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

18 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. 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

    ReplyDelete
  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

    ReplyDelete
  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

    ReplyDelete
  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 .

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

    ReplyDelete
  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

    ReplyDelete