HR Talk: Top 10 Questions Re: SSS Sickness Benefit Answered - Tina in Manila (2024)

What happens when you get sick?

Uso na ang COVID-19 positive ngayon. At 95,000 confirmed cases, you will meet a suspected COVID-19 patient as you go on your daily lives. Everywhere I look, someone is positive.

Too Many People are Contracting COVID-19

My aunt’s adopted son was tested positive of COVID-19.

He is a BPO worker. Despite all health precautions, he still tested positive. Given that BPO workers work in closed air-conditioned areas with possible shared headsets and breathing space, it is easier for them to contract COVID-19. There’s just too many BPO workers running around and factors to consider that getting COVID-19 is just a matter of time. While positive, he is asymptomatic and is finishing up his 14-day home quarantine.

A factory that shut down last week.

All workers were tested via rapid test of COVID-19 and turned out negative. By the end of the week, the operations manager died at their home after complaining about COVID-19 like symptoms earlier. After testing, 8 out of 12 head office workers were positive! 6 were completely asymptomatic (no symptoms), one had a mild flu and loss of smell/taste, while the 8th one narrowly escaped being confined in the hospital after taking Lian Hua, a therapeutic drug that ex-San Juan Mayor Abalos took when he got COVID-19.

The rules are clear. According to Labor Advisory No. 4, Series of 2020, if you are under home quarantine, those 14 days are unpaid if there’s no more leaves available.

If you get hospitalized, there is limited PhilHealth hospitalization coverage to help. Here is the maximum Philhealth coverage you can get:

However, there is also SSS Sickness Benefit which allows you to claim if you test positive for COVID-19. Regardless too of COVID-19, you can apply for this benefit for any prolonged sickness so long as you’re affected for 4 days or more. Excited? I am!

Tell Us More About the SSS Sickness Benefit

The SSS Sickness Benefit is a benefit paid to a member for not working due to illness or accident. It is 90% of the Average Daily Salary Credit, with a maximum of 120 days in a year, up to 2 years.

The process sounds complicated but it is actually very easy. All you need to do is submit complete documents to the SSS and you will get the money. The problem is that most people don’t have their documents ready when they see their physician/get hospital confined. So when they ask HR on how to have their sickness reimbursed, they need to return to the doctor/hospital again to get their requirements. Because of the delay, employees don’t get their full reimbursem*nts!

So here you go, para mabilis,I wrote this all-in-one post regarding SSS Sickness Benefit para lahat na ng requirements, ma-arrange na ng applicant and company. It’s a bit long because there’s small changes between an applicant who is employed and an applicant who is paying voluntarily. But once you get the gist of it, it becomes easy and convenient. Thank you talaga to SSS for providing this benefit. Imagine, at 120 days max, this is even bigger than the maternity benefit. All you need is to follow the steps when you apply. So here goes.

Here are the Top 10 Questions Re: SSS Sickness Benefit:

1. What are the Qualifications of the SSS Sickness Benefit?
2. How to Compute for the SSS Sickness Benefit? Do you have a convenient Sickness Benefit Calculator to share?
3. How will SSS pay out the SSS Sickness Benefit?
4. How many days of benefit can you claim?
5. Can you claim this benefit if you’re an OFW? What happens if you get sick overseas?
6. What is the Deadlines for Applying for SSS Sickness Benefit?
7. How to Apply for the SSS Sickness Benefit if You Pay SSS Voluntarily?
8. How to Apply for the SSS Sickness Benefit if You’re Employed
9. What are the additional documents a company needs to provide if the SSS Sickness Benefit Claim is filed through Company Representative?
10. What IDs Can You Use to Apply for SSS Sickness?

1. What are the Qualifications of the SSS Sickness Benefit?

a. You need to be out sick for FOUR (4) OR MORE days. It may be sick at home or in the hospital, but doctor has to verify you are sick.
b. There’s no more sick leaves left in the present year.
c. You have promptly informed the company if you’re employed. If you’re a voluntary member, inform SSS.
d. You had paid at least THREE (3) SSS contributions in the first 12 months before the semester of contingency.

IMPORTANT: You must be sick to avail of the SSS Sickness Benefit. A doctor must certify you are sick. If you are merely in home quarantine and not COVID-19 positive, do not lie on your medical certificate to claim SSS Sickness Benefit.

2. How to Compute for the SSS Sickness Benefit?

The calculation for the SSS Sickness Benefit is very similar to the SSS Maternity Benefit — The only difference is that it’s 90% of your Average Daily Salary Credit:

1. Check out if you have enough SSS contributions.It is the yellow box highlighted in YELLOW. You need at least 3 hulogs for the period. For example, you got sick this August 2020, you need to have at least 3 hulogs in April 2019 to March 2020 to qualify for ANY SSS sickness benefit.

2. Get your Average Monthly Salary Credit = Top 6 Highest MSC Divided by 6

Check out the total amount of hulogs to check your Average Monthly Credit. Similar to SSS maternity benefit, get only the top 6 premium contributions. In this case, there’s Php 2,400.00 six times between April 2019 to March 2020.

Check out the SSS 2019 Contribution to see how much is the Monthly Salary Credit for Php 2,400.00 average. In this case, Php 20,000.00, the highest.

3. Multiply the Average Monthly Credit by 0.9. That’s 90% of the Average Salary Credit.At Php 20,000, that’s Php 20,000 x 0.9 = Php 18,000.

4. Multiply the Php 18,000 x 6 and divide it by 180.

In our example, Php 18,000 x 6 divided by 180 = Php 600.00 per day.

That’s the Sickness Benefit you will get per day sick, multiplied by number of days. If you’re sick for 14 days, multiply Php 600.00 x 14 days = Php 8,400.00 sickness benefit.

Do you have a convenient Sickness Benefit Calculator to share?

Yes, I’ve made a convenient Sickness Benefit Calculator for convenience — Simply input the data on the Yellow boxes and the calculator will compute the estimated SSS Sickness Benefit for you:

Download here for Free Excel: FINAL SSS Sickness Benefit 080120 (Please use the PC for smoother access)

DISCLAIMER: This online calculator is made available solely for the convenience of public. It follows the SSS schedule of contribution tables and is based on the author’s own interpretation. It provides calculations based on the information you provide. All data entered are not stored. It is suggested, however, to clear your browser cache after completing your transaction. Should you find any inaccuracy, or have suggestions to improve this calculator, please PM me.

But even without the sickness calculator, it’s so easy to calculate. Just follow the table below:

3. How will SSS pay out the SSS Sickness Benefit?

If you are paying your SSS voluntarily, SSS will directly deposit the approved SSS sickness benefit onto your bank account.

If you are employed, your employer will pay for the SSS sickness benefit via your payroll. “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.”

Applications may be filed in any SSS branch that is most convenie​nt to employer.

4. How Many Days of Benefit Can You Claim?

The maximum number of sickness benefit is 120 years within a year ONLY. If you exceed 120 days, SSS will not cover. If you get sick in December, SSS will only cover 31 days of the year.

If the person’s sickness continues to the next year, they can still claim the next 120 days on the second year. However, they cannot exceed 240 days total for the same sickness.

5. Can you claim SSS Sickness Benefit if You’re an OFW and an SSS Contributing Member and you got sick? What happens if you got sick overseas?

Yes, if you’re an OFW and underwent home confinement, you can file your SBA form within the first 35-day period from the onset of your sickness to avail of the benefit.

If you got sick overseas, the documents must be in English and has either been certified by the Philippine Embassy or Consulate Office, or notarized abroad.

6. What is the Deadlines for Applying for SSS Sickness Benefit?

You can apply at the SSS Branch near you. Please take note the following deadlines when applying for SSS sickness benefit:

WARNING: Please take note of the tight deadlines!

It is only when you are a voluntary paying member and home confined for sickness that you have a stricter deadline that you need to notify . If you were hospital confined, it’s still a year from your first day of sickness.

If you were late in your notification filing, the sickness benefit will only start no sooner than the five days you have informed SSS.

Example, Jane was home confined from July 1 to 31, 2020 (31 days). Jane should have filed between July 2 to 6 (5 days). Instead, she filed on July 8, 2020, a delay of 3 days. Hence, minus 5 days, even though she was sick from July 1, SSS will only count it from July 3, 2020. This means, only the sickness from July 3 to 31 (29 days) will be paid by the SSS.

If you are Employed

If you are employed, your employer will be the one to file for your SSS Sickness Benefit.

If you are sick and has NOT been hospitalized, you have to notify the employer within five (5) calendar days after the start of sickness or injury. If an employee fails to notify their employer within 5 days, the SSS will only count the confinement five days before you notified them.

The employer, in turn, must notify the SSS of the confinement within (5) calendar days after receipt of the notification from the employee member.

IMPORTANT: If the ER fails to inform SSS within the five-day rule, then the employer will be reimbursed only for each day of confinement from the 10th calendar day before he notified SSS.

For example, Karen was home confinement was from March 1 to March 31, 2020 (31 days).

• Karen informed ER on March 5, 2020 (must be within March 2 to 6) — No delay
• Company informed SSS late on March 15, 2020 (must be within March 7 to 11).
• SSS should have paid for 31 days from March 1-31, 2020
• But commensurable period is only 27 days, which SSS will reimburse to Company: March 5 to March 31, 2020 only (31 days applied by ER will be reduced to only 27 days for the ER’s reimbursem*nt).

If the sick and non-hospital confined employee has given the required notification to the employer, but the company did NOT notify the SSS of the confinement within the prescribed period. This resulted to the reduction of the benefit or denial of the claim, and the ER shall have no right to recover the daily sickness allowance advanced to the EE.

Notification to the employer is not needed if the member’s confinement is in a hospital or if member got sick or was injured while working or while he was within the company premises. In this case, the employer has ten (10) calendar days from the start of the employee’s sickness or injury while he was working or while he was within the company premises to inform SSS.

While notification carries a strict deadline, the employer have the flexibility to have the SSS Sickness Benefit reimbursed within the ONE year of the start of sickness, which was paid for by the Employer to the employee.

To notify SSS in the time of COVID-19, here are the instructions:

7. How to Apply for the SSS Sickness Benefit If You are A Voluntary Paying Member?

IMPORTANT: If you’re a voluntary member and was home confined, you must submit to SSS your Sickness Benefit Application Form (SBA Form) within YOUR FIRST 5 days of your sickness. If you’re hospital confined, deadline is 1 year.

Step 1: If you’re a Voluntary Member, please download and fill up this Sickness Benefit Application Form (SBA) HERE.

Make sure that you put N/A if the data is not applicable. Initial every part where there’s a correction:

Step 2: Make sure your attending physician carefully and properly fills up:

a) Medical Certificate Form on the SSS Sickness Benefit Application Form, and
b) Your SSS Medical Certificate.

Here is the SSS Medical Certificate Form you need your physician to fill up. Attach this to the completed SBA Form:

Download: SSS Medical Certificate Form

If this is blank, your application will NOT be approved.

Step 3: Make sure you have opened a Bank Account in an SSS-accredited bank. SSS will directly deposit the SSS sickness benefit there.

You need to submit a photocopy of any of the following so SSS can ensure your bank account truly exists:

a. ATM Card with account number
b. Bank account passbook with your name
c. Bank Certificate or Statement
d. Deposit slip showing your savings account number

Photo Source: The Daily Mad Cat WordPress Blog

If you don’t have a bank account yet, SSS will provide you a Letter of Introduction (LOI) so you can open an account in their accredited bank. After you have a bank account, put the information here on the SBA Form:

Step 4: Submit the form with the other supporting documents:

IMPORTANT: Make sure all the documents you submit have your Complete Name and SSS Number.

If you were hospitalized, you need to submit the following:

• Original or Certified True Copy of the Discharge Summary or Clinical Abstract, AND
• Any of the following: Laboratory, X-ray, ECG or any diagnostic result or
  • If operated, the Operating Room Record
  • If you’re using the SSS Medical Specialist, he/she may still ask you to provide additional documents as proof of sickness.

If your sickness happened while you were still employed, and yet you are currently separated from the employer, you need an additional a) Certificate of Separation from Employment where the date of separation is clear, stating that you have not received SSS Sickness Benefit from your employer, and b) the Employer’s L-501 Form. If you are self-employed, you do not need to provide this anymore.Download: Certificate of Non Advancement of SSS Sickness Benefit

This is what the L-501 Form looks like:Image Source: Specimen Signature Card (L-501 Form)

If your employer does not want to give you the above, you can alternately fill up, notarize and submit an Affidavit of Undertaking in either English, Tagalog or Visayas along with your other documents. This is what the Affidavit of Undertaking looks like:

IMPORTANT: Please have it notarized before submitting it to SSS. Notarization is not expensive. Some charge only Php 50. Make sure you print two copies, one for you and the other to the notary.

Step 5: Submit all of the above to SSS with a copy of your Primary ID or Two Primary IDs.

Step 6: If your representative is applying for you, ask him to bring his valid ID and a Transmittal List:

Below is the SSS Transmittal List:

He/she must also bring his/her ONE Primary ID or two secondary ID Cards with signature and

8. How to Apply for the SSS Sickness Benefit If You are Employed?

Step 1: Print and fill up the the Sickness Benefit Notification Form (Download HERE).

Bring this with you when you see your attending doctor so he/she can fill up the Medical Evaluation (Part V) on the second page. Submit this to the company with your Sickness Benefit Reimbursem*nt Form:

This is what the Sickness Benefit Notification Form looks like:

IMPORTANT: Make sure your attending physician fills up Part VI. Medical Evaluation of your Sickness Notification Form so you can file for reimbursem*nt.

Step 2. Attach the Sickness Notification Form, and fill up and submit it to your employer with the Sickness Benefit Reimbursem*nt Form, which looks like this:

Remember, both the Sickness Notification Form and the Sickness Benefit Reimbursem*nt Application must be ORIGINAL. If the data is not applicable, writeN/A.All alterations should be initialed by the member or the company representative.

The Reimbursem*nt requires the money to be advanced to you by your employer. Sign this if you have already been advanced.

Step 3 : If you were hospitalized, you also need to submit the following:

1. Original or Certified True Copy of the Discharge Summary or Clinical Abstract, AND
2. Any of the following: Laboratory, X-ray, ECG or any diagnostic result:
   • If operated, the Operating Room Record
   • If you’re using the SSS Medical Specialist, he/she may still ask you to provide additional documents as proof of sickness.

IMPORTANT: Make sure all the documents you submit have your Complete Name and SSS Number.

Step 4: Submit the above with your Valid ID.

Either a) One Primary ID (e.g., UMID, Passport, PRC ID or Seaman’s Book) or Two (2) Secondary ID one of which should have your photograph and signature:

9. What are the additional documents a company needs to provide if the SSS Sickness Benefit Claim is filed through Company Representative?

You need to submit the following documents:

1. Letter of Auth​orization (LOA) issued by the employer’s authorized signatory reflected in the Employer Specimen Signature Card (SS Form L-501)
2. Original company ID of company representative.
3. System-generated Transmittal List (TL) or System-generated Acknowledgment Letter, if filed through Electronic Notification (three copies); or Employer TL (three copies)
4. Member’s Sickness Notification Application
5. Member’s identification card/s or document/s (photocopy)
6. All attached medical documents and reports, if any – Make sure the applicant’s name and SSS number is written on each page.

This is what the Employer Transmittal List looks like:

Download: SSS Sickness Benefit Transmittal List HERE

10. What IDs Can You Use to Apply for SSS Sickness?

Primary IDs include the following:

• Philippine passport – Department of Foreign Affairs
• Driver’s License – Land Transportation Office
• SSS UMID Card – Social Security System
• GSIS eCard – Government Services and Insurance Corporation
• Digitized Postal ID – Philippine Postal Corporation
• PRC ID – Professional Regulation Commission
• IBP ID – Integrated Bar of the Philippines
• OWWA ID – Overseas Worker’s Welfare Administration
• Diplomat ID – Philippine Embassy
• OFW ID – Department of Labor and Employment
• Voter’s ID – Commission on Election
• GOCC and Government Office ID– branch or agency of government (Example; PNP ID, AFP ID, DENR ID, DepED ID, etc.)

Here are the list of Secondary IDs:

• TIN ID
• GSIS ID
• Voter’s ID or Affidavit or Registration
• Postal ID *Primary for banking purposes
• School ID
• NSO Birth Certificate
• Baptismal Certificate
• NBI Clearance
• Police Clearance
• Barangay Clearance
• Health Card/Medical Card
• Fisherman’s Card (Bureau of Fisheries and Aquatic
• Credit Card
• OWWA ID (Overseas Workers Welfare Admnistration)
• Bank Account Passbook
• ATM Card with Cardholder’s Name
• Senior Citizen ID
• PhilHealth ID

FINAL NOTE: Best to Enlist to SSS

Please note the important thing about the SSS Sickness Benefit — You need to have enough hulogs to be covered.

What’s more, the hulogs must not be done retroactively so that one can receive the benefit. The contributions must be paid on time.

No SSS contributions that are paid RETROACTIVELY (orpahabol) based on the deadline will be included in determining your eligibility for the maternity benefit. This is most important when the contingency date of payment is within or after the semester of contingency.

SOURCE: SSS Corporate Communications Department, July 2019

I hope that by seeing all the benefits that SSS can provide, Filipinos will be more vigilant in paying their SSS contributions on time, and take advantage of many of the benefits offered by the SSS:

• SSS Sickness Benefit
• SSS 105-Day Maternity Benefit
• SSS Retirement Benefit
• SSS Salary and SSS Calamity Loans
• SSS Death Benefit
• SSS Funeral Benefit
• SSS Involuntary Unemployment Benefit
• SSS Employee’s Compensation program
• And of course, the finished SBWS Program (Free money for qualified applicants)

Have a wonderful MECQ week ahead!

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