Guide in Filing and Claiming SSS Sickness Benefits

The Philippine Social Security System provides a social insurance program that aims to protect its members. There are 8 SSS Benefits You Probably Didn’t Know About and one of the benefits provided by SSS is the Sickness benefits claim. If you are a member that has been unable to work for four days, you can file and claim your SSS Sickness benefits. Below is a set of information that could serve as your Guide in Filing and Claiming SSS Sickness Benefits.

Guide in Filing and Claiming SSS Sickness Benefits

The first thing you need to know is whether you are already qualified to file and claim for SSS sickness benefits or not yet. Here are the conditions you need to know before you get qualified to avail of the said benefits.

You are qualified to avail of the said benefits if you are:

1.  A member who got sick or injured and confined either in a hospital or at home, and you couldn’t work for at least four (4) days.
2. A member paid at least three months of contributions within the 12 months preceding the semester of your injury or sickness. 
3. Duly notify the SSS if you are sick or injured. 

• Amount of Benefits

When it comes to Guide in Filing and Claiming SSS Sickness Benefits, the next thing you need to know is the amount of the benefit you could receive.  

The amount of daily sickness benefit allowance would be equivalent to ninety percent (90 %) of your average daily salary credit or ADSC.

In one calendar year, members are allowed to have sickness benefits for a maximum of 120 days.

Some terminologies you need to know to understand how to compute your SSS Sickness Benefits correctly:

• Semester refers to the two (2) consecutive quarters ending in the quarter of your sickness.
• On the other hand, the quarter relates to three straight months in March, June, September, or December.  
• The compensation base for contributors and benefits related to the total earnings for the month or the Monthly Salary Credit.

You can refer to this link to see the table for the 2021 Contribution Table:

https://www.sss.gov.ph/sss/DownloadContent?fileName=2021-CONTRIBUTION-SCHEDULE.pdf#page=8 

1. You can divide the total monthly salary credits by 180 days to get the ADSC or the average daily salary credits.
2. You can compute the daily sickness allowance by multiplying the ADSC by 90 %.
3. To arrive at the number of benefits due, you need to multiply your daily sickness allowance by the approved number of days. 

Forms and other documents

There are a few things that you or your employer need to prepare to file and claim your SSS Sickness benefits. The documents you have to prepare would vary, depending on whether you are employed, self-employed, voluntary member, etc. Here are some of the forms and documents you will need to prepare and submit:

If you are personally filling for your SSS Sickness benefits:

The needed forms and documents when you are personally filing for your SSS Sickness Benefits are:

1. Sickness Notification Form

When filing for SSS Sickness Benefits, you need to fill up and pass your Sickness Notification Form. 

You can refer to this link to print or download your SNF:

https://www.sss.gov.ph/sss/DownloadContent?fileName=SIC_01252.pdf

2. Identification Card and documents

Next, you need to provide a copy of your valid identification card or documents such as:

• Driver’s License
• Passport
• NBI clearance
• Postal Identity card

You can also check the link below to see the list of valid Id’s and Documents accepted in SSS:

https://www.sss.gov.ph/sss/appmanager/pages.jsp?page=employeesregistration

3. Medical documents such as:

• Laboratory 
• X-ray
• ECG
• Diagnostic results
• Other documents that will support your claim

If you are Unemployed/ Self-employed or a Voluntary Member:

If you are a member that belongs to the category mentioned above, here are the documents that you need to file and claim your SSS Sickness Benefits claim:

1. Sickness Benefit Application form

You will need to fill up the Sickness benefit application form for the unemployed/ self-employed or voluntary member. Below is a link where you could get a copy or print the said form.

https://www.sss.gov.ph/sss/DownloadContent?fileName=SSSForms_Sickness_Benefit.pdf

2. Medical Certificates

Medical certificates would be needed to be submitted together with the other necessary documents. You need to remember that an SSS Medical Specialist will determine the additional medical records you need to submit to evaluate your claim.

*Note: In case of injury or sickness acquired abroad, the documents issued by the foreign country should be in English translation. It is also essential to get your documents authenticated by the Philippine Embassy or Consulate Office, or a notary public must duly notarize it from the country where you are. 

Filing for Your SBRA or Sickness Benefit Reimbursement Application (Employed Members)

If you are an employed member, these are the documents and forms that you will need when filing for your Sickness Benefit Reimbursement Application:

1. Sickness Benefit Reimbursement Application Form

One of the forms that you or your employer needs to fill up and submit is the SBRA form. You can get your copy of the form on the link provided below:

https://www.sss.gov.ph/sss/DownloadContent?fileName=SIC_01253.pdf

2. SN Form or Certificate of Medical Approval

You need to have a Sickness notification form, or a Certificate of Medical Approval approved and issued by the SSS Medical Evaluation Section. 

3. SS Cards and other valid Id’s

You or your employer must also have their SS card or any valid ID cards/documents such as:

• SSS card
• PRC card
• UMID card
• Passport

You or your employer could also check the list of secondary IDs/documents on this link: 

https://www.sss.gov.ph/sss/DownloadContent?fileName=List%20of%20Valid%20Identification%20Cards.pdf

Filing SBRA for your employees via the SSS website (For Employers)

Before serving an SBRA online for your employee, you first need to make sure that:

1. You have a registered My. SSS account, and you can easily view and transact online. 
2. You enroll in the Sickness and maternity Benefit Payment Thru-the-Bank Program.
3. You register your Bank account with any of the participating PESONet banks.
4. You have an SSS notification that includes in the SBRA claim. 
5. Lastly, you have a certification to advance the sickness benefit of your employee, according to their sickness notification.

How to File an SBRA for your Employees

Another vital piece of information in the Guide in Filing and Claiming SSS Sickness Benefits is how to file for an SBRA for your employee online. Listed below is the step-by-step process of filing your employee’s SBRA online. 

1. You need to log in to your My.SSS account.
2. Next, you need to encode your User ID and your Password. 
3. Check the box for the captcha to ensure that you are not a bot. 
4. You need to look and click the button that allows you to submit your application form. You’ll be able to see this under the E-Services. 
5. Fill up all the other information that is needed, then proceed to click the certification box. Then press the Submit button. 
6. You will see a confirmation page on your screen; make sure to save or copy your Transaction Reference Number. 
7. Lastly, you need to check your registered email to see if confirmation of successful SBRA. 

You can use this link to direct you to the SSS page for My.SSS Account:

https://www.sss.gov.ph/

Notifying SSS about the Sickness/ Injury

When it comes to Guide in Filing and Claiming SSS Sickness Benefits, the next thing you need to know is how and when to notify SSS of your sickness or injury. 

One of the requirements when filing and claiming for SSS sickness benefits is notifying or informing SSS of your sickness or injury. You can check the details below to know when and how you should notify SSS. 

For Employed members:

1. If you are an employed member, you need to advise your employer about your sickness or injury within five calendar days after the start of your mishap. 
2. Your employer shall notify SSS of your sickness/injury within the five calendar days after the start of your confinement. 

*Note: it is unnecessary to inform your employer of your mishap if you are confined in a hospital or have acquired the injury while on duty. They are also aware of your current condition because it would be automatic. 

For Unemployed, Self-employed, Separated from employment and Voluntary Members:

1. For home confinement, you need to directly notify SSS of your sickness/injury five days after the start of your confinement. 
2. If you are confined in a hospital, the notification could be made within one year.

*Note: 

You need to follow the rule on notification; failure to do so would be a ground for reducing or denying your claim. 

Additional information for OFW Members:

1. You have additional 30 days grace period if you are confined at your home.
2. However, if you are a qualified member who has been hospitalized, the prescriptive period of filing for your sickness notification will be one year from the date of your discharge.

Filing in line with SSS Circular No. 2020-004-b

Due to the Pandemic, the state was under a state of calamity for six months. Additionally, the SSS Calamity Loan Assistance Application provide on it. However, In SSS Circular No. 2020-004-b, a few adjustments were made for the convenience and safety of both employees and members. Here are some of the minor adjustments that are in line with SSS Circular No. 2020-004-b.

Starting the month of March 2020 up to the lifting of ECQ or GCQ in your area, the sickness notification rule you need to follow will be: 

1. Employee to Employer: You must submit your Sickness Notification Form within the sixty calendar days after the lifting of ECQ or GCQ
2. Employer to SSS: You need to submit the Sickness Notification Form of your employment within the sixty calendar days after receiving it from your employee. 
3. Self-Employed/Voluntary Member/OFW to SSS: Within the sixty calendar days after lifting ECQ and GCQ, you must submit your application form to SSS.

If the last day of filing falls on a holiday or weekdays:

If your deadlines fall on the weekends or holidays. You can file your sickness notification or Sickness Benefit Reimbursement Application on the next working day for hospital and home confinement. You need to immediately file it the following day to avoid having a penalty of delay. 

• Disbursement Procedure

The last step in Guide in filing and claiming SSS sickness benefits would be the disbursement process. Here is how you can claim your sickness benefits:

 For Employed Members:

• The payment of your daily sickness allowance would be advanced by your employer every payday.
• When SSS receives satisfactory proof of payment and legality, it will reimburse your employer for the legally advanced amount. The reimbursement would be sent thru the employer’s depository bank.

Note: If you’re an employer, you are required to enroll in the SMB-PTB or the “Sickness and maternity Benefits payments thru-the-Bank Program.”

For Members that are OFWs Separated from employment (Voluntary and SE members): 

• SSS will pay your sickness benefits directly to your depository bank account in any SSS-accredited bank under the SMB-PTB.
• If you are a member that has no existing bank account, the SSS will issue you a Letter of Introduction form. You will then need to present this to an SSS-accredited bank for you to open a cash card account or saving account. 
• The SSS will notify you of your benefit payment via email or Text.

Note: Your sickness benefit claims are mandatorily disbursed through your UMID card. If you don’t have a UMID card, you can pay through PESONet participating banks, E-wallets, or any accredited Cash payout outlets or accredited remittance transfer companies. 

Being a member of SSS is an advantage, especially when you need extra help because of your sickness or injury. Applying for sickness benefits could be a long process if you don’t know what to do. The information provided above could help you because it talks about the complete Guide in Filing and Claiming SSS Sickness Benefits.