Untitled Document

 

 

 

 

BENEFITS
LOANS
SERVICES     
  SICKNESS BENEFIT
 
 

FOR SELF-EMPLOYED, VOLUNTARY, OVERSEAS FILIPINO WORKER (OFW), NON-WORKING SPOUSE (NWS), AND MEMBER SEPARATED FROM EMPLOYMENT

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.

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).

  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.

      Please refer to the following table: 2021 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.

FREQUENTLY ASKED QUESTIONS:

How many days in a year can a member be granted 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.

What is the prescriptive period in the filing of sickness benefit claim?

The following prescriptive periods in filing Sickness Benefit application must be strictly followed:

FILING OF SICKNESS BENEFIT APPLICATION (SBA) FORM
HOME CONFINEMENT HOSPITAL CONFINEMENT

SBA Form must be submitted to SSS within five (5) calendar days after the start date of confinement.

SBA Form must be submitted to SSS within one (1) year from the date of hospital discharge.

NOTE: Starting August 18, 2015, OFW-members are given a 30-day grace period beyond the existing five-day prescriptive period in the filing of sickness benefit application. This is to address the concern that due to the distance between their place of work/residence and the nearest SSS foreign branch, their claim for sickness benefit are often penalized for late filing. The additional 30-day grace period shall be applied only to cases that do not require hospital confinement.

What are the 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.

EXAMPLE: The member gets sick and was confined at home from March 1 to 31, 2019 for a total of 31 days.

The notification was done on March 8, 2019 (two days late).

Notification should have been made between March 2 to 6, 2019 or within five (5) calendar days after the start date of confinement.

Hence, the compensable period will be from March 3 to 31, 2019 only for a total of 29 days

 

What if the last day of filing falls on a weekend or a holiday?

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.

What is the disbursement procedure of sickness 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, self-employed, and voluntary members, including OFWs and those separated from employment, shall be required to enroll the following details in the Disbursement Account Enrollment Module and upload proof of account in the My.SSS Facility in the SSS website:

If through PESONet participating banks: Bank name and account number
If through E-wallet: Mobile number linked to bank account number

If through RTC/CPO:

Mobile number

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.

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

What are the documentary requirements?

  1. Sickness Benefit Application (SBA) Form
  2. SS ID/UMID card or any valid primary ID cards/documents, as follows:
    • Driver’s License
    • Passport
    • Voter’s ID Card
    • National Bureau of Investigation (NBI) Clearance
    • Postal Identity Card
    • Any other government-issued (secondary) ID cards/documents
  1. 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
FILER DOCUMENTS TO BE PRESENTED
Member Original of any one (1) of the member’s primary ID cards/documents or two (2) secondary ID cards/documents, both with signature and at least one with photo.

Member's authorized representative

Original of any one (1) of the member’s and the authorized representative’s primary ID cards/documents or two (2) secondary ID cards/documents, both with signature and at least one with photo.

NOTE:

  • For sickness/injury that happened abroad, the documents issued by foreign country should be with English translation and duly authenticated by the Philippine Embassy/Consulate Office or duly notarized by notary public in host country.
  • The SSS Medical Specialist may require the submission of additional medical records/documents necessary for the evaluation of the claim.

 

What are the additional documentary requirements?

For Self-Employed/Voluntary Member (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 authorized signatory as reflected in the Specimen Signature Card or SS Form L-501)

For Member Separated from Employment

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 authorized signatory as reflected in SS Form L-501)

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 authorized signatory as reflected in SS Form L-501

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

Where can the member file the sickness claim?

The sickness benefit application may be filed by self-employed and voluntary members, and those separated from employment at any SSS branch that is most convenient to them