AT A GLANCE:

Sickness Benefit is a daily cash allowance paid by the employer to the member who is unable to work due to sickness or injury for each day of compensable confinement or a fraction thereof.

What is Sickness Benefit under the SSS Law?

Under Section 1, Rule 25 of the Implementing Rules and Regulations of Republic Act No. 11199, or the Social Security Act of 2018, the Sickness Benefit is defined as a daily cash allowance paid by the employer to the member who is unable to work due to sickness or injury for each day of compensable confinement or a fraction thereof, or by the Social Security System (SSS), if such person is unemployed or is Self-Employed (SE), Overseas Filipino Workers (OFW), voluntary member (VM) who have been previously covered either as employed/SE/OFW, and non-working (NW) spouse.

Who May Qualify for Sickness Benefit?

Section 2, Rule 25 of the Implementing Rules is instructive that to qualify for the grant of the sickness benefit, the member must meet the following requirements: 

i. Has paid at least three (3) monthly contributions within the twelve-month (12) period immediately before the semester of sickness or injury; [Sec 14, (a)]

No contributions paid retroactively by SE/VM/OFWs shall be used in determining his/her eligibility to sickness benefit wherein the date of payment is within or after the semester of contingency;

ii. Was confined for at least four (4) days either in a hospital or elsewhere as defined by the SSS; [Sec 14, (a)]

iii. Has notified the employer, if employed, or the SSS, if unemployed or SE/VM of the sickness or injury; [Sec. 14, (a), 3] and

iv. Has used up all current company sick leave with pay for the current year, if employed, except sea-based OFWs. [Sec. 14, (b)]

What are the Notification Requirements for Sickness Benefit?

Notification by the Employee or Member

Under Section 3, Rule 25 of the Implementing Rules, the rules on notification in the grant of sickness benefit are as follows:

1. For hospital confinement, notification to employer is not necessary, however, the employer shall inform the SSS of such confinement in the prescribed manner within one (1) year from date of discharge;
2. For confinement elsewhere, as may be defined by the SSS, the employee shall notify the employer of the sickness or injury in the prescribed manner within five (5) calendar days after the start of confinement. The employer shall in turn notify the SSS within five (5) calendar days after receipt from employee; 
3. For sickness/injury that occurred while working or within premises of the employer, notification by employee to employer is not necessary. However, the employer shall notify the SSS of such sickness/injury in the prescribed manner within five (5) calendar days after onset of sickness/injury;
4. The unemployed or SE member, land-based OFWs, or VM including NW spouse, shall directly notify the SSS of the confinement in the prescribed manner within five (5) calendar days after the start of confinement, except when such confinement is in a hospital, notification to the SSS in the prescribed manner shall be within one (1) year from date of discharge; and
5. OFWs are given thirty-five (35) calendar days in filing sickness benefits. This applies only for confinement elsewhere as defined by the SSS. (Section 3, Rule 25 of the Implementing Rules )

Notification by the Employer

Section 4, Rule 25 of the Implementing Rules provides for the rules on notification by the Employer as follows:

1. For hospital confinement, the employer shall notify the SSS in the prescribed manner within one (1) year from date of discharge;
2. For confinement elsewhere as defined by the SSS, the employer shall notify the SSS in the prescribed manner within five (5) calendar days after receipt of notification from the employee; and
3. For sickness/injury that occurred while working or within company’s premises, the employer shall notify the SSS of such sickness/injury/confinement in the prescribed manner within five (5) calendar days after onset of sickness/injury.

How Much is the Sickness Benefit?

Section 5, Rule 25 of the Implementing Rules states that the daily sickness allowance shall be equivalent to ninety-percent (90%) of the member’s average daily salary credit.

How Long May a Member Receive Sickness Benefit?

The grant of sickness benefit is subject to the following guidelines:

1. A member may be granted a maximum sickness benefit of one hundred twenty (120 days) in one (1) calendar year;
2. The sickness benefit shall be paid for not more than two hundred forty (240) days on account of the same illness or confinement;
3. Any unused portion of the allowable one hundred twenty (120) days sickness benefit cannot be carried forward nor added to the total number of compensable days allowable in the following year;
4. In cases where notification is necessary, the confinement shall be deemed to have started not earlier than the fifth (5th) day immediately preceding the date of notification;
5. The compensable confinement shall begin on the first (1st) day of sickness and the payment of such allowances shall be made by the employer every regular payday or on the fifteenth (15th) and last day of each month, and similarly in the case of direct payment by the SSS, for as long as such allowances are due and payable, provided that, such allowance shall begin only after all sick leaves of absence with full pay to the credit of the employee-member shall have been exhausted, as applicable;
6. One hundred percent (100%) of the daily benefits provided in the preceding paragraph shall be reimbursed by the SSS to said employer upon receipt of satisfactory proof of such payment and legality thereof, subject to the following:
   1. The employer has notified the SSS of such confinement in the prescribed manner within five (5) calendar days after receipt of notification from the employee member; and
   2. The SSS shall reimburse the employer or pay the unemployed member only for confinement within the one-year period immediately preceding the date the claim for benefit or reimbursement is received by the SSS, except confinement in a hospital in which case the claim for benefit or reimbursement must be filed within one (1) year from the last day of confinement.
7. For notification to the SSS made by the employer beyond five (5) calendar days after receipt of the notification from the employee-member, said employer shall be reimbursed only for each day of confinement starting from the tenth (10th) calendar day immediately preceding the date of notification to the SSS;
8. Where the employee has given the required notification to the employer, but the latter fails to notify the SSS of the confinement within the prescribed period resulting in the reduction of the benefit or denial of the claim, such employer shall have no right to recover the daily sickness allowance advanced to the employee-member;
9. The claim of reimbursement shall be adjudicated by the SSS within a period of two (2) months from receipt thereof, provided, that should no payment be received by the employer within one (1) month after the period prescribed herein for adjudication, the reimbursement shall thereafter earn simple interest of one percent (1%) per month until paid;
10. The provisions regarding the notification required of the member and the employer as well as the period within which the claim for benefit or reimbursement may be filed shall apply to all claims filed with the SSS;
11. When the start of the sickness confinement period falls on the semester wherein the member will not qualify for sickness benefit, the confinement period shall be shortened in such a way that the first (1st) day of confinement shall be adjusted forward to the next semester wherein he/she would qualify for the remaining period of confinement; and
12. Sickness and disability benefits may be availed of simultaneously, provided, that the following conditions are satisfied: 
    1. Sickness/injury and disability are not related; and 
    2. Member meets all the qualifying conditions for the grant of sickness and disability benefits. (Section 6, Rule 25 of the Implementing Rules)

Read also: Salient Features of Republic Act No. 11199, amending Republic Act No. 8282, also known as the New Social Security Law of 2018

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Alburo Alburo and Associates Law Offices specializes in business law and labor law consulting. For inquiries regarding legal services, you may reach us at info@alburolaw.com, or dial us at (02)7745-4391/ 09175772207/ 09778050020.

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