The amount of a member's sickness benefit per day is equivalent to ninety percent (90%) of the member's average daily salary credit.
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.
Count 12 months backwards starting from the month immediately before the semester of
Identify the six highest monthly salary credits within the 12-month period.
salary credit 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 P16,000 effective January 1, 2014).
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 2013 for 20 days:
The semester of sickness would be from July 2013 to December 2013.
The 12-month period would be from July 2012 to June 2013 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 credit would be divided by 180 to get the average daily salary credit
of P500 (P90,000/180).
The daily sickness allowance is 90 percent of the of the average daily salary credit or P450 (P500 x 90%).
The sickness benefit due is P9,000 (P450 x 20 days).
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. For unemployed, self-employed
or voluntary members, the sickness benefit will be paid directly by the SSS to the member.
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.
For example, SSS receives the employer's
reimbursement claim on Oct. 3, 2013 for the sickness period September 23 to Oct. 14, 2012.
The employer will be reimbursed for the period Oct. 4 to 14,2012 only as Sept. 23 to Oct.
3, 2012 falls outside the prescribed one-year period for reimbursement claim.
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.
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.