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Sickness Benefit

 

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For Employees and Employers:

SICKNESS NOTIFICATION


A member should notify the employer within fi​ve (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 nece​ssary if the member’s confinement is in a hospital or if member got sick or was injured while working or while he was within the company premises. In this case, the employer must notify the SSS within ten (10) calendar days from the start of the employee’s sickness or injury while he was working or while he was within the company premises.

PROCEDURE AND DOCUMENTARY REQUIREMENTS

A member can file for sickness notification personally or through the company representative.

If filed personally, the member should submit the following:

Plus the following documents, if needed:

In case of work-related claims:

  • Accident/Sickness Report from employer, if work-connected; and
  • Police Report (for vehicular accident with third party involvement), if work-related; and
  • 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 diagnosis

In case of sickness that occurred while on strike/shutdown/and member will file to SSS personally, submit the above-mentioned requirements together with the following:​

  • Certificate of Notice of Strike issued by 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

If filed through Company Representative, the following documents should be forwarded to SSS:

REMINDERS
  • ​​A Medical Specialist shall determine other required medical documents based on a separate checklist.
  • For sickness or injury acquired abroad, documents issued by the foreign country should be in English translation and must be authenticated by the Philippine Embassy or Consulate Office, or duly notarized by a notary public from the host country.​

SICKNESS REIMBURSEMENT


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 the date the claim for benefit or reimbursement is received by the SSS, except for confinements in hospital.

PROCEDURE AND DOCUMENTARY REQUIREMENTS

In order to reimburse the sickness benefit that was advanced to the member, the employer needs to file for reimbursement. The member should also confirm that the amount stated on the form has been advanced by signing the certification on the form. When filing, the employer should submit to SSS the following documents:

Plus the following documents:

For business and household employers

For Company Representatives

Note: If member is entitled to SS and EC Sickness Benefit, fill out Part IIB of the Sickness Benefit Reimbursement Application for the computation of both benefits.

​​REMINDERS
  • Applications may be filed in any SSS branch that is most convenie​nt to employer.
  • 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.

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For Self-Employed and Voluntary Members:

SICKNESS BENEFIT APPLICATION


Self-employed and voluntary paying members should notify the SSS directly within five (5) calendar days after the start of confinement, unless such confinement is in a hospital, in which case, notification should be made within one (1) year from start of confinement.

If a self-employed or voluntarily paying member notifies SSS 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.

PROCEDURE AND DOCUMENTARY REQUIREMENTS

The member should submit the following to the SSS:

For self-employed and voluntary members who were previously employed

If confinement period applied for is within the period of employment or prior to date of separation, the member should also present:

​​REMINDERS
  • ​Applications may be filed in any SSS branch that is most convenient to the member.
  • For hospital confinement, the claim for benefit must be filed within one (1) year from the date of discharge. For home confinement, the claim 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.
  • Members are also required to enroll in the Sickness and Maternity Benefit Payment thru the Bank Program and once approved, the Sickness Benefit Payment will be credited directly to the member’s single savings/current/cash card/prepaid account in the SSS-accredited banks.​

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For Members Separated from Employment:

SICKNESS BENEFIT APPLICATION


Members separated from employment should notify the SSS directly within five (5) calendar days after the start of confinement, unless such confinement is in a hospital, in which case, notification should be made within one (1) year from start of confinement.

If a member separated from employment notifies SSS 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.

PROCEDURE AND DOCUMENTARY REQUIREMENTS

The member should submit the following to the SSS:

Plus the following documents:

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

If confinement period applied for is after the date of separation

Note: Certificate of separation is not required for self-employed/voluntary member (previously employed) or member separated from employment under any of the following conditions in which supporting document/s shall be required to be submitted, as enumerated below:

REMINDERS
  • ​A Medical Specialist shall determine other required medical documents based on a separate checklist.
  • For sickness or injury acquired abroad, documents issued by the foreign country should be in English translation and must be authenticated by the Philippine Embassy or Consulate Office, or duly notarized by a notary public from the host country.
  • Applications may be filed in any SSS branch that is most convenient to the member.
  • For hospital confinement, the claim for benefit must be filed within one (1) year from the date of discharge. For home confinement, the claim 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.
  • Members are also required to enroll in the Sickness and Maternity Benefit Payment thru the Bank Program and once approved, the Sickness Benefit Payment will be credited directly to the member’s single savings/current/cash card/prepaid account in the SSS-accredited banks.

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