Detailed information about SSS Sickness Benefit Requirements for Employed Members in the Philippines. Read till end to clearly understand what you must do, and avoid pitfalls.
What Is the SSS Sickness Benefit?
The SSS (Social Security System) provides a sickness benefit to qualified members as a daily cash allowance when they can’t work due to illness or injury. In the case of employed members, the benefit helps offset lost wages during your period of incapacity.
Unlike private sick leave (if any), this is a government-mandated support, subject to meeting certain conditions.
Below, we walk you through eligibility rules, required documents, the filing process, computation, deadlines, and tips to maximize your claim.
Eligibility Requirements (for Employed Members)
To qualify, employed members must satisfy all of the following conditions (If any of the following conditions are not met, your claim might be reduced or denied.):
Active SSS Member Status: You must have an active SSS membership and your contributions should be up to date (i.e. posted).
Contribution Threshold: You must have paid at least three (3) monthly contributions during the 12-month period immediately preceding the semester in which your sickness or injury occurred.
Period of Incapacity (Confinement Requirement): You must have been confined (either at home or in a hospital) for at least four (4) consecutive calendar days due to the illness or injury.
Notification of Employer (Timely Reporting): You must notify your employer within five (5) calendar days from the start of your sickness (for home confinement).
- After the employer receives your notice, the employer must forward the notification to SSS within five (5) calendar days.
- If the confinement is in a hospital, the notification to SSS may be filed within one (1) year from hospital discharge.
Use Up Paid Sick Leave (If Company Has One): You must exhaust your employer-provided paid sick leaves (if the company grants them) before claiming SSS sickness benefit.
Within Annual & Illness Limits:
- The sickness benefit can be paid for up to 120 days in one calendar year.
- In case the same illness or injury persists long, SSS may limit the compensable days to 240 days, beyond which it could shift to disability benefit consideration.
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Documents & Requirements You Must Submit
To support your application, you must prepare and submit the following:
- Sickness Benefit Application (SBA) / Sickness Notification Form: This is the official form (for employees) that your employer files.
- Medical Certificate (Form MED-01688): The doctor must detail the diagnosis, start and end dates of confinement, and certify that you were unfit to work.
- Clinical Abstracts / Lab / Diagnostic Results: If applicable, supporting documents like lab tests, X-rays, ECG, hospital records, especially for more serious or prolonged illnesses.
- Valid ID of the Employee: Use a government-issued ID (UMID, driver’s license, passport, etc.).
- Employer Certification / Company Records: The employer may need to certify that you notified them within the required period, that your sick leave is exhausted, etc.
- Separation Certificate (if recently separated and confinement occurred before separation): If your sickness happens around your separation or within your prior employment period, additional documentation may apply.
Make sure all submissions are accurate and complete, missing or inconsistent documents often cause delays or denials.
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How SSS Sickness Benefit Is Computed
Once your claim is accepted, SSS computes your benefit as follows:
- Select the Base Period (Base Year)
Exclude the semester of sickness. Look at the 12 months immediately before that semester. - Pick the Six Highest Monthly Salary Credits (MSCs)
From those 12 months, choose the six months with the highest MSCs. (Each MSC may have a ceiling limit.) - Sum Those Six MSCs
Add them up to get a total. - Divide by 180 to Get Average Daily Salary Credit (ADSC)
( \text{ADSC} = \dfrac{\text{Sum of 6 MSCs}}{180} ) - Daily Sickness Allowance (DSA)
This is 90% of the ADSC. - Multiply DSA by Number of Compensable Days
Multiply that by the number of approved days of confinement. The result is your total sickness benefit.
Example:
Suppose your six highest MSCs sum to ₱96,000
- ADSC = 96,000 ÷ 180 = ₱533.33
- DSA = 90% of that = ₱480
- If you were confined for 10 days, your benefit = ₱480 × 10 = ₱4,800
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Procedure to File Claim For Employed Members
Here’s the step-by-step process for employed members:
- Get medical attention and secure your medical certificate: Undergo diagnosis, treatment, or confinement by a licensed physician.
- Notify your employer (within 5 days): Present your medical certificate and inform your HR or immediate supervisor.
- Employer forwards notification to SSS: The employer logs into My.SSS / SSS portal and files the Sickness Notification within 5 days of receiving your notice.
- Employer advances payment: The employer must advance the sickness benefit to you based on their computation (DSA × days) no later than your next regular payday.
- Employer files for reimbursement: After paying you, the employer submits a Sickness Benefit Reimbursement Application (SBRA) to SSS (through the online portal) to get reimbursed.
- SSS processes & settles: Once approved, SSS reimburses the employer via its disbursement facility (bank, PESONet, etc.).
- You receive the benefit through employer: Since the employer advanced it, you don’t have to wait for direct SSS disbursement (for employed members).
Throughout, you can monitor status via My.SSS or through HR.
Deadlines & Penalties: Don’t Miss Them
Filing deadlines are strict, and missing them can reduce or disqualify your claim:
| Scenario | Employee → Employer | Employer → SSS | Notes |
|---|---|---|---|
| Home confinement | Within 5 calendar days | Within 5 days of receipt | Late notice shifts the start date of compensable period |
| Hospital confinement | (No need for employee notification) | Within 1 year from discharge | Late filing may bar claims beyond allowed period |
If you fail to comply with the notification deadlines, SSS may regard the start of confinement to be five days before your actual notice (thus reducing days).
Also, if your employer fails to reimburse SSS within allowed time, that may affect their reimbursement or your benefit.
Finally, the sickness benefit has prescriptive periods (statutes of limitation). If too much time passes, claims may become unenforceable under civil law.
Common Pitfalls & Tips to Maximize Your Claim
- Notify promptly. A late notice can shorten your compensable days.
- Make sure contributions are posted. If one of your contributions is late or missing, your base period may change and reduce benefit.
- Keep good medical records. If your illness is serious or prolonged, supporting diagnostics can strengthen your claim.
- Don’t rely solely on company leave. Use them first (if available), but don’t skip filing SSS sickness when needed.
- Monitor SBRA and SSS updates. Stay on top of status via My.SSS.
- Check your disbursement enrollment. Ensure your employer or SSS has your correct bank account or UMID-ATM info.
At A Glance
- Employed SSS members can claim sickness benefit (a daily cash allowance) if they meet strict conditions: active membership, at least 3 recent contributions, at least 4 days of confinement, and timely notification.
- The benefit is calculated from your top six monthly salary credits, converted into an ADSC, then multiplied by 90%, times the number of days.
- The employer advances your benefit and then seeks reimbursement from SSS.
- Do not miss deadlines, late filing or notification can reduce or disqualify your claim.
- With good preparation, accurate medical records, timely notifications, posted contributions, you maximize your chance to get your rightful benefit.
