Falling ill or sustaining an injury that renders you unable to work can be a stressful and financially straining experience. Fortunately, as a member of the Social Security System (SSS) in the Philippines, you may be eligible to receive sickness benefits – a daily cash allowance paid out when you are unable to work due to sickness or injury.
Claiming sickness benefits can provide much-needed financial assistance during difficult times. This article will explain in detail the sickness benefits provided by SSS, from eligibility criteria to notification procedures to benefits covered. Read on for a comprehensive guide on how to access your sickness benefits.
Eligibility Criteria for SSS Sickness Benefits
To qualify for sickness benefits from SSS, you must fulfill the following requirements:
1. Inability to Work Due to Sickness or Injury
First and foremost, you must be unable to work for a minimum of 4 consecutive days due to a sickness or injury. The inability to work may arise from confinement at home or in a hospital. SSS covers a wide range of illnesses and injuries, from minor ailments like flu to major conditions requiring surgery. Check out the list of sicknesses covered by SSS to see if yours is included.
2. Minimum Contributions Paid
You must have paid at least 3 months worth of contributions to SSS within the 12 months preceding the semester of your sickness or injury. This demonstrates an active membership status.
3. Notification to SSS
You must directly notify SSS of your sickness or injury within the stipulated notification period. You can do this using the Sickness Notification Form. Failure to notify SSS on time can result in your claim being reduced or denied.
If you satisfy the above criteria, you may be eligible to claim sickness benefits regardless of your employment category. This covers self-employed individuals, voluntary members, Overseas Filipino Workers (OFWs), non-working spouses and those separated from employment.
Calculation of Sickness Benefit Amount
The daily sickness benefit allowance you receive is calculated based on your average daily salary credit (ADSC), determined as follows:
- Identify your 6 highest monthly salary credits within the 12 months immediately prior to the semester of your sickness. Do not include the semester when your sickness or injury occurred.
- Add together these 6 monthly salary credits to derive your total monthly salary credit.
- Divide the total monthly salary credit by 180 days to calculate your ADSC.
- Finally, multiply your ADSC by 90% to arrive at your daily sickness allowance amount.
You can refer to the contribution and salary credit table on our website for details on the monthly salary credit brackets.
Maximum Duration of Sickness Benefits
There are limits imposed on the maximum number of days you can receive sickness benefits:
- The maximum number of compensable days permitted per calendar year is 120 days. Any unused days cannot be carried forward to the subsequent year.
- For the same illness, you may receive sickness benefits for up to 240 days maximum. If the illness persists beyond 240 days, it will be considered a disability claim instead of sickness.
Notification Procedures and Periods
To avoid penalties or reductions, you must notify SSS of your sickness or injury within the prescribed notification period:
You are required to notify SSS within 5 calendar days from the commencement date of home confinement.
You are required to notify SSS within 1 year from the date of discharge from hospital confinement.
Failure to abide by these notification timelines can result in the reduction or denial of your sickness benefits. Late notification will mean the sickness period is deemed to start later than the actual date.
Benefits Covered Under SSS Sickness
If you are eligible, the SSS sickness benefit provides the following coverage:
- A daily cash allowance equivalent to 90% of your average daily salary credit. This provides income replacement when you are unable to work.
- Coverage for both home and hospital confinement due to sickness or injury.
- Payout for up to 120 compensable days per calendar year.
- Continued coverage for the same illness for up to 240 days in total.
- Option to claim reimbursement for medicines, laboratory tests, doctor visits and other medical care related to your sickness.
- Maternity leave benefits for eligible pregnant female members.
- Death and funeral benefits for the surviving dependents if the sickness results in the member’s death.
- Loan privileges such as salary loan and calamity loan to aid recovery.
The sickness benefit provides comprehensive support during your period of inability to work due to illness or injury.
Frequently Asked Questions
Here are some common queries pertaining to SSS sickness benefits:
What happens if I miss the notification deadline?
Late notification leads to a reduction in compensable days. For home confinement, the qualifying period is adjusted to start 5 days before your actual notification date.
Can I submit on a weekend or holiday if it falls on the last day?
Yes, you can submit your claim on the next working day without incurring any penalties. This applies for both the 5-day and 1-year notification periods.
How long after approval will I receive my payout?
Once approved, funds will be credited to your account within 5 banking days or available for collection at remittance outlets.
What documents do I need to file my claim?
The key documents required are the SBA form, valid ID, medical certificate and test results, and separation certificate (for formerly employed members).
Where can I submit my sickness benefit claim?
You can file your claim at any SSS branch that is most easily accessible to you.
Get the Support You Deserve
Coping with illness or injury is challenging enough without financial burdens. As an SSS member, you have the right to claim sickness benefits when you are rendered unable to work.
Take the time to understand the qualification criteria, calculation formulas, notification rules and benefits covered above. The SSS sickness benefit provides crucial income replacement and medical care support when you need it most.