Under the Social Security Act of 2018 (Republic Act No. 11199), the Sickness Benefit is a daily cash allowance paid to a member for the number of days they are unable to work due to sickness or injury. With the Social Security System (SSS) transitioning to full digitization, the application process is now primarily conducted through the My.SSS Portal.

I. Eligibility Requirements

To qualify for the SSS Sickness Benefit, a member must meet the following statutory criteria:

Inability to Work: The member must be unable to work due to sickness or injury and must be confined either in a hospital or at home for at least four (4) days.
Contribution Requirement: The member must have paid at least three (3) monthly contributions within the 12-month period immediately preceding the semester of sickness or injury.
Exhaustion of Sick Leaves: For employed members, all current company sick leaves with pay for the current year must have been exhausted.
Notification: The SSS must be duly notified. (Note: Notification rules vary between employed and self-employed/voluntary members).

II. The Online Application Process

The SSS now mandates that claims for sickness benefits be filed electronically via the My.SSS Member Portal. Manual filing is generally only permitted in exceptional circumstances or system downtimes.

1. Enrollment in the Disbursement Account Enrollment Module (DAEM)

Before filing a claim, the member must ensure they have an enrolled disbursement account.

Log in to the My.SSS Member Portal.
Navigate to the E-Services tab and select Disbursement Account Enrollment Module.
Register a bank account (PESONet-participating), an e-wallet (e.g., GCash, Maya), or a Remittance Transfer Center (RTC).
Upload a proof of account (e.g., screenshot of mobile app, bank certificate, or ATM card photo).

2. Filing the Sickness Benefit Application (SBA)

For Employed Members: The employee must notify their employer. The employer, in turn, files the Sickness Benefit Reimbursement Application (SBRA) through the My.SSS Employer Portal.
For Voluntary, Self-Employed, and OFW Members:
1. Log in to the My.SSS Member Portal.
2. Go to the E-Services tab and click Submit Sickness Benefit Application.
3. Carefully read the instructions and click Proceed.
4. Enter the required medical information, including the start date of confinement, number of days, and the nature of the illness.
5. Upload the mandatory supporting medical documents (see below).
6. Review the details and submit.

III. Mandatory Documentation

The following documents must be scanned or photographed clearly and uploaded during the online submission:

Medical Certificate: Issued by the attending physician, indicating the diagnosis, the period of confinement, and the physician's PTR and License Number.
Clinical Records: For hospital confinement, a Discharge Summary or Clinical Abstract. For home confinement, laboratory results or diagnostic reports (X-ray, ultrasound, ECG, etc.) that support the diagnosis.
Identification: At least one primary ID (UMID Card, Passport, Driver’s License) or two secondary IDs.

IV. Notification Rules and Deadlines

Timely notification is critical. Failure to notify within the prescribed periods may result in the reduction or denial of the claim.

Employed Members: Must notify the employer within five (5) calendar days after the start of confinement. The employer must then notify the SSS within five (5) calendar days after receipt of the notification from the employee.
Self-Employed/Voluntary/OFW Members: Must notify the SSS directly within five (5) calendar days after the start of confinement, unless the confinement is in a hospital, in which case the notification period is one (1) year from the date of discharge.

V. Calculation of the Benefit

The daily sickness allowance is equivalent to 90% of the member's average daily salary credit (ADSC).

Formula Overview:

Identify the semester of sickness (the two consecutive quarters in which the sickness fell).

Look at the 12-month period prior to that semester.

Pick the six highest Monthly Salary Credits (MSC) within that 12-month period.

Total these six MSCs and divide by 180 to get the ADSC.

Multiply the ADSC by 90% to get the daily allowance.

Multiply by the approved number of days.

VI. Important Reminders

Maximum Limit: A member can be granted a maximum of 120 days of sickness benefit in one calendar year.
Extension: Any unused portion of the 120 days cannot be carried forward to the next year.
Medical Examination: The SSS reserves the right to conduct a medical physical examination or a home visit to verify the legitimacy of the confinement.
Progression to Disability: If the illness persists beyond 240 days (inclusive of the 120 days for the current year and 120 days for the succeeding year), the member may consider filing for a Disability Benefit.