SSS Sickness Benefit Requirements for Employed. The Social Security System (SSS) offers the Sickness Benefit program to provide financial support to its members who are unable to work due to illness or injury.
This benefit is available to employed, self-employed, voluntary, Overseas Filipino Workers (OFW), and non-working spouse members. In this article, we will explore the eligibility requirements, computation of benefits, and the application process to ensure you can make the most of this valuable assistance.
SSS Sickness Benefit Requirements for Employed
To qualify for the SSS Sickness Benefit, members must meet the following conditions:
- Inability to Work Due to Sickness or Injury: The member must be unable to perform work duties due to an illness or injury and must be confined at home or in a hospital for at least four consecutive days.
- Sufficient Contribution Payments: The member must have paid at least three months of SSS contributions within the 12-month period preceding the semester of illness or injury.
- Proper Notification: The SSS must be notified of the illness or injury. For employed members, the employer is responsible for submitting the notification within five days from the start of the illness. Self-employed, voluntary, and OFW members must notify the SSS directly within five calendar days of confinement or within a year of hospital discharge for hospital confinement.
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How the SSS Sickness Benefit is Computed
The amount of the Sickness Benefit is calculated based on the member’s average daily salary credit (ADSC), which is 90% of the member’s daily income. Here’s a step-by-step breakdown of the computation process:
- Identify the Semester of Contingency: The semester of contingency is defined as two consecutive quarters, ending with the quarter in which the illness or injury occurs.
- Determine the 12-Month Period: Count backwards 12 months from the start of the semester of contingency.
- Select the Six Highest Monthly Salary Credits: Out of the 12-month period, choose the six highest monthly salary credits to determine the total monthly salary credit.
- Compute the ADSC: Divide the total monthly salary credit by 180 days to obtain the ADSC.
- Calculate the Daily Sickness Allowance: Multiply the ADSC by 90% to determine the daily sickness allowance.
- Final Computation: Multiply the daily sickness allowance by the approved number of sick days to get the total sickness benefit.
Maximum Days and Claim Period
SSS members can avail of the Sickness Benefit for a maximum of 120 days in a calendar year. If a member’s illness persists beyond 240 days, the case may be considered a disability, and the Disability Benefit will be applied instead.
The claim must be filed within the prescribed period to avoid denial or reduction of benefits. For self-employed, voluntary, and OFW members, the Sickness Benefit Application (SBA) form must be submitted within five days of confinement or within a year from hospital discharge.
Filing the Sickness Benefit Application
For Employed Members
- Notify Your Employer: Inform your employer within five days from the start of your illness or injury. They will submit the SBA form to SSS on your behalf.
- Submission of Documents: Ensure that your employer submits the completed SBA form along with the necessary medical documentation to SSS.
For Self-Employed, Voluntary, and OFW Members
- Direct Notification: Submit the SBA form and required documents directly to SSS within the prescribed period.
- Medical Documentation: Provide any relevant medical records, such as a doctor’s certificate, laboratory results, and hospital records, if applicable.
Supporting Documents Required
- Sickness Benefit Application (SBA) Form: Properly filled out and signed.
- SSS ID or UMID Card: As primary identification. In its absence, other government-issued IDs like a driver’s license, passport, or voter’s ID can be used.
- Medical Records: Supporting documents for prolonged confinement, such as laboratory results, X-rays, and clinical records.
Disbursement of Benefits
The SSS has streamlined the disbursement of sickness benefits through various channels:
- UMID-ATM Card: Members with a UMID-ATM card can receive benefits directly to their accounts.
- Bank Transfers: For members without a UMID card, benefits are credited to their enrolled bank accounts under the PESONet system.
- E-Wallets or Remittance Centers: For members who prefer, benefits can be credited to electronic wallets or claimed through accredited remittance centers.
Members will be notified through SMS or email once the benefit is credited to their accounts. The process typically takes five banking days from the date of settlement.
Common Issues and Solutions
QNo:1. What if the notification period is missed?
Ans: Failure to notify SSS within the prescribed period may result in the reduction or denial of the claim. If the notification is late, the compensable period will begin five days before the actual notification date.
QNo:2. What happens if the sickness period exceeds 120 days?
Ans: If the sickness extends beyond 120 days but is less than 240 days, the additional days may be considered. However, for illnesses lasting more than 240 days, the SSS will evaluate the case as a potential disability claim.
QNo:3. How is the benefit affected by late filing due to holidays?
Ans: If the last day of filing falls on a holiday or weekend, members can submit their claims on the next working day without penalties.
Conclusion
The SSS Sickness Benefit provides essential financial assistance to members who are temporarily unable to work due to illness or injury. Understanding the eligibility criteria, computation methods, and proper application procedures is crucial for maximizing this benefit. For more detailed information, visit the SSS website or contact your nearest SSS branch for guidance.