NQa Legal Research

-ALL RIGHTS RESERVED-

July 4, 2019

By: SSS
Sickness Benefit

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).

Please refer to the following table:

1. 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.