Estimated reading time: 6 minutes

(Updated: July, 22, 2024)

The Social Security System (SSS) offers invaluable support during trying times and is more than just a retirement scheme. The SSS Sickness Benefit is one such benefit, intended to give members financial help when they are unable to work due to illness or accident. Now, we’ll go into the specifics of SSS’s sickness benefits, including the qualifications for eligibility, and the application procedure.

What is the SSS Sickness Benefit?

The Social Security System (SSS) offers a financial support program called the SSS Sickness Benefit to its members who are unable to work as a result of illness or accident. It acts as a type of income replacement during times of illness, assisting people in adjusting to the financial effects of losing their normal source of income.

Active SSS members who have met the qualifying requirements and paid the necessary contributions are eligible for this benefit. Based on the member’s credit for their average daily earnings, it offers a daily cash allowance. Furthermore, depending on the kind of illness or injury, the benefit’s length varies but is normally limited to a maximum of 120 days, with the potential for an extension in specific situations.

Qualifying Conditions for Sickness Benefits

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 daily sickness benefit payment for the member is equal to ninety percent (90%) of his or her average daily salary credit (ADSC).

• Excluding the semester of contingency.
• A semester is defined as two (2) consecutive quarters that do not include a sick quarter.
• Three (3) consecutive months ending in March, June, September, or December are referred to as a quarter.
• Beginning with the month immediately before the semester of contingency, count back twelve (12) months.
• To get the overall monthly salary credit over a 12-month period, choose the six (6) greatest monthly salary credits.
• The term “monthly salary credit” (MSC) refers to the compensation structure for perks and contributions based on monthly wages.
• The average daily salary credit (ADSC) is calculated by dividing the total monthly salary credit by 180 days.
• To calculate the daily illness benefit, double the ADSC by 90%.
• To calculate the amount of benefits payable, multiply the daily illness allowance by the number of authorized days.

Also read: GUIDE: SSS Retirement Requirements

What is the Prescribed Period for Filing a Sickness Benefit Claim?

The following prescriptive periods in filing a 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. In addition this address the concern that due to the distance between their place of work/residence and the nearest SSS foreign branch, their claim for sickness benefits are often penalized for late filing. 

The additional 30-day grace period shall be applied only to cases that do not require hospital confinement.

Requirements

1. Sickness Notification (SN) Form
2. ID card/s and/or document/s

• Medical documents, if any In case of work-related claims, all the above-listed documents, plus the following:
• 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, original/certified true copy of 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

How to Apply for SSS Sickness Benefit Online?

People who do not visit SSS branches often can file sickness benefit reimbursement claims at their homes.

Who is eligible to apply online?

Active SSS members who are:

• Self-employed members,
• Voluntary members,
• Non-working spouses, and 
• Overseas Filipino workers (OFWs)

What are the Requirements to apply online?

1. You must have an online SSS account on My.SSS portal  https://member.sss.gov.ph/
2. You must have an approved bank or e-wallet account (in the SSS Disbursement Account Enrollment Module (DAEM), also found at the My. SSS portal).

Also read: LIST: Sickness Covered by SSS

Step-by-Step Guide for Filling out SSS Sickness Benefit Online

Here’s the process of filing an SSS sickness benefit online:

1. Sign in to your My.SSS account.
2. Click the Submit Sickness Benefit Application under the E-Services tab of the Employee Self-Service Portal.
3. After reading the privacy and policy, click on Ok to proceed.
4. Click on Proceed for SSS validation of provided information and confirmation of eligibility for Sickness Benefit. Afterward, fill in the following information provided.
5. Check the list of the following requirements and other reminders upon proceeding.
6. Upload the requested documents into the online portal. Next, click on ‘I certify and Submit to go to the next page”.
7. Click OK to confirm the transaction.
8. Take note of the transaction details and check your email, a notification from SSS.

Frequently Asked Questions

Here is a list of common questions regarding the SSS sickness benefit:

How many days can a member be granted sickness benefits?

A member can obtain sickness benefits for a maximum of 120 days per year. Any unused portions cannot be added to the total number of compensable days next year.

How much claim for SSS Sickness Benefit?

The Sickness Benefit provides a daily allowance equivalent to 90% of the member’s Average Daily Salary Credit (ADSC), applicable for a maximum of 120 days within a calendar year.

Closing Thoughts

Keep in mind to put your health first, be responsible with your money, and ask for help if you require it. The SSS Sickness Benefit acts as a lifeline, allowing members to concentrate on getting better without having to worry about money. You can navigate through times of illness or injury with more security and confidence by utilizing this benefit and other tools that are accessible. – WhatALife!/Jayve

Sources: (1), (2), (3)

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Also read: GUIDE: How to apply for SSS Salary Loan ONLINE?