SSS Sickness Benefit – SSS Sickness Benefit Requirements For Employed

The SSS Sickness Benefit is a crucial part of the Social Security System (SSS) in the Philippines. It serves as a financial assistance program designed to support members who are temporarily unable to work due to illness or injury. If you’re an SSS member in the Philippines, knowing how the sickness benefit works can help you navigate through a difficult period and ensure you receive the support you’re entitled to.

This article provides a detailed guide on how the SSS Sickness Benefit works, including eligibility, the application process, required documents, the benefit amount, and more. If you’re a Filipino worker, understanding this benefit can help you access financial aid when you need it the most.

The SSS Sickness Benefit is a cash assistance program provided by the Social Security System (SSS) to its members who are unable to work due to illness or injury. The benefit is designed to replace a portion of your income while you are recovering and temporarily unable to work. It is one of the many benefits offered by the SSS to its members, alongside others like maternity, disability, retirement, and death benefits.

The sickness benefit is available for both employees and self-employed individuals, and it ensures that you don’t have to face financial hardship while you are ill or recovering from an injury. It is important to note that the benefit is only available for those who meet the eligibility requirements set by the SSS.

Read also: SSS Maternity Benefits – SSS Maternity Qualifying Period 2025

If a member meets the following criteria, he or she is eligible for this benefit:

• A person who is unable to work due to sickness or injury and occupies a hospital bed or is confined to their home for a minimum of four (4) days.
• Paid at least three (3) months’ contributions during the 12-month period immediately prior to the semester in which the sickness or injury occurred. In determining a SE/VM/OFW’s eligibility for the benefit, SSS shall only take into account contributions paid prior to the semester of contingency.
• It has been informed to the employer, if employed, or to the Social Security System (SSS), if he/she is a SE/VM/OFW/separated from employment concerning an illness or injury.
• If employed, has exhausted all current sick leave with pay for the current year, except for sea-based OFWs.

It is the member’s responsibility to notify his/her employer immediately in the event of sickness or injury and submit the following proof of illness or injury:

The following is indicated on the medical certificate (Med 01688):

• Diagnosed completely
• Number of days of sick leave including recuperation recommended
• Address of clinic
• Number of contact
• Licence number legibly written

• Medical documents that are certified as true copies

When SSS receives the above documents, it shall, in turn, notify the employer in the employer’s My.SSS account, upon receipt of such documents. It is no longer necessary to submit documents over the counter.

Read Also: SSS Retirement Benefits – How Much Is SSS Retirement Benefit

• Visit My.SSS Account and login.
• Then select “Submit Sickness Benefit Application” under the E-Services tab.
• Click “Proceed” to continue after reading the important reminders.
• Please fill out all the required information and click “Proceed“.
• Please upload the required supporting document/s. To view the list of documentary requirements and important reminders, click the “I” icon. Make sure you have read and understood the Certification portion, and then click “I Certify and Submit” to proceed. Once the transaction has been confirmed, click “OK”.
• A notification message will be displayed by the System. Once you have clicked “View”, you will be able to see the details of your transaction. Please check your email inbox for SSS notifications.

Read also: SSS Disability Benefit – PWD Claim SSS Disability Benefit

• Visit to the My.SSS Account of the employer and login.
• Select the “Submit SS Sickness Benefit Reimbursement Application (SBRA)” Tab.
• Please enter the member’s CRN/SS Number or Claim Reference Number or Date Filed, then click the “Search” button.
• There will be a display of the details of the approved Sickness Notification.
• You may proceed with the SBRA submission by clicking the Claim Reference Number.
• Please enter the Required details as approved.
• Encoded information will be displayed for review and certification by the employer.
• A confirmation email will be sent to the employer upon the successful submission of the SBRA.

Read also: SSS Sickness Notification Form – Download – Online Submit

However, the following sickness benefit claims are exempt from online filing and must be submitted in person at any SSS branch office and foreign representative office:

• A denied claim has been reconsidered for payment
• A deceased member’s unclaimed benefit
• Unclaimed reimbursements from inactive/closed/terminated/retired employers

The following information is indicated on the SSS Medical Certificate (Med 01688):

• Diagnosed completely
• Number of days of sick leave including recuperation recommended
• Address of clinic
• Number of contact
• Licence number legibly written

If there are any supporting medical documents for prolonged confinement or illness:

• Results of laboratory tests, X-rays, ECGs, and other diagnostic tests
• Records from the operating room/clinic that will aid in diagnosis

NOTE: If an illness or injury occurred abroad, the documents issued by the foreign country must be translated into English and authenticated by the Philippine Embassy or Consulate Office or notarized by a notary public in the foreign country.

The SSS Medical Specialist may request the submission of additional medical records/documents necessary for the evaluation of the claim.

Additional Requirements for Self-Employed/Voluntary Members that were previously employed

If the confinement period applied for is within employment period or prior to the date of separation:

• A certificate of separation from employment with the effective date of separation along with no advance payment has been made (signed by the employer’s Human Resource Manager).

If the confinement period applies after the separation date:

• The certificate of separation from employment contains the effective date of separation (signed by the employer’s Human Resource Manager)

NOTE: Separation certificates are not required for self-employed and voluntary members (previously employed) or for those separated from employment under any of the following conditions, in which case supporting documents will be requested based on the following:

If the company is on strike,

• A notice of strike duly acknowledged by the Department of Labor and Employment (DOLE);
• Notarized Affidavit of Undertaking by the member stating that no advance payment was granted

When a company is dissolved or ceases to operate:

• An Affidavit of Undertaking, duly notarized, from the member stating that no advance payment was granted and indicating the effective date of separation.

If a court case is pending regarding the separation of members:

• A certificate from the DOLE; and
• The member’s notarized Affidavit of Undertaking clearly stating that no advance payment was granted and the member’s effective date of separation

If you’ve been separated from employment because of absence without leave (AWOL) or strained relations with your employer:

• Affidavit of Undertaking, duly notarized, signed by the member stating that no advance payment has been granted and indicating the date of separation.

The amount of the member’s daily sickness benefit allowance is equal to ninety percent (90%) of his/her average daily salary credit (ADSC).

Benefit Calculator

• The semester of contingency should be excluded.

• The term semester refers to a period of two (2) consecutive quarters that includes the quarter of sickness.
• The term quarters refers to a period of three (3) consecutive months ending in March, June, September, or December.

• Count twelve (12) months backwards beginning with the month immediately preceding the semester of contingency.
• Identify and add the 6 highest monthly salary credits within a 12-month period in order to calculate the total monthly salary credit.

• A monthly salary credit (MSC) is a compensation based on the total earnings for the month that can be used to calculate contributions and benefits.

• The average daily salary credit (ADSC) is calculated by dividing the total MSC by 180 days.
• To calculate the daily sickness allowance, multiply the ADSC by 90 percent (90%).
• The amount of sickness allowance due is calculated by multiplying the daily sickness allowance by the number of days approved for the benefit.

IMPORTANT: According to Circular No. 2020-032, dated 24 November 2020, starting January 2021, SS contributions will include workers’ investment and savings programs (WISPs) (SSS Provident Funds). Benefits under the Regular SSS Program are computed on the basis of contributions up to ₱20,000 MSC.

The computation of benefits does not include contributions paid during or after the semester of contingency.

Benefits and contributions under the Regular SS and EC programs will be calculated based on the member’s MSC up to a maximum of P20,000. Members who contribute more than P20,000 to the MSC will be eligible to participate in the MPF Program and their contributions will be credited to their individual accounts.

Read also: SSS Pension Calculator – How to Use the SSS Pension Calculator

• A member is entitled to sickness benefit for a maximum of 120 days within a calendar year. If any portion of the compensable days is unused, it cannot be carried forward or added to the following year.
• A sickness benefit cannot be paid under the same circumstance for more than 240 days on account of the same illness. The claim will be considered a disability claim if the sickness or injury persists for more than 240 days.

The Submission of a Sickness Notification (for the Employed)

Home Confinement

• Employee to employer: Within five (5) calendar days of the beginning of confinement
• Employer to SSS: Within five (5) calendar days after employee receipt

Hospital Confinement

• Employee to employer: No notification is required
• Employer to SSS: Within one (1) year of discharge from the hospital

Submission of Sickness Benefit Applications (for SEs, VMs, and OFWs)

• Home confinement: After the start of confinement, within five (5) calendar days
• If confined to a hospital: Within one (1) year of being discharged from the hospital

Submission of an Application For Reimbursement of Sickness Benefits (for the Employer).

• If it is home confinement: Within one year of the beginning of confinement
• If confined to a hospital: Within one (1) year of being discharged from the hospital

The amount of the member’s daily sickness benefit allowance equals ninety percent (90%) of the member’s average daily salary credit (ADSC), and is calculated based on the member’s average daily salary. The semester of contingency should be excluded.

The failure to comply with the rule on notification will lead to a reduction or denial of the sickness claim application. In the event that the member notifies the SSS of the confinement after the prescribed five-day period, the confinement shall be deemed to have begun not earlier than the fifth (5th) day immediately preceding the date of notification.

All sickness benefit claims will be disbursed through the qualified payee’s Unified Multi-Purpose Identification (UMID) card enrolled as an Automated Teller Machine (ATM) card. The payment shall be made through participating banks that participate in the Development Bank of the Philippines (DBP) Disbursement Facility through the Philippine Electronic Fund Transfer System and Operations Network (PESONet), electronic wallets (E-Wallets), or accredited remittance transfer companies (RTCs)/cash payout outlets (CPOs).

In order to enroll qualified payees in the Disbursement Account Enrollment Module (DAEM), qualified payees must enter the following information as well as upload a proof of account (POA), a government-issued ID card/document in JPEG or PDF format, a selfie photograph with the ID/document and the uploaded proof of account for the disbursement account being enrolled on the SSS website:

If through PESONet Participating banks:	Bank Name and account number
If through E-wallet:	Mobile Number linked with bank account number
If through RTC or CPO:	Mobile Number

SSS will notify members via email or SMS when their sickness benefit claims have been credited to their PESONet bank/eWallet accounts, or if payment has already been made through RTCs/CPOs. Members may also access information about their disbursements through the Inquiry Module of their My.SSS accounts.

The crediting of benefit payments must be completed within five (5) banking days of settlement.

In some cases, your SSS Sickness Benefit claim may be denied. This could be due to various reasons, such as incomplete documents, insufficient contribution history, or failure to meet the eligibility requirements.

If your claim is denied, here’s what you can do:

1. Review the Denial Notice: The SSS will send a letter explaining the reason for the denial. Review this carefully to understand why your claim was rejected.
2. File an Appeal: If you believe the denial was in error, you can file an appeal with the SSS. Provide any additional information or documentation that supports your case.
3. Consult SSS Customer Service: If you’re unsure why your claim was denied, contact SSS Customer Service for assistance.

Waiting Period

The SSS Sickness Benefit has a waiting period of three (3) days. This means that if you are sick or injured, the first three days of your condition are not covered by the benefit. However, once the waiting period is over, you will start receiving your sickness benefit.

Work-Related Injuries

If your sickness or injury is work-related, you may be entitled to additional benefits through Philippine Health Insurance Corporation (PhilHealth) or the Employees’ Compensation Commission (ECC). In such cases, you may be eligible for a higher amount of benefits.

Delays and Processing Time

The processing time for the SSS Sickness Benefit may take a few weeks. Make sure that all documents are properly submitted and that your claim is complete to avoid delays.

How do I qualify for a SSS sickness benefit?

Ans: This benefit is available to members if they meet the following requirements:

• An employee who is unable to work due to illness or injury and is confined to either a hospital or at home for a period of at least four (4) days due to the illness or injury.
• At least three (3) months of contributions have been paid within the 12-month period immediately preceding the semester of sickness or injury.

How many days to file SSS sickness benefit after?

Ans: If you are confined at home, you must submit the Sickness Benefit Application form within five calendar days of the commencement of confinement. Sickness Benefit Application Forms must be submitted to the Social Security Administration within one year of the date of discharge from the hospital.

How to claim disability in SSS?

Ans: If you wish to claim disability benefits from the Social Security System (SSS), you must file a Disability Claim Application (DisCA) form, provide a medical certificate from your physician, and possibly undergo a physical examination and interview in an SSS office.

The SSS Sickness Benefit plays a vital role in providing financial assistance to members who are temporarily unable to work due to illness or injury. By understanding the eligibility requirements, application process, and benefit computation, members can ensure they receive the support they are entitled to during difficult times. Proper documentation and timely filing are crucial to avoid claim rejection or delays. Being informed about the SSS Sickness Benefit helps Filipino workers safeguard their financial well-being while focusing on recovery