Filing SSS Sickness Benefits in the Philippines
(A comprehensive legal guide under Republic Act No. 11199 and related SSS issuances)
1. Overview
The Sickness Benefit is a daily cash allowance paid by the Social Security System (SSS) to a member who is unable to work due to illness or injury and who meets the qualifying conditions prescribed by Republic Act No. 11199 (Social Security Act of 2018), its Implementing Rules and Regulations (IRR), and successive SSS Circulars (e.g., 2019-009, 2021-009, 2023-004, 2024-006). It applies to employees (private-sector), self-employed, voluntary members, household workers (kasambahay), and land-based Overseas Filipino Workers (OFWs).
2. Legal Foundations
| Statute / Issuance | Key Provisions Relevant to Sickness Benefit |
|---|---|
| RA 11199, §§14-15 | Creates the sickness benefit; sets 120-day limit per calendar year; mandates employer advance payment. |
| IRR of RA 11199, Rule 14 | Operationalizes qualifying conditions, notification rules, and computation. |
| SSS Circular 2019-009 | Online filing by employers via My.SSS. |
| SSS Circular 2021-009 | “SSS Pandemic Relief” – extended deadlines, acceptance of e-medical certificates. |
| SSS Circular 2023-004 | Mandatory use of Sickness Benefit Reimbursement Application (SBRA) Portal. |
| SSS Circular 2024-006 | Consolidated digital filing rules; penalties for late employer reimbursement claims. |
3. Eligibility & Qualifying Conditions
Contribution Requirement: At least 3 monthly contributions within the 12-month period immediately before the semester of contingency.
Incapacity: Confinement (hospital or home) for ≥ 4 consecutive calendar days due to illness/injury certified by a licensed physician.
Used Sick Leave: For employed members, all company-paid sick leaves for the current year must be exhausted before entitlement.
Proper Notification:
- Employee → Employer: within 5 calendar days from onset; if hospital confinement, within 1 year from discharge.
- Employer → SSS: within 5 calendar days from receipt of employee notice; hospital cases within 1 year.
- Self-Employed / Voluntary / OFW: direct notice to SSS within 5 days (home) or 1 year (hospital).
120-Day Rule: Maximum 120 compensable days per calendar year per member; beyond 240 days may transition to Disability Benefit.
4. Benefit Amount & Computation
Daily Sickness Allowance (DSA) = 90% of the member’s Average Daily Salary Credit (ADSC).
ADSC = Sum of the six highest Monthly Salary Credits (MSC) in the last 12 months before the semester of sickness ÷ 180.
Total Benefit = DSA × approved number of days (subject to the 120-day annual cap and medical evaluation).
Employer’s Role:
- Advance the full amount to the employee within 30 days of filing.
- Reimbursement from SSS through the SBRA Portal; SSS remits to employer’s enrolled bank account or via PESONet.
5. Required Documents
| Member Type | Core Documents | Additional / Situational |
|---|---|---|
| Employed | • SSS Form CLD-9N (Sickness Benefit Application) • Medical Certificate (Form MMD-102) with attachments • Employer certification via My.SSS |
• Operative record / histopathology (for surgery) • Spreadsheet (for multiple employees, if bulk filing) |
| Self-Employed / Voluntary / OFW | Same forms filed personally or online | • Proof of payment of contributions (if not yet posted) • Passport stamp / OEC (for OFWs abroad) |
| Electronic Forms | Scanned or e-signed PDFs accepted under Circular 2024-006; e-Medical Certificates via PhilHealth Konsulta providers integrated by API. |
6. Step-by-Step Filing Procedure
A. Employees (Philippine-based)
- Notify employer within 5 days (use company HR portal or written notice).
- Submit medical documents to HR (original or soft copy).
- Employer logs in to My.SSS > e-Services > Sickness Benefit Application; encodes data, uploads docs.
- Employer prints SB Application Slip for employee’s record; signs both parties.
- Employer advances benefit (payroll, cash, or e-wallet).
- SSS validates; reimbursement credited to employer—normally within 10-15 working days if no deficiency.
B. Self-Employed / Voluntary / Kasambahay / OFW
- Create/Log in to My.SSS account.
- Navigate to “Apply for Sickness Benefit”, fill out CLD-9N-A, upload medical certificate.
- Upload supporting IDs and proof of contributions if prompted.
- Track status via “My.SSS > Transactions”.
- Benefit credited directly to member’s registered bank, e-wallet, or UnionBank Quick Card.
7. Deadlines & Prescriptive Periods
| Action | Deadline | Consequence of Delay |
|---|---|---|
| Member notice to employer (home confinement) | 5 calendar days | Employer may deduct 1 day benefit per day of delay (max 10). |
| Employer notice to SSS | 5 calendar days | Reimbursement reduced accordingly. |
| Hospital cases notice | 1 year from discharge | No reduction. |
| Filing of SBRA (employer reimbursement) | Within 1 year from last compensable day | Absolute bar to reimbursement beyond 1 year (unless force majeure). |
8. Employer Obligations & Penalties
- Advancement Duty: Mandatory; refusal actionable under Art. 303 of Labor Code and RA 11199 §28.
- Record-Keeping: Maintain sickness logs for 5 years.
- Penalties: P5,000-P20,000 fine and/or 6-12 years imprisonment for fraud, misrepresentation, or non-remittance of deductions.
- Contribution Continuity: Deduct employer and employee SSS contributions for months when salary is paid (including sick-leave differentials).
9. Processing Time & Modes of Release
- Normal queue: 10-15 working days from complete submission.
- Complex / specialist cases: 20-30 days (requires Medical Evaluation Section review).
- Release: PESONet-participating bank, UBP Quick Card, PayMaya, GCash or cheque (fall-back).
10. Appeals & Remedies
- Reconsideration: File within 60 days from receipt of SSS denial/partial approval with the same branch, supplying additional evidence.
- SSS Commission Appeal: Within 6 months of branch denial (RA 11199 §5).
- Court of Appeals (Rule 43): Within 15 days from SSS Commission decision.
- Further Appeal: Supreme Court via Petition for Review on Certiorari (Rule 45). Note: Exhaust administrative remedies before resorting to courts.
11. Common Pitfalls & Practical Tips
- Mismatch of signatures – ensure IDs match My.SSS profile.
- Unposted contributions – upload validated receipts (SS Form R-5) for self-employed.
- Late employer reimbursement filing – implement HR ticklers.
- Incorrect medical data – use ICD-10 codes; secure updated certifications for extensions.
- 120-day cut-off – apply for Disability Benefit if incapacity exceeds 240 days.
- OFW time zone issues – still follow Philippine “calendar day” reckoning.
12. Recent & Upcoming Policy Updates (as of August 2025)
| Year | Update | Effect |
|---|---|---|
| 2023 | Integration of PhilHealth Konsulta e-medical certificates | Auto-populate illness codes; fewer attachments. |
| 2024 | SBRA Portal mandatory for all employers & household employers | Paper filings no longer accepted except force-majeure. |
| 2025 (proposed) | Draft Circular on AI-assisted medical verification | 48-hour processing target; public consultation ongoing Q4 2025. |
13. Frequently Asked Questions
| Question | Answer (concise) |
|---|---|
| Can I receive sickness and maternity benefits at the same time? | No. Periods cannot overlap (RA 11199 §14(f)). |
| Is COVID-19 still a compensable illness? | Yes, if resulting incapacity is medically certified; attach RT-PCR or medical abstract. |
| Are mental-health conditions covered? | Yes, provided incapacity and treatment plan are certified by a licensed psychiatrist or clinical psychologist. |
| Does resignation forfeit a pending sickness claim? | No. Membership continues; the employer must still advance and may offset against final pay. |
| How are partial days treated? | Fractions are rounded up to one whole compensable day. |
14. Conclusion
The SSS Sickness Benefit is a robust social-insurance protection that hinges on timely notification, accurate documentation, and strict observance of filing periods. Both employers and members must now navigate a predominantly digital system that significantly shortens processing time but imposes heavier penalties for non-compliance. Staying current with SSS Circulars—and maintaining an updated My.SSS profile—ensures that you or your employees receive the full measure of protection envisioned by RA 11199.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. For case-specific guidance, consult the SSS or a qualified Philippine labor-law practitioner.