Understanding the SSS Sickness Benefit: Determining the Semester of Contingency

In the realm of Philippine social security law, the Sickness Benefit serves as a vital wage-loss replacement for employees and self-employed individuals unable to work due to illness or injury. Central to claiming this benefit is the concept of the "Semester of Contingency." This period is the diagnostic anchor used by the Social Security System (SSS) to determine both a member's eligibility and the computation of their daily allowance.

1. Defining Key Terms

To pinpoint the Semester of Contingency, one must first understand two foundational SSS definitions:

Contingency: The date on which the member became unable to work due to sickness or injury, as certified by a physician.
Quarter: A period of three (3) consecutive calendar months ending on the last day of March, June, September, and December.
Semester: A period of two (2) consecutive quarters (6 months) ending in the quarter of contingency.

2. The Rule of the "Semester of Contingency"

The Semester of Contingency is defined as the two-quarter period ending in the quarter in which the sickness or injury occurred.

To identify it, follow these steps:

Identify the Date of Sickness: Note the exact month the illness began.
Identify the Quarter of Contingency: Determine which calendar quarter that month falls into (Q1, Q2, Q3, or Q4).
Identify the Semester: The Semester of Contingency consists of the Quarter of Contingency and the quarter immediately preceding it.

The Calendar Quarters:

Q1: January, February, March
Q2: April, May, June
Q3: July, August, September
Q4: October, November, December

3. Practical Examples

Date of Contingency	Quarter of Contingency	Semester of Contingency
May 15, 2024	Q2 (April - June 2024)	January 2024 to June 2024
August 10, 2024	Q3 (July - Sept 2024)	April 2024 to September 2024
January 5, 2025	Q1 (Jan - March 2025)	October 2024 to March 2025

4. Why the Semester of Contingency Matters

The determination of this semester is critical for two primary reasons: Qualifying Contributions and the Average Daily Salary Credit (ADSC).

A. The Qualifying Rule

Under Republic Act No. 11199 (The Social Security Act of 2018), a member is qualified for the sickness benefit if:

They are confined (at home or in a hospital) for at least four (4) days.
They have paid at least three (3) monthly contributions within the 12-month period immediately preceding the Semester of Contingency.

B. Calculation of the Benefit

The Semester of Contingency dictates the "look-back" period for your compensation.

Exclude the Semester of Contingency: Move backward from the start of the semester.
Identify the 12-Month Period: Look at the 12 months immediately prior to the Semester of Contingency.
Select the 6 Highest Salary Credits: From that 12-month period, pick the six highest Monthly Salary Credits (MSC).
Compute the ADSC: The sum of these six highest MSCs is divided by 180 to get the Average Daily Salary Credit.
Daily Sickness Allowance: The benefit is equal to 90% of the resulting ADSC.

5. Legal Prescriptions and Notification

While determining the semester is a mathematical exercise, the right to the benefit is contingent upon proper notice:

For Employees: The employee must notify the employer within five (5) calendar days after the start of confinement. The employer, in turn, must notify the SSS within five (5) calendar days after receipt of the notification from the employee.
For Self-Employed/Voluntary Members: They 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 notification must be made within one (1) year from the last day of confinement.

Important Note: Failure to observe the notification period or the 12-month look-back rule (based on the correctly identified Semester of Contingency) may result in the reduction or total denial of the claim.

Summary Table for Determination

Month of Sickness	Semester of Contingency	12-Month Period for Contributions
Jan / Feb / Mar	Oct (Prev Year) to Mar (Current)	Oct (2 Years Prior) to Sept (Prev Year)
Apr / May / Jun	Jan to Jun (Current)	Jan to Dec (Prev Year)
Jul / Aug / Sep	Apr to Sep (Current)	Apr (Prev Year) to Mar (Current)
Oct / Nov / Dec	Jul to Dec (Current)	Jul (Prev Year) to Jun (Current)