehicular accident with third party involvement);
3. 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 the diagnosis.

In case of sickness that occurred while on strike/shutdown, the member will file the necessary documents directly at the SSS.  He or she must submit the above requirements, including the following:

• Certificate of Notice of Strike issued by the 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 SELF-EMPLOYED Members:

1. Duly accomplished Sickness Benefit Application (SBA)
2. If filed by the member, present original of any one (1) of the primary ID cards/documents or two (2) secondary ID cards/documents, both with signature and at least one (1) with a photo.
3. If filed by member’s representative:
   1. Original of any one of the Authorized Representative’s primary ID cards/documents or two secondary ID cards/documents, both with signature and at least one with a photo.
   2. Original of any one of the Member’s Primary ID cards/documents or two secondary ID cards/documents, both with signature and at least one with a photo.
4. In case of prolonged confinements or sickness, original/certified true copy of the following:
   1. Laboratory, X-ray, ECG and other diagnostic results.
   2. Operating room/clinical records that will support the diagnosis.

How much will I receive from the SSS?

The amount you will receive will be equal to 90& of your average daily salary credit.  For example: if your average daily credit is Php 1,000, then you will receive Php 900 per day of sickness or confinement.

If you are an employed member, your employer should give you the sickness benefit in advance.

The sickness benefit is granted up to a maximum of 120 days in one calendar year.

 

Reference: http://www.sss.gov.ph

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