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Social Security:
What is the 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.
How does an SSS member qualify for the sickness benefit?
A member is qualified to avail himself of this benefit if:
- he is unable to work due to sickness or injury and is thus confined either in the hospital or at home for at least four days;
- he has paid at least three monthly contributions within the 12-month period immediately before the semester of sickness;
- he has used up all current company sick leaves with pay for the current year; and
- he has notified his employer or the SSS, if he is a separated, voluntary or self-employed member.
How much sickness benefit is an employee entitled to receive?
The amount of an employee's sickness benefit is computed as: the daily sickness allowance times the approved number of days.
Effective May 24, 1997, the daily sickness allowance is 90 per cent of the average daily salary credit (Section 14 of Republic Act 8282).
How is the sickness benefit computed?
- 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 on the last day of March, June, September or December.
- Count 12 months backwards starting from the month immediately before the semester of sickness.
- 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. The maximum covered earnings or compensation is P15,000 beginning January 2002.
Please refer to the following table:
Range of
Compensation |
Monthly
Salary Credit |
| 1,000 - 1,249.99 |
1,000 |
| 1,250 - 1,749.99 |
1,500 |
| 1,750 - 2,249.99 |
2,000 |
| 2,250 - 2,749.99 |
2,500 |
| 2,750 - 3,249.99 |
3,000 |
| 3,250 - 3,749.99 |
3,500 |
| 3,750 - 4,249.99 |
4,000 |
| 4,250 - 4,749.99 |
4,500 |
| 4,750 - 5,249.99 |
5,000 |
| 5,250 - 5,749.99 |
5,500 |
| 5,750 - 6,249.99 |
6,000 |
| 6,250 - 6,749.99 |
6,500 |
| 6,750 - 7,249.99 |
7,000 |
| 7,250 - 7,749.99 |
7,500 |
| 7,750 - 8,249.99 |
8,000 |
| 8,250 - 8,749.99 |
8,500 |
| 8,750 - 9,249.99 |
9,000 |
| 9,250 - 9,749.99 |
9,500 |
| 9,750 - 10,249.99 |
10,000 |
| 10,250 - 10,749.99 |
10,500 |
| 10,750 - 11,249.99 |
11,000 |
| 11,250
- 11,749.99 |
11,500 |
| 11,750
- 12,249.99 |
12,000 |
| 12,250
- 12,749.99 |
12,500 |
| 12,750
- 13,249.99 |
13,000 |
| 13,250
- 13,749.99 |
13,500 |
| 13,750
- 14,249.99 |
14,000 |
| 14,250
- 14,749.99 |
14,500 |
| 14,750
- O V E R |
15,000 |
- Add the six highest monthly salary credits to get the total monthly salary credit.
- Divide the total monthly salary credit by 180 days to get the average daily salary credit.
- Multiply the average daily salary credit by 90 per cent to get the daily sickness allowance.
- Multiply the daily sickness allowance by the approved number of days to arrive at the amount of benefit due.
For example, let us say that an SSS member falls sick or gets injured in October 1998 for 20 days:
- The semester of sickness would be from July 1998 to December 1998.
- The 12-month period would be from July 1997 to June 1998 within which the six highest monthly salary credits will be chosen.
- Let us assume that the six highest monthly salary credits are P11,000 each. Thus, the total monthly salary credit is P66,000 (P11,000 x 6).
- The total monthly salary credit would be divided by 180 to get the average daily salary credit or P366.67 (P66,000/180).
- The daily sickness allowance is 90 per cent of the average daily salary credit or P330 (P366.67 x 0.9).
- Thus, the daily sickness allowance for 1998 is P330. This amount was derived by determining the daily salary credit as follows: P11,000 (maximum salary credit) x 6/180 = 366.67.
- Ninety per cent of P366.67 is P330.
- The total sickness benefit is P6,600 (330 x 20 days).
How many days in a year can a member avail himself of the sickness benefit?
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 allowable compensable days in the subsequent 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, the claim will be considered a disability claim.
Who should an employee notify regarding his sickness or injury?
A member should notify his employer within five calendar days after the start of the sickness or injury. The employer, in turn, has another five calendar days to notify the SSS. Notification to the employer is not necessary if an employed member's confinement is in a hospital or if he fell sick or was injured while working or was within the company premises. In this case, the employer has to notify the SSS within five days of the employee's sickness or injury. This is the rule on notification.
What is the procedure for notification for unemployed, self-employed and voluntary members?
If a member is unemployed, a self-employed person or voluntarily paying, he should directly notify the SSS within five calendar days after the start of confinement, unless such confinement is in a hospital in which case, notification is not necessary.
What are the effects of failure or delay in notification?
- If the employee notifies his employer, or the SSS, in the case of an unemployed member, 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 the five calendar days after receipt of the notification from the employee, the employer shall be reimbursed only for each day of confinement from the 10th calendar day immediately preceding the date of notification to the SSS.
- If the employee has given the required notification to his employer, but the employer fails to notify the SSS within the prescribed period resulting in the reduction or denial by the SSS of the claim, the employer shall have no right to recover the daily sickness allowance he paid to his employee.
For more questions on Social Security, check out http://www.sss.gov.ph/.
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