Tag Archive: SSS Sickness Benefits


Mar 07

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 10th 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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Feb 27

When I first got my SSS number, I just thought I had one pre-employment requirement accomplished successfully.  I was just happy to be able to submit my SSS number to the HR department of my first-ever job and that was it.   Little did I know that my 10-digit SSS number would be my lifetime identification with the Social Security System and would be my ticket to various benefits that I would need as I traipsed my way into adulthood.

So if you are adulting (as most fresh graduates and young professionals like to call it these days), I am pretty sure you will find this article helpful.  This is a summary of the benefits you can get (and are entitled to!) as a member of the Social Security System.  Yes, you don’t just look forward to your pension (which, at this point, is probably one of the strangest things you’ll hear) from SSS because there are a lot of other benefits you can avail from the agency while you are still an active, contributing member.

  1. Sickness Benefit

You will get sick and sometimes, you will require more than just bed rest and time off of your laptop.  You might get injured while working on a project.  You might need to have some bladder stones removed.  Should any of these happen (we hope not!), you can get a daily cash allowance from the SSS to compensate the days you were not able to go to work.

Conditions: Your confinement should last for at least four days and all your company sick leaves should already be maxed out (so yes, it has to be a serious illness).  And when SSS checks your contributions, you should have at least made three months’ worth of contributions within the last 12 months prior to your confinement.

How much can you get? The daily allowance is equivalent to 90% of your average daily salary credit.

  1. Maternity Benefit

Whether you gave birth or had a miscarriage, you are entitled to SSS maternity benefits in the form of daily cash allowance.

Conditions: You should have at least three months’ work of contributions within the last 12 months prior to confinement.

How much can you get? The daily allowance is equivalent to 100% of your average daily salary credit.  If you gave birth through normal delivery or had a miscarriage, this will be multiplied by 60 days.  If you had a cesarean section, this should be multiplied by 78 days.

  1. Disability Benefit

This applies whether you’ve been partially or totally disabled.  This may be in the form of a monthly pension or a lump sum amount.

Conditions: You should have at least a month’s contribution before the semester of disability.  How do you know whether you should receive a monthly pension or the lump sum amount?

If you made at least 36 monthly contributions and all these are acknowledged by the SSS, you will get the monthly disability pension.  Otherwise, you get the lump sum amount.

How much can you get? Monthly disability pension ranges from P1,000 to P2,400 and a monthly supplemental allowance of P500, depending on your years of service.

  1. Death Benefit

If you are the beneficiary of a deceased SSS member, you may receive a monthly pension or a lump sum amount, depending on whether you are a primary or a secondary beneficiary.

Primary beneficiaries are the spouse and dependent children of the deceased SSS member.  Secondary beneficiaries are dependent parents.

Conditions: If the member made at least 36 monthly contributions, the beneficiaries will receive a monthly death pension.  If the contributions are lower than 36 months, the beneficiaries get a lump sum amount.

How much will the beneficiaries get?  The monthly death pension ranges from P1,000 to P2,400, depending on the deceased member’s years in service.  If the member has dependent minor children, they will get a pension equivalent to 10% of the member’s monthly pension or P250, whichever is higher.  They also get a 13th-month pension every December.

  1. Funeral Benefit

An individual is entitled to claim the funeral benefits if he or she shouldered the burial expenses of a deceased SSS member.

Conditions: You should have at least one contribution if you are a voluntary, self-employed, or OFW member.  Employees automatically get funeral benefits as long as they are covered by their employers.

Amount: The amount ranges from P20,000 to P40,000 depending on the member’s contributions and years of service.

  1. Employees’ Compensation (EC) Program

Employees who acquire a sickness or injury, leading to their permanent disability or death, due to their profession are entitled to cash benefits from the EC Program.

Conditions: The injury, sickness, or death shall undergo evaluation and should the EC find that these were caused by intoxication, negligence, and self-harm, the member shall not qualify for the EC Program.

Amount: SSS shoulders the medical services, appliances, and rehabilitation services of the injured employee.  This benefit may coincide with the SSS sickness and disability benefits; this means that the EC does not supersede whatever other benefits the employee is entitled to from SSS.

  1. Salary Loan

Thinking of getting your mom an automatic washing machine?  You can by applying for a salary loan with the SSS.

Conditions: You will qualify for the SSS salary loan if you have at least six months’ worth of contributions within the last 12 months.  The SSS will determine your loan payments depending on the contributions you have made.

Amount: The loan is equivalent to your average salary credits in the last 12 months.  An interest rate of 10% per year will be applied to the principal amount.  You may renew your loan after you have paid off at least 50% of the original amount.

  1. P.E.S.O Fund

P.E.S.O stands for Personal Equity and Savings Option.  It is a program of the SSS that provides members with additional savings options, especially to those who are capable of contributing more than the required rates of employed and voluntary members.

Conditions: You should not be older than 55 years old and have at least six months’ worth of contributions within the last 12 months.  If you are an employed member, you may talk to your HR or accounting department and advise them that you have enrolled to the P.E.S.O Fund of the SSS; see if they can facilitate your monthly contributions to your P.E.S.O account through salary deduction.

Amount: Your benefits from the P.E.S.O fund will be released to you upon retirement, disability, or death claim through a monthly pension, lump sum, or combination of both.

The secret to making your SSS membership work for you is to be faithful in paying your contributions.  If you should save or set aside some amount as your savings, make your SSS contributions mandatory against your personal budget, especially if you are self-employed.

Insurance is something you pay for but wish you never have to use.  Yet everyone is encouraged to invest in insurance because you never know when you will need additional funds for emergency cases.

Welcome to your adult life!

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

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08 - 16

The SSS Calamity Loan is a special privilege offered by the SSS to members who reside, work, or have properties in areas declared by the government to be under a state of calamity.  This type of loan is not open to all and not readily available unless the government and SSS come to an agreement during emergency situations.  What SSS members can truly count on are the following benefits that are automatically available to members with updated contributions and loans.

For your ready reference, below is a summary of SSS benefits that every member can enjoy:

TYPE OF BENEFIT QUALIFYING CONDITIONS AMOUNT OF BENEFIT
SICKNESS

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

  • The member is unable to work due to sickness or injury and is confined either in a hospital or at home for at least four days.
  • He/she has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury.
  • He/she has used up all company sick leaves with pay for the current year and has duly notified his/her employer; or
  • He/she must notify the SSS directly by filing a sickness benefit application if he/she is separated from employment, a self-employed or voluntary member, including overseas Filipino worker OFW) members.
  • The amount of the member’s daily Sickness Benefit allowance is equivalent to 90% of his/her average daily salary credit (ADSC).
  • The Sickness Benefit is granted up to a maximum of 120 days in one calendar year.
Maternity

A daily cash allowance granted to a female member who is unable to work due to childbirth or miscarriage.

  • The member has paid at least three months of contributions within the 12-month period immediately before the semester of her childbirth or miscarriage.
  • If employed, she must have given notification of her pregnancy through her employer, or
  • She must directly notify the SSS if she is separated from employment, a self-employed or voluntary member, including OFW-member.
  • The amount of the daily Maternity Benefit allowance is equivalent to 100% of her ADSC, multiplied by 60 days in case of normal delivery/miscarriage/ ectopic pregnancy without operation/H-mole, or by 78 days for caesarean section delivery/ ectopic pregnancy with operation.
  • The Maternity Benefit is granted up to the first four deliveries or miscarriages only.
Disability

A cash benefit granted – either as a monthly pension or a lump sum amount – to a member who becomes permanently disabled, either partially or totally.

  • The member has paid at least one month contribution before the semester of disability.
  • To qualify for a monthly disability pension, he/she must have paid at least 36 monthly contributions prior to the semester of disability.
  • If with less than 36 monthly contributions, he/she is granted a lump sum amount.
  • If qualified, the member is granted a monthly Disability Pension, plus a P500 monthly Supplemental Allowance.
  • The lowest monthly Disability Pension is P1,000 if the member has less than ten credited years of service (CYS); P1,200 if with at least ten CYS, and P2,400 if with at least 20 CYS.
Retirement

A cash benefit granted either as a monthly pension or a lump sum amount to member who can no longer work due to old age.

  • The member is at least 60 years old (optional retirement), separated from employment or has ceased to be self-employed; and has paid at least 120 monthly contributions prior to the semester of retirement; or
  • The member is 65 years old (mandatory retirement), whether employed or not; and has paid at least 120 monthly contributions prior to the semester of retirement.
  • To qualify for a monthly retirement pension, the member must have paid at least 120 monthly contributions prior to the semester of retirement.
  • If with less than 120 monthly contributions, he/she may be granted a lump sum amount, but will also be given the option to continue paying contributions to complete the 120 months to become eligible for monthly pension.
  • If qualified, the member is granted a monthly Retirement Pension, plus a 13th month pension payable every December.
  • The retiree has the option to receive the first 18 months pension in lump sum, discounted at a preferential rate of interest to be determined by the SSS. This option can be exercised only upon filing of the first retirement claim, and the Dependent’s Pension and the 13th month pension are excluded from the advanced 18 months pension.
  • If the member has dependent minor children, they are given a Dependent’s Pension equivalent to 10% of the member’s monthly pension or P250, whichever is higher.  Only 5 minor children, beginning from the youngest, are entitled a Dependent’s Pension. No substitution is allowed.
  • The lowest monthly Retirement Pension is P1,200 if the member has 120 monthly contributions or at least 10 CYS; or P2,400 if with at least 20 CYS.
Death

A cash benefit granted – either as a monthly pension or a lump sum amount – to the beneficiaries of a deceased member.

  • A monthly death pension is granted to primary beneficiary (legitimate spouse until he/she remarries, and dependent legitimate, legitimated or legally adopted, and illegitimate children)of the deceased member who had paid at least 36 monthly contributions prior to the semester of death.
  • A lump sum amount is granted to the primary beneficiary if the deceased member had less than 36 monthly contributions.
  • If there are no primary beneficiaries, the member’s secondary beneficiaries (dependent parents) shall be given a lump sum amount.
  • If qualified, the member’s primary beneficiary is granted a monthly Death Pension, plus a 13th month pension payable every December.
  • If the member has dependent minor children, they are given a Dependent’s Pension equivalent to 10% of the member’s monthly pension or P250, whichever is higher. Only 5 minor children, beginning from the youngest are entitled to Dependent’s Pension.  No substitution is allowed.
  • The lowest monthly Death Pension is P1,000 if the member had less than 10 CYS; P1,200 if with at least 10 CYS; and P2,400 if with at least 20 CYS.
Funeral

A cash benefit given to whoever paid for the burial expenses of the deceased member.

  • The employee-member was reported for coverage by his/her employer;
  • A self-employed member/OFW/non-working spouse who had at least 1 contributor payment;
  • A voluntary member who was previously covered either as employed/self-employed/OFW and had at least one contribution/payment.
  • The Funeral Benefit is a variable amount ranging from a minimum of P20,000 to a maximum of P40,000, depending on the member’s paid contributions and CYS.
Employees’ Compensation Program (EC)
  • Cash benefit for temporary sickness or disability, permanent partial or total disability, and death.
  • Medical services, appliances, and supplies
  • Rehabilitation Services
  • The EC Program aims to assist those who suffer from work-connected sickness or injury resulting in disability or death. Starting June 1984, the benefits under the EC Program may be enjoyed simultaneously with benefits under the Social Security Program, thus, allowing double compensation for covered members who suffer work-related contingencies.  All SSS-registered employers and their employees are compulsorily covered under the EC Program and need not register again under the EC.
Salary Loan

A cash loan granted to an employed, currently-paying self-employed or voluntary member.  It is intended to meet the member’s short-term credit needs.

  • An employed, currently-paying self-employed or voluntary member who has six posted monthly contributions within the last 12 months prior to the month of filing of loan application.
  • For one-month loan, the member must have 36 posted monthly contributions prior to the month of filing of application.
  • For two-month loan, the member must have 72 posted monthly contributions prior to the month of filing of loan application.
  • If employed, the member’s employer must be updated in the payment of contribution and loan remittances.  The member must also be updated in the payment of other loans with SSS.
  • A one-month loan is equivalent to the average of member’s last 12 monthly salary credits (MSCs), or the amount applied for, whichever is lower.
  • A two-month loan is equivalent to twice the average of the member’s last 12 MSCs posted, rounded to the next higher MSC, or the amount applied for, whichever is lower.
  • The loan shall be charged an interest rate of 10% per annum until fully paid, based on diminishing principal balance, and shall be amortized over a period of 24 months.
  • If the loan is not fully paid at the end of the term, interest shall continue to be charged on the outstanding principal balance until fully paid.
  • In case of default, the arrearages/unpaid loan shall be deducted from the member’s short-term benefit claims (e.g. sickness/maternity), if any, or from his/her final benefit claim (e.g. death, retirement, total disability).
  • The loan can be renewed after payment of at least 50% of the original loan amount and at least 50% of the loan term has lapsed.

Source: https://www.sss.gov.ph

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07 - 27

Matagal na akong hindi nakapag hulog sa aking SSS / Philhealth account; ngayon, may sakit ako at maco-confine.  Pwede ko bang habulin ang mga nalibanan kong buwan para makapag claim pa din ako ng benefits?

This is a common question we receive from followers.  Apparently, a lot of Filipinos think that paying their monthly contributions for government-mandated insurances is optional.

It isn’t.  We all need to activate our SSS and Philhealth memberships and diligently remit our monthly contributions to ensure that we are protected and covered by benefits.

We summarized SSS and Philhealth’s requirements and needed premium payments before a member can claim his benefits from these government agencies.  We aim to encourage everyone to update and maintain their monthly contributions to ensure hassle-free benefits claim anytime emergency strikes.

Read on.

Philhealth

  • Member must have paid at least three months’ premium contributions within the immediate six-month period prior to the first day of confinement to avail of benefits.
  • Philhealth does not accept retroactive payments for unpaid months.
  • Contributions made on admission date, during the confinement period, or after the member or dependent is discharged from the health care institution will not be counted as qualifying contributions.

What are the requirements for eligibility and when is a member eligible to claim?

Sponsored Members Date of hospitalization/availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members 1. There are certain confinement cases wherein three months worth of premium within the last sixmonths (3/6) prior to confinement is acceptable.

2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy and other selected surgical procedures, the member must have paid nine months worth of premium within the last twelve months.

Lifetime Member The member just has to show their Lifetime ID Card; no need to pay premiums anymore.  This now includes Senior Citizens; in which case, all they need to show is their SC IDs.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers Date of hospitalization/availment must be within the coverage period specified in the member’s MDR.

 

SSS

A. Maternity Benefits

The maternity benefit is offered only to female SSS members.  A member is qualified to avail of this benefit if:

  1. She has paid at least three monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage.
  2. She has given the required notification of her pregnancy to SSS through her employer if employed; or submitted the maternity notification directly to the SSS if separated from employment, a voluntary or self-employed member.
  3. SSS does not accept retroactive payments for unpaid months.

The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages.

B. Sickness Benefits

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.

A member is qualified to avail of this benefit if:

  1. He is unable to work due to sickness or injury and confined either in a hospital or at home for at least four days;
  2. He has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury;
  3. He has used up all current company sick leaves with pay; and
  4. He has notified the ER, or directly the SSS, if separated from employment, VM or SE regarding his sickness or injury.

C. Retirement

The retirement benefit is a cash benefit paid either in monthly pension or as lump sum to a member who can no longer work due to old age.

A member is qualified to avail of this benefit if:

  1. Member must have paid at least 120 monthly contributions prior to the semester of retirement and is any of the following, whichever is applicable:
    • At least 60 years old and separated from employment or has ceased to be an SE/OFW/Household Helper (optional retirement);
    • At least 65 years old whether still employed/SE, working as OFW/Household Helper or not (technical retirement);
    • At least 55 years old and separated from employment or has ceased to be an SE, if an “underground mineworker” (optional retirement);
    • At least 60 years old whether still employed/SE or not, if an “underground mineworker” (technical retirement); or
    • A total disability pensioner who has recovered from disability and is at least 60 years old (or at least 55 years old, if an underground mineworker).
  2. A former retiree-pensioner whose monthly pension was suspended due to re-employment / self-employment and is now separated from employment or has ceased to be an SE.
  3. A member who is 60 years old and above, but not yet 65, with 120 contributions or more may continue paying as VM up to 65 years old to avail of the higher amount of benefit.

If you have questions regarding benefit claims from Philhealth and SSS, send us a message and we will do our best to find the answers for you.

 

Sources:

www.sss.gov.ph

www.philhealth.gov.ph

Chips And Nibblers (1)

Closet Queen

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10-18

My sister, a private school teacher, gave birth in January 21, 2016 to a healthy baby boy.  I am not sure if her case can be considered a premature delivery since she gave birth three weeks earlier than her scheduled due date.  Nonetheless, her delivery was uneventful and the baby came out healthy and strong.

Less than two months after she gave birth, my sister suffered from a severe case of skin asthma.  It got so bad that she was even prohibited by her doctor to carry or cuddle her baby.  She also had difficulty breathing at night and whenever she is exposed to smoke and dust.  She was confined in the hospital for five days until her rashes cleared out.

A few days after she was discharged from confinement, she filed her sickness benefit claims from the Social Security System (SSS).  Unfortunately, her claim was denied.  This was puzzling to us as she just recently received her maternity benefits from the SSS; she had no difficulty filing and claiming the proceeds.

We tried calling the SSS but no one seems to be able to give us a plausible answer.  I did my own research and these are my findings:

  1. A female SSS member who has successfully claimed her maternity benefits is no longer eligible to claim other types of benefits within a specified period:
    • A female who gave birth through normal delivery, or had a miscarriage, cannot file for sickness benefits claim within 60 days after childbirth or miscarriage.
    • A female who gave birth through caesarean section cannot file for sickness benefits claim within 78 days after childbirth.
  2. By law, an SSS member may only receive / claim one benefit at a given time.

My sister was able to claim her maternity benefits shortly after her baby turned one month old.  This was the reason why her claim for sickness benefits was denied by the SSS.

When we got hold of this information, my sister was able to clarify her concern better with the SSS.  She was then able to confirm that due to her maternity claim, she is not eligible for sickness benefits claims until after the 60-day prescription period.

Most SSS members may not be aware of this policy and it is best that claimants clarify minor details in their claims in order to avoid confusion later on.

Now you know.

Source:

http://www.facebook.com/SSSPh

https://www.sss.gov.ph/sss/appmanager/pages.jsp?page=sicknessapplication

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