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Social Security System (SSS) Pensioners of the Philippines have to know the benefits of their membership. Are you aware of the medical conditions the SSS benefits can cover?

Knowing which illnesses the SSS pension can cover will help members ensure they can get the financial and medical assistance they need when dealing with any sickness.

The following contents will show the lists of sicknesses covered by SSS and more specific information regarding the benefits.

What is covered by the SSS Pension?

Chronic Illnesses

SSS pension covers certain long-term illnesses such as hypertension, arthritis, diabetes, and cancer. If a member has been diagnosed with any of the listening conditions, they are eligible for regular payments, which may depend on how severe the medical condition may be, along with other factors.

Maternity Benefits

The soon-to-be mothers who are registered members of the SSS also qualify for maternity benefits as long as they fulfill a specific criterion. 

The prerequisites include enrolling in a PhilHealth or HMO plan and having worked for at least three months before conception. These advantages may lessen the financial strain associated with pregnancy, labor, delivery services, and postpartum care.

The highest available benefit from SSS for maternity is P70,000 and only applies to members with a salary of P20,000 or more.

For a single mother, the amount may go up to P80,000.

A member must pay a minimum of three monthly contributions over the year prior to qualifying for some benefits related to childbirth, miscarriage, or emergency pregnancy termination.

Disability Benefits

In case a member experiences an illness or injury resulting in a state of disability, there is a chance for them to receive monthly financial support through the SSS. The disability allowance will depend on the member’s monthly salary before the disability occurred, their age, and the number of dependents. The maximum benefit will be capped, which will be set by law.

The purpose of this benefit is to assist members who go through the recovery process or adjust to living with a disability. SSS also provides rehabilitation programs that can help members live independently easily so they can return to how they used to be. 

Applying for an SSS disability pension in the Philippines requires careful consideration, as many rules and regulations govern these programs.

Death Benefits

If a member of the SSS in the Philippines passes away due to an illness or injury covered by their membership, their beneficiaries will be able to receive the death benefits. The benefits may vary depending on several factors, such as the duration of the member’s employment and whether or not they have dependents when the members have passed away.

This benefit can be crucial as it can help the member’s loved ones with the cost relating to their loved one passing, such can be used in funeral expenses. 

What is Not Covered by the SSS?

Pre-existing Conditions

Pre-existing conditions are not generally covered by most health insurance plans, including the ones provided by SSS membership in the Philippines. The SSS will not cover the members’ conditions prior to their membership.

Cosmetic Procedures

Procedures like plastic surgery, non-emergency dental care, and vision correction surgeries are not included in the SSS benefit plan since these are considered elective rather than medically necessary treatments. 

How to File SSS Sickness Benefit Claims?

Items cited below are basic requirements for sickness benefits and disability claims:

Sickness Benefits

• SSS Medical Certificate
• Attending Physician’s Medical Certificate issued with the following information:
  • Full name
  • PRC number
  • Clinic address
  • Contact information
  • History of illness and complete diagnosis
  • Recommended number of days needed for recuperation

  Disability Claims

• Disability Claim Application (DisCA) form
• Member’s photo and signature
• Attending physician’s Medical Certificate issued within six months from the date of filing with the following information:
  • Full name
  • PRC number
  • Clinic address
  • Contact information
  • History of present illness and complete diagnosis

There may be additional documents that may be requested by SSS depending on the sickness or disability that the members may have. 

FAQ

How many days in a year can a member be granted sick benefits?

A member can be granted sickness benefits for 120 days maximum in a year. Any unused days can be carried out to allowable compensable days in the following year. 

Sickness benefits shall not be paid for more than 240 days due to the same illness. If the sickness or injury continues after 240 days, it will be labeled a disability claim.

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

• Home Confinement – SBA form must be submitted to SSS within five calendar days after the start date of confinement.
• Hospital Confinement – SBA form must be submitted to SSS within one year of discharge.

What are the implications of late filing?

Failure to know the rule on the notification will ground for reducing or denying a sickness claim application.

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

When the last day to notify the SSS members of sickness or injury falls on weekends or holidays, the application may be filed on the upcoming working day without penalty for delay.

What are the documentary requirements?

• Sickness Benefit Application (SBA) form
• SS ID/UMID card or any valid ID cards/documents
  • Driver’s license
  • Passport
  • Voter’s ID card
  • National Bureau of Investigation (NBI) Clearance
  • Postal Identity Card
  • Any other government-issued ID
• Supporting medical documents
  • Laboratory
  • X-ray
  • ECG
  • Other diagnostic results

Where can a member file the sickness claim?

Self-employed and voluntary members may fill out the sickness benefit application. – WhatALife!/Zain

Source: (1), (2), (3)

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Also read: How to file for SSS Funeral Benefit Claim online: Ultimate Guide