What is the sickness benefit?

The sickness benefit is a daily cash allowance paid for the number of days a
member is unable to work due to sickness or injury.
How does an SSS member qualify for the sickness benefit?
1. unable to work due to sickness or injury and confined either in a hospital
or at home for at least four days;
2. at least three months of contributions within the 12 month period
immediately before the semester of sickness has been paid;
3. all company sick leaves with pay for the current year has been used up;
4. the employer has been notified, or, if a separated, voluntary or self
employed member, the !!! directly.
How much sickness benefit is a member entitled
to receive?
The amount of a member"s sickness benefit
per day is e#uivalent to ninety percent
$%&'( of the member"s avera)e daily salary
credit.
How is the sickness benefit computed?
1. *+clude the semester of sickness.
, semester refers to two
consecutive #uarters endin) in the
#uarter of sickness.
, quarter refers to three
consecutive months endin) -arch,
.une, !eptember or /ecember.
2. 0ount 12 months backwards startin) from the month immediately before
the semester of sickness.
3. 1dentify the si+ hi)hest monthly salary credits within the 12month
period.
Monthly salary credit means the compensation base for contributions
and benefits related to the total earnin)s for the month. $The ma+imum
covered earnin)s or compensation is 213,&&& effective .an 1, 2&&2(.
2lease refer to the followin) table4
Range of
Compensation
Monthly
Salary Credit
1,000 - 1,249.99 1,000
1,250 - 1,749.99 1,500
1,750 - 2,249.99 2,000
2,250 - 2,749.99 2,500
2,750 - 3,249.99 3,000
3,250 - 3,749.99 3,500
3,750 - 4,249.99 4,000
4,250 - 4,749.99 4,500
4,750 - 5,249.99 5,000
5,250 - 5,749.99 5,500
5,750 - 6,249.99 6,000
6,250 - 6,749.99 6,500
6,750 - 7,249.99 7,000
7,250 - 7,749.99 7,500
7,750 - 8,249.99 8,000
8,250 - 8,749.99 8,500
8,750 - 9,249.99 9,000
9,250 - 9,749.99 9,500
9,750 - 10,249.99 10,000
10,250 - 10,749.99 10,500
10,750 - 11,249.99 11,000
11,250 - 11,749.99 11,500
11,750 - 12,249.99 12,000
12,250 - 12,749.99 12,500
12,750 - 13,249.99 13,000
13,250 - 13,749.99 13,500
13,750 - 14,249.99 14,000
14,250 - 14,749.99 14,500
14,750 - O V E R 15,000
4. ,dd the si+ hi)hest monthly salary credits to )et the total monthly salary
credit.
3. /ivide the total monthly salary credits by 15& days to )et the avera)e
daily salary credit.
6. -ultiply the avera)e daily salary credit by %& percent to )et the daily
sickness allowance.
7. -ultiply the daily sickness allowance by approved number of days to
arrive at the amount of benefit due.
For example, let us say that an !!! member )ets sick or injured in 8ctober
2&&4 for 2& days4
a. The semester of sickness would be from .uly 2&&4 to /ecember 2&&4.
b. The 12month period would be from .uly 2&&3 to .une 2&&4 within
which the si+ hi)hest monthly salary credits will be chosen.
c. 9et us assume that the si+ hi)hest monthly salary credits are 213, &&&
each. The total monthly credit would be 2%&, &&& $213, &&& + 6(.
d. The total monthly salary would be divided by 15& to )et the avera)e
daily salary credit or 23&& $2%&, &&&:15&(.
e. The sickness benefit due is 2%,&&& $243& + 2& days(.
How many days in a year can a member avail himself of the sickness benefit?
, member can be )ranted sickness benefit for a ma+imum of 12& days in one
calendar year. ,ny unused portion of the allowable 12& days sickness benefit
cannot be carried forward and added to the total number of allowed
compensable days for the followin) year.
The sickness benefit shall not be paid for more than 24& days on account of the
same illness. 1f the sickness or injury still persists after 24& days, his claim will
be considered a disability claim.
Who should an employee notify regarding his sickness or inury?
, member should notify the employer within five $3( calendar days after the
start of sickness or injury. The employer, in turn, must notify the !!! of the
confinement within $3( calendar days after receipt of the notification from the
employee member.
;otification to the employer is not necessary if the member"s confinement is in
a hospital or if the member )ot sick or was injured while workin) or was within
the company premises. 1n this case, the employer must notify the !!! within
five $3( calendar days from the start of the employee"s sickness or injury while
workin) or was within the company premises.
What is the procedure for notification for unemployed! self"employed and
voluntary members?
<nemployed, selfemployed or voluntary payin) members should notify the
!!! directly within five $3( calendar days after the start of confinement, unless
such confinement is in the hospital,in which case, notification is not necessary.
What are the effects of failure or delay in notification?
1. 1f the employee notifies the employer, or the !!!, in the case of an
unemployed, selfemployed or voluntary payin) member, beyond the
prescribed fiveday period, the confinement shall be deemed to have
started not earlier than the fifth day immediately precedin) the date of
notification.
2. 1f the employer notifies the !!! beyond the five $3( calendar days after
the receipt of the notification from the employee, the employer shall be
reimbursed only for each day of confinement startin) from the 1&th
calendar day immediately precedin) the date of notification to the !!!.
3. 1f the employee has )iven the re#uired notification to the employer, but
the employer fails to notify the !!! of the confinement within the
prescribed period resultin) in the reduction of the benefit or denial of the
claim, the employer shall have no ri)ht to recover the daily sickness
allowance advanced to the employee.
How would an employed member be paid his sickness beneft?
The payment of the daily sickness allowance is advanced by the employer every regular payday. The
SSS will then reimburse the employer of the amount legally advanced upon receipt of satisfactory
proof of such payment and legality thereof.
The SSS will reimburse the employer only for confnements within the one year period immediately
preceding and the date the claim for beneft or reimbursement is received by the SSS, except for
confnements in hospital (i.e. SSS receives the employers reimbursement claim on ct. !, "##$ for
the sickness period September "! to ct. %$, "##!. The employer will be reimbursed for the period
ct. $ to %$,"##! only as Sept. "! to ct. !, "##! falls outside the prescribed one&year period for
reimbursement claim.
How about the unemployed, self-employed or voluntary member?
The sickness beneft will be paid directly by the SSS to the unemployed, self&employed or voluntary
members.
What is the prescribed period of fling for a member who is confned in a hospital?
'or hospital confnement, the claim for beneft must be fled within one (%( year from the last day of
confnement from the hospital. 'or home confnement, the claim for reimbursement by the employer
must be fled within one (%( year from the start of illness. 'ailure to fle the claim within the
prescribed period will result to denial of the claim.
What forms are needed in fling for sickness beneft?
%. For the employed member
a. SSS 'orm )*+&,- (Sickness -otifcation(.
For the employer
b. SSS 'orm .&!#$ (Sickness .eneft /eimbursement 0pplication(.
". For the unemployed/self-employed/voluntary member
a. SSS 'orm )*+&,0 (Sickness .eneft )laim for 1nemployed2Self&employed23oluntary
4embers(
b. SSS 'orm 44+&%#" (4edical )ertifcate(
!. ther documents5
a. For unemployed members
)ertifcation from last employer showing the e6ective date of separation from
employment or notice of the companys closure2strike or certifcation from the
+epartment of *abor and 7mployment that the employee or employer has a
pending labor case.
)ertifcation that no advance payment was granted, if the date of separation form
employment is within the confnement period being applied for.
8resentation of the SS +igiti9ed :+2SSS 'orm 7&; (acknowledgment stub( with "
valid :ds, one of which with the recent photo. To ensure receipt of benefts by
members, authori9ed company representatives who fle sickness beneft claims
shall present the members SS digiti9ed :+ or 7&; (acknowledgement stub( with two
valid :ds (at least one with photo(. This re<uirement is in addition to the
presentation by the company representatives own SSS digiti9ed :+ and blue card.
Where does the member fle his claim for sickness beneft?
For the employed/separated member & claims may be fled at the nearest SSS o=ce. >owever,
processing will be done at the branch where the employer and employee records are based.
For the voluntary/self-employed member & claims may be fled at the SSS o=ce nearest the
members residence. >owever, processing will be done at the branch where the record is based.

List of accredited banks5
%. 0l&0manah :slamic :nvestment .ank of the 8hilippines
". 0llied .anking )orporation
!. 0sia 1nited .ank )orporation
$. .ank of )ommerce
?. .ank of the 8hilippine :slands
;. )entury Savings .ank
@. )hina .anking )orporation
A. )itystate Savings .ank, :nc
,. )ountry /ural .ank of Taguig :nc.
%#. 7astwest .ank
%%. *and .ank of the 8hilippines
%". 4aybank 8hilippines :nc.
%!. 4etropolitan .ank B Trust )ompany
%$. 8hilippine .ank of )ommunications
%?. 8hilippine .usiness .ank
%;. 8hilippine -ational .ank
%@. 8hilippine 8ostal Savings .ank
%A. 8hilippine Savings .ank
%,. 8hilippine 3eterans .ank
"#. /).) Savings .ank, :nc.
"%. /i9al )ommercial .anking )orporation
"". /ural .ank of 8ililia :nc.
"!. Security .ank and Trust )ompany
"$. Standard )hartered .anking )orporation
"?. 1nion .ank of the 8hilippines