1. What is sickness benefit?

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.

2. How does an SSS member qualify for the sickness benefit? a. He is unable to work due to sickness or injury and confined either in a hospital or at home for at least four days. b. He has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury. c. He has used up all company sick leaves with pay. d. He has notified the employer. 3. How much sickness benefit is a member entitled to receive?

The amount of sickness benefit per day is equivalent to 90% of the members average daily salary credit.

4. How is the sickness benefit computed? a. Exclude the semester 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. b. Count 12 months backwards starting from the month immediately before the semester of sickness. c. Identify the six highest monthly salary credits within the 12-month period.

Monthly salary credit means the compensation base for contributions and benefits related to the total earnings for the month.

d. Add the six highest monthly salary credits to get the total monthly salary credit. e. Divide the total monthly salary credits by 180 days to get the average daily salary credit. f. Multiply the average daily salary credit by 90% to get the daily sickness allowance. g. Multiply the daily sickness allowance by approved number of days to arrive at the amount of benefit due.

For example: SSS member gets sick in October 2008 for 20 days. The semester sickness would be from July 2008 to December 2008. The 12-month period would be from July 2007 to June 2008 within which the six highest monthly salary credits will be chosen. Let us assume that the six highest monthly salary credits are P15,000.00 each. The total monthly salary credits would be P90,000.00 (P15,000.00 x 6). The total monthly salary credits would be divided by 180 to get the average daily salary credit. P500.00 = (P90,000.00/180) Daily sickness allowance is P450.00 = (P500.00 x 90%) Sickness benefit due is P9,000.00 = (P450.00 x 20 days).

5. How many days in a year can a member avail of the sickness benefit?

A member can be granted sickness benefit for a maximum of 120 days in one calendar year. Any unused portion for the allowable 120 days sickness benefit cannot be carried forward and added to the total number 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 still persists after 240 days, his claim will be considered a disability claim.

6. Who should an employee notify regarding the sickness or injury?

A member should notify the employer within five (5) calendar days after the start of sickness. 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 the start of confinement if the members confinement is in a hospital. If the member got sick 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 employees sickness while he was working or while he was within the companys premises.

7. What are the effects of failure or delay in 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 days 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.

8. How would an employed member be paid sickness benefit?

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.

The SSS will reimburse the employer only for confinements within the one-year period immediately preceding the date the claim for the benefit or reimbursement is received by the SSS, except for confinements in hospital.

For example, SSS receives the employers reimbursement claim on Oct. 3, 2008 for the sickness period September 23 to October 14, 2007 only as Sept. 23 to October 3, 2007 falls outside the prescribed one-year period for reimbursement claim.

9. What is the prescribed period in filing a claim for sickness benefit of a member confined in a hospital?

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.

10.What forms are needed in filing for sickness benefit?

For employed member: SS Form CLD-9N (Sickness Notification) For the employer: a. SS Form B-304 (Sickness Benefit Reimbursement Application) b. SS Card or Acknowledgment Stub of SS Form E-6 with two valid IDs, one of which with recent photo. To ensure receipt of benefits by members, the authorized company representatives who file sickness benefit claims shall present the members SS Card or Acknowledgment Stub of SS Form E-6 with two valid IDs, at least one with photo. This requirement is in addition to the presentation by the company representatives own SS Card and blue card.

11.Where does the member file the claim for sickness benefit?

For the employed member - claims must be filed at the SSS servicing branch. Processing of claims are done at branch where the employer and employee records are based.