Wednesday, March 23, 2016

How to Apply SSS Sickness Benefit or Social Security System

How to Apply SSS Sickness Benefit or Social Security System

Overview:

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.

Qualifying Conditions:

A member is qualified to avail of this benefit if:

1. A member is unable to work due to sickness or injury and confined either in a hospital or at home for at least four (4) days;

2. He/she has paid at least three (3) months of contributions within the 12-month period immediately before the semester of sickness or injury;

3. He/she has used up all current company sick leaves with pay; and

4. He/she has notified the employer regarding his sickness or injury by filing the sickness benefit application; if he/she is unemployed, voluntary or self-employed member, the sickness notification should be submitted directly to SSS.

How to Apply:

A. Notification Procedures

For Employees and Employers:

A member should notify the employer within five (5) calendar days after the start of sickness or injury. The employer, in turn, must notify the SSS of the confinement within (5) calendar days after receipt of the notification from the employee member. 

Notification to the employer shall be made within one year from start of confinement if the member's confinement is in a hospital. If the member got sick or was injured while working or while he was within the company premises, sickness notification shall be made within ten (10) days from the start of confinement. In this case, the employer must notify the SSS within 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.

For Unemployed, Self-employed and Voluntary Members:

Unemployed, self-employed or voluntary paying members should notify the SSS directly within five (5) calendar days after the start of confinement, unless such confinement is in a hospital, in which case, notification should be made within one (1) year from start of confinement.

Effects of failure or delay in notification 
  • If the employee notifies the employer, or the SSS, in the case of an unemployed, self-employed or voluntarily paying member, beyond the prescribed five-day period, the confinement shall be deemed to have started not earlier than the fifth day immediately preceding the date of notification.
  • If the employer notifies the SSS beyond five (5) calendar days after receipt of the notification from the employee, the employer shall be reimbursed only for each day of confinement starting from the 10th calendar day immediately preceding the date of notification to the SSS.
  • If the employee has given the required notification to the employer, but the employer fails to notify the SSS of the confinement within the prescribed period resulting in the reduction of the benefit or denial of the claim, the employer shall have no right to recover the daily sickness allowance advanced to the employee.

B. Application Requirements

1. Forms Needed

A. For the Employee: Sickness Notification (SS Form CLD-9N)

How to Apply SSS Sickness Benefit or Social Security System
Sample: Sickness Notification / Visit SSS: Sickness Notification 

B. For the Employer: SSS Form B-304 (Sickness Benefit Reimbursement Application)

How to Apply SSS Sickness Benefit or Social Security System
Sample: SSS Form B-304 / Visit SSS: SSS Form B-304

C. For Unemployed/Self-Employed/Voluntary member 

A. Sickness Benefit Application Form for Unemployed/Self-employed/Voluntary Members (SS Form CLD-9A)

How to Apply SSS Sickness Benefit or Social Security System
Sample: Sickness Benefit Form / Visit SSS: Sickness Benefit

B. Medical certificate (SS Form MMD-102)

How to Apply SSS Sickness Benefit or Social Security System
Sample: Medical Certificate Form / Visit SSS: Medical Cetificate

2. Certified true copy of medical records

A.Hospital abstract
B. Operating Room Record
C. X-ray, CT Scan, ECG, Ultrasound Results, if any
D. Other clinical record/diagnostic procedure results

3. Proof of Identification

1. UMID or SSS biometrics ID card or two (2) other valid IDs, both with signature and at least one (1) with photo and date of birth.

4. Additional Requirements

A. For Unemployed Members
  • Certification from last employer showing the effective date of separation from employment or notice of the company's closure/strike or certification from the Department of Labor and Employment (DOLE) that the employee or employer has pending labor case.
  • Certification that no advance payment was granted, if the date of separation form employment is within the confinement period being applied for.
B. For claim filed by Authorized Company Representative
  • Blue card, representative's SS card, or two (2) valid IDs both with signature and at least one (1) with photo; and
  • Photocopy of the member's SS card or two (2) valid IDs both with signature and at least one (1) with photo and date of birth duly signed by the member and authenticated by the authorized company signatory.
5. Filing Procedure

Claims may be filed at the nearest SSS office. However, processing will be done at the branch where the employer and employee records are based.

The amount of a member's sickness benefit per day is equivalent to ninety percent (90%) of the member's average daily salary credit.

Benefit Computation:

1. Exclude the semester of sickness.
  • A semester refers to two consecutive quarters ending in the quarter of sickness.
  • A quarter refers to three consecutive months ending March, June, September or December.
2. Count 12 months backwards starting from the month immediately before the semester of sickness.

3. Identify the six highest monthly salary credits within the 12-month period.

Monthly salary credit salary credit means the compensation base for contributions and benefits related to the total earnings for the month. (The maximum covered earnings or compensation is P16,000 effective January 1, 2014).

4. Add the six highest monthly salary credits to get the total monthly salary credit.

5. Divide the total monthly salary credits by 180 days to get the average daily salary credit.

6. Multiply the average daily salary credit by 90 percent to get the daily sickness allowance.

7. Multiply the daily sickness allowance by approved number of days to arrive at the amount of benefit due.

For example, let us say that an SSS member gets sick or injured in October 2013 for 20 days:

a. The semester of sickness would be from July 2013 to December 2013.

b. The 12-month period would be from July 2012 to June 2013 within which the six highest monthly salary credits will be chosen.

c. Let us assume that the six highest monthly salary credits are P15, 000 each. The total monthly credit would be P90, 000 (P15, 000 x 6).

d. The total monthly salary credit would be divided by 180 to get the average daily salary credit of P500 (P90,000/180).

e. The daily sickness allowance is 90 percent of the of the average daily salary credit or P450 (P500 x 90%).

f. The sickness benefit due is P9,000 (P450 x 20 days).

IMPORTANT!
  • 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. For unemployed, self-employed or voluntary members, the sickness benefit will be paid directly by the SSS to the member.
  • The SSS will reimburse the employer only for confinements within the one year period immediately preceding and the date the claim for benefit or reimbursement is received by the SSS, except for confinements in hospital.
  • For example, SSS receives the employer's reimbursement claim on Oct. 3, 2013 for the sickness period September 23 to Oct. 14, 2012. The employer will be reimbursed for the period Oct. 4 to 14,2012 only as Sept. 23 to Oct. 3, 2012 falls outside the prescribed one-year period for reimbursement claim.
  • For hospital confinement, the claim for benefit must be filed within one (1) year from the last day of confinement from the hospital. For home confinement, the claim for reimbursement by the employer must be filed within one (1) year from the start of illness. Failure to file the claim within the prescribed period will result to denial of the claim.
  • A member can be granted sickness benefit for a maximum of 120 days in one calendar year. Any unused portion of the allowable 120 days sickness benefit cannot be carried forward and added to the total number of allowed compensable days for the following year.
  • The sickness benefit shall not be paid for more than 240 days on account of the same illness. If the sickness or injury still persists after 240 days, his claim will be considered a disability claim.
For More Information:

SSS Building East Avenue, Diliman Quezon City, Philippines
For comments, concerns and inquiries contact:
SSS Trunkline No. (632) 920-6401
SSS Call Center: 920-6446 to 55; IVRS: 917-7777; 
SSS Email: member_relations@sss.gov.ph; 
SSS Facebook: https://www.facebook.com/SSSPh

Source: https://www.sss.gov.ph

48 comments:

  1. Binigyan ulit ako ng doctor ng 14 days na home confinement,malinaw na nakasulat sa SSS form..but why 4 days lang ang inapproved ng SSS officer? Dahil ba sa may previuos na ako na approved 14 days na paid na before ng employer ko? O dahil ba sa nagkasakit ako at di ako nakapaghulog last month kasi di nagtrabaho. But they said atleaat 3 months right? Kindly explain

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  2. Pwede bang kumuha ng sickness benefits kapag di nakakuha ng maternity benefits? Late ko na kasi nalaman na atleast 60days before due date ang required sa maternity. Voluntary member here... Thanks sa sasagot

    ReplyDelete
    Replies
    1. Nope. Magkaibang benefit yun e. But check with sss if pwede pang lakarin mat benefits mo.

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    2. pwede pa po yan.. ganyan nangyare saken last year check with sss po para sa requirements

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    3. Pwede po un hanggang mag 14 years old ang bata not sure sa age pero pwede po kailangan lng nila ng ultrasound ung original copy

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    4. Panu po kung naiwala na ung ultrasound... Kasi 6 years na anak ko

      Delete
  3. sir, mam pwde po b makakuha ng sckness benefits ang 1 mmber kht 13-14mnths plng xang member???and paano po kng skali nagconfine po xa s hsptal ng may 20 2017 at nailabas xa ng may -24 2017.at hndi p po nmin nrport s sss.pwde p po kya un.till now po kc hndi p nkakalakad ung member dhil s car accident.thnk u

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  4. Hi Goodmorning SSS, just wanna ask kung bakit poh sobrang tagal/hirap magdownload ng mga forms? hindi man lamang poh nalabas ung uploading bar kahit malakas nman ang net namin! Hope you could give any solution for this matter please.
    Thank you!

    ReplyDelete
  5. Good day! it is possible pa po ba na may makuha sa sss sickness benefits, kung na late filing na?
    wala na po bang ibang way para makapag claim?
    kahit mabawasan ang days???
    thank you po

    ReplyDelete
  6. SCENARIO:
    FIRST CONFINEMENT 6/13 (1/2DAY)-18/2017 RECUENCO CLINIC
    2ND CONFINEMENT 6/18-29/2017 VRP HOSPITAL
    @ VRP HOSPITAL ASSIGNED DR SIGNED MY SSS SICKNESS NOTIFICATIONS 14 DAYS AND THE
    SSS APPROVED IT. IN OUR COMPANY THEY APPLIED MY SL FOR THE CORRESPONDING
    WORKING DAYS. SO I STILL HAVE A REIMBURSEMENT TO RECEIVED OR THE COMPANY WILL
    RECEIVED MY REIMBURSEMENT ALTHOUGH THEY DEDUCT ME SSS CONTRIBUTION AND TAX FOR
    MY SSS LEAVE. THANKS


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  7. Pede po b magfile sickness notification kapag nkaleave due to pregnant spotting need mgbedrest for 15 days? Hoping for response. Thank you!

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  8. Hello ask ko lang po kung qualified po ako mag file ng sickness benefit after 5 months nanganak at nakatanggap ng maternity benefit. Naoperahan ako ng myoma after 5 months ko manganak. Separated po ako from my company at hndi makabalik sa work dahil need ko ipatanggal ang malaking myoma ko. Hoping an answer from you..

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  9. Hi po, ask ko lang regarding sss sickness , kasi nakapag file na ako ng notification na approved na rin na reimbursed na rin ng company kaso lang hindi nakapag pasa ng reimbursement form, pero napasa na lahat ng requirements, yon lang yong kulang reimbursement form, hindi naba tlga erereimburse yon ng sss sa company? wala bang ibang way? kasi ok namn lahat ng document yon lang tlga ang kulang? please I need your help

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  10. Gano katagal ibigay yung reimbursement ?? Yung agency ko lase kinukulet ko ang tagal ibigay yung pera 2 months na

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  11. requirements for filing a claim when confined in overseas hospital..tnx

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  12. pano po pag home confinement due to viral disease? nagkaron po ako ng bulutong, 14 days rest, bwal lumabas as well as per doctor's advice. qualified po ba to for sickness benefit? may pending loan pako. mareleasan kaya ako? salamt s mgrereply

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  13. informative post! I really like and appreciate your work, thank you for sharing such a useful facts and information about pay policy hrm strategies, keep updating the blog, hear i prefer some more information about jobs for your career hr jobs in hyderabad .

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  14. Napauwi po ako dahil nagka sinusitis aug 24.maka avail po ba ako kahit late na ng 2 buwan?

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  15. Napauwi po ako galing barko dahil nagks sinusitis ako noong aug 24 2017.mka avail po baa ako ng sickness benefit khit late ng 2 buwan.may pending loan pa ako sa sss

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  16. Ask ko lang kung pwede bang magavail husband ko kasi nagkatigdas sya at pinapahinga ng doctor from nov 12 to 16...may sickleave p sya...pwede p b syang magavail? Kahit may sickleave pa sya?

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  17. Hello po ask ko lang kung pwedeng mag-avail ang husband ng sickness(nag undergone laparascopic cholesyctomy) kahit voluntary member if pwede what are the requirements?

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  18. Ask lng po nconfine po aq ng thurs.2am then lumabas po ako sunday then extend ng doctor rest for 2days counted po b ang weekends pra mfile ko s sss?

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  19. Hello po, pwede pa po bang makuha benefits kahit 10 months na po after your confinement? and sno po ba dapat mag asikaso non? employee po ba or ung employer?.. and if forfeited na xa, cno po ang may negligence non?

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  20. PAANO MALALAMAN NG ISANG MEMBER KUNG DENIED OR RETURNED UNG APPLICATION NG SICKNESS BENEFIT, KUNG MAG IINQUIRE K S SSS OFFICE EXCEPT ONLINE INQUIRY,, EHH ANG ISASAGOT SAYO CONFEDENTIAL, EHH IKAW NA MISMO UNG NAG IINQUIRE..

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  21. DI PA BA SAPAT ANG MEDICAL CERTIFICATE AS PROOF SA PAG CLAIM NG SICKNESS BENEFITS?

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  22. may empleyado kami naaksidente dto sa company, under agency siya, nilakad naman agad ang NOTIFICATION at REIMBURSEMENT then, now.. sabi daw sa SSS need daw nya magpunta sa SSS for medical examination. okay po ba iyon?

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  23. ask ko lang po ilang days po pwedeng ifile ung sick leave kung 1month na po and 15days na pwede pa din po ba ifile ung sick leave

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  24. Pwede pa po ba mag file ng sick leave if almost Five months na ang lumipas after maoperahan?

    ReplyDelete
  25. Hello. I am an SSS member for 26 years.
    I undergo a total abdominal hysterectomy (gynecological surgery) on August 2015, and rested for 60 days as per my doc’s advise. I availed the Magna Carta Women or the Special Women’s Leave duly paid by my employer. I did not file for the SSS Sickness Benefit as I was not advised to do so. I just really thought that only the Magna Carta for Women benefit I can avail that time.
    Just this March of this year 2018, I got infos that when undergo a gynecological surgery, can avail booth benefits the Magna Carta for Women and the SSS Sickness Benefits because these benefits are different. Magna Carta be paid by the employer while SSS Sickness Benefit be paid by SSS.
    So, I called up SSS regarding this and they said to just try to file for it will be evaulated. So, last March 19, 2018, I tried submitting my SSS Sickness Benefits with all the documents required e. g. hospital records, ID through my employer and submitted by our company representative.
    After 3 weeks (just yesterday March 11), our HR informed me that SSS declined my claim.
    My question is, is it okay that I will go to SSS personally to explain them the reason why I filed my SSS Sickness Benefit very late and try to ask them to pardon and grant my request?
    Hoping for any comments here.

    Thank you.

    ReplyDelete
    Replies
    1. UPDATE: I went to nearest SSS office in my area last April 17. So, as expected, still they declined my claim as it is very late already and lapses the allowed one year period from hospitalization.
      But, they advised me to file for a DISABILITY BENEFIT CLAIM as this benefit allows the member to notify within 10 years. But, subject for SSS evaluation.
      So, I have to go back to my doctor for her to sign the SSS DISABILITY FORM. All the attachments are still the same with the SSS Sickness.
      So hopefully, SSS would approve my claim this time.

      Delete
  26. Hi Krystel. Pweding-pwede.
    Try to read this:
    IMPORTANT!
    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. For unemployed, self-employed or voluntary members, the sickness benefit will be paid directly by the SSS to the member.
    The SSS will reimburse the employer only for confinements within the one year period immediately preceding and the date the claim for benefit or reimbursement is received by the SSS, except for confinements in hospital.
    For example, SSS receives the employer's reimbursement claim on Oct. 3, 2013 for the sickness period September 23 to Oct. 14, 2012. The employer will be reimbursed for the period Oct. 4 to 14,2012 only as Sept. 23 to Oct. 3, 2012 falls outside the prescribed one-year period for reimbursement claim.
    For hospital confinement, the claim for benefit must be filed within one (1) year from the last day of confinement from the hospital. For home confinement, the claim for reimbursement by the employer must be filed within one (1) year from the start of illness. Failure to file the claim within the prescribed period will result to denial of the claim.
    A member can be granted sickness benefit for a maximum of 120 days in one calendar year. Any unused portion of the allowable 120 days sickness benefit cannot be carried forward and added to the total number of allowed compensable days for the following year.
    The sickness benefit shall not be paid for more than 240 days on account of the same illness. If the sickness or injury still persists after 240 days, his claim will be considered a disability claim.

    ReplyDelete
  27. Ask ko po pwede ba ako magfile ng ss benefit for injury kahit n walang police report. April 5, 2017 ako nagkafracture. Voluntary member po ako

    ReplyDelete
  28. Hello, pwede p b ako magfile ng ss benefits for injury dated 4/5 due to accident. Wala akong police report. Thanks.

    ReplyDelete
  29. I'm impressed, I must say. Seldom do I encounter a blog that's both educative and interesting, and let me tell you, you've hit the nail on the head. The problem is something which not enough people are speaking intelligently about. I'm very happy I found this during my search for something concerning this. yahoo login mail

    ReplyDelete
  30. the practice’s research found a similar case of a dog who experienced stomach upset after eating fertilizer with similar ingredients but at slightly different concentrations. walmartone com

    ReplyDelete
  31. Good am po pwede pa po ba ko mag file ng sss benefits naaksidente ako feb13 2018

    ReplyDelete
  32. Hi,

    Paano po if advised to rest for 7 days due to acute laryngitis and wala pa po kameng sick leave, so unpaid po.. Di po ba pwede mag avail ng SSS sickness benefit?

    ReplyDelete
  33. ..hi gud day tnong q lng po kng pwed q pdn maifile ung sss sickness loan q..last april 6 2017 naaksidente po aq..1wik dn po aq sa hospital due to a thigh fracture bone npsa nmn po lht ng requurements sa employer q n denied lng po ng sss at mga month of june npo nkuha ung mga req q sa employer q dun q po nlm n ndenied sya nubg month of may dhil nagend contract n ako sa knila bago pa maipasa.hindi ko naipasa agad kase hindi pa ako nakakalakad ng maayos nun mga minth of october aq naadvise n pwed na magwork ng doctor ko kaso office work padin..pwed ko padin po kaya sya ifile ngaun??

    ReplyDelete
  34. matagal akong member kaya lang dina ako nakapaghulog morethan 35yrs.pwede kaya akong makakuha medicalfinancial.15 days sa ospital my tubig baga hina tibok ng puso.nasa bahay na lang,naka oxgen total billmorethan 4000.00 thousand.

    ReplyDelete
  35. Good day po ask q po lng pwude po b aq mgfile ng sickness s sss dhil po ngksakit aq nun july 3 2018 ngpunta kmi s ospital at nklabas dn po aq ng july 4 2018. Pro s bhay n aq ngpa2galing and my follow up check up aq ulit every tuesday hnggng july 17 2018

    ReplyDelete
  36. Hi! Tanong ko lang. Nag notify kasi ako sa HR namin of my sickness last Thursday (07/19) pero nag start ako mag leave nung 07/16. Di pa knuha ng HR ung documents ko kase hindi pa kumpleto, di nila tinanggap ung id na pnrovide ko. Pero pinakita nya kasi sakin na nag file sya sa sss online then nakikiusap na ibalik ko agad ung mga requirements. May possibility kaya na bbayaran nila ako this coming payday namin kahit di ko pa naipapasa ung requirements ko? Ilang days ba ang allowed sa employer na magpasa ng requirements sa ssspara mairemburse ung amount na inadvance nila sakin?

    ReplyDelete
  37. sir / madam.

    bakit po ganun tinatakan ng late ung pro long sickness ko. pero na recieved nman nila bago pa mag 1 year. tpos pinabalik balik nila sa akin yung kc my mga kulang na requirements. nung nacompleto ko na lahat. bigla nalang nilang tinatakan ng late filling. at hinde na pwede i file ng sickness kc late na daw.

    ReplyDelete
  38. 1 year na hindi nakapaghulog sa sss ang boyfriend ko dahil contractual lang, ngayong nagkawork na cya ulit, nahulugan ng agency ng 1month palang , kahit 5months na cya sa agency nia. Now gusto nia magamit ang sickness benefit ng sss dahil naoperahan cya, pwde kaya un kahit hindi updated peru nahulugan naman ng hindi lang 3month? Ganun din ba sa philhealth?

    ReplyDelete
  39. pag naaprubahan po ba ang sickness notification, ang next ay reimbursement?

    ReplyDelete
  40. hello po, 10 months na po ang SSS ko , pwede ko po ba ilipat ang SSS ko para sa self employed. nag ka injury po kc ako. d ako naka file ng sick leave, since wala po ako kasama sa buhay kaya diko po na i file. yung 10months ko pwede po ba magamit yun??

    ReplyDelete
  41. gud pm po member po ako ng sss since 1989 almost 15 years po akong naka pa-work. nag-stop ako sa work year 2005 at hindi ko na po nagawang makapag hulog dahil narin sa kakulangan ng financial.. ask ko lang po kung pwede kong makuha yung lahat ng naihulog ko simula ng mag start akong makapagtrabaho pwede po ba yun..

    ReplyDelete
  42. Hi po pwedi bang mag file ng sickness kahit walang ID

    ReplyDelete