List of Sickness Covered by SSS and How to Claim It?
As a pension expert, I understand the importance of having health insurance coverage, especially for chronic illnesses that require long-term care. The Social Security System (SSS) in the Philippines provides coverage for a number of medical conditions, including chronic illnesses, maternity benefits, disability benefits, and death benefits.
One of the most critical aspects of this coverage is the extent to which medical conditions and illnesses are covered. In this blog post, we will discuss the list of sickness covered by SSS and how to file a claim for these benefits.
List of Sickness Covered by SSS
Chronic Illnesses
The SSS covers certain long-term illnesses such as hypertension, arthritis, diabetes, and cancer. If you have been diagnosed with any of these conditions, you may be eligible for regular payments depending on the severity of your medical condition and any other factors.
The payments can help you cover the costs of medication, doctor visits, and other medical expenses. To qualify for benefits, the symptoms must be severe enough to partially or totally incapacitate the member for work. A medical certificate from a licensed physician is required to confirm the member’s incapacity to work due to illness.
Maternity Benefits
Expecting mothers who are registered members of the Social Security System may qualify for maternity benefits as long as they fulfill specific criteria.
These requirements consist of being employed for a minimum of three months before conceiving and enrolled in either PhilHealth or HMO plans. The maternity benefits can help ease the financial burden of expenses associated with prenatal care, delivery, and postpartum care.
Check Out: How to Avail 70k SSS Maternity Benefits
Disability Benefits
In case you experience an illness or injury that results in a disability, there is a chance for you to obtain monthly financial support through the SSS. The amount of this disability allowance is calculated based on your monthly salary before your disability occurred.
Its purpose is to assist you as you go through your recovery process or adjust to living with a disability.
Moreover, the SSS provides rehabilitation programs that can help you regain your independence and ease your transition back into the workforce.
Death Benefits
If a member of the Social Security System in the Philippines passes away due to an illness or injury that was covered by their membership, their beneficiaries may be eligible to receive death benefits. However, the amount of these benefits depends on several factors, such as the length of the member’s employment and whether they had dependents when they passed away.
These benefits can serve as a crucial lifeline for the member’s loved ones, helping them cover the costs associated with their passing, such as funeral expenses. It is essential to understand the requirements for these benefits and to file a claim promptly to receive the necessary financial support during a difficult time.
How to File a Claim for SSS Sickness Benefits?
To file a claim for SSS sickness benefits, you will need to follow these steps:
1- Fill out the necessary forms
You will need to fill out the appropriate forms for the benefit you are claiming. You can download these forms from the SSS website or pick them up at your local SSS office.
2- Submit the forms
After completing the necessary forms for your SSS benefits claim, it’s important to submit them along with any relevant supporting documents.
The support documents can include;
- Copy of your Philippine ID card,
- Copy of medical bills or receipts,
- Copy of doctor’s prescription or certification related to your illness,
- and other necessary papers.
You can do this either by visiting the SSS office in person or by submitting the documents through the convenient SSS online portal.
By providing all the required documents, you can ensure that your claim is processed smoothly and efficiently.
3- Wait for processing
The SSS will review your claim and determine your eligibility for benefits. This process can take up to 2 weeks, so be patient.
4- Receive your SSS sickness benefits
If your claim is approved, you will receive your SSS sickness benefits through direct deposit or a check sent to your mailing address.
Did you know? You can now also compute your Sickness Benefits in just few clicks with our easy to use SSS Sickness Benefit Calculator.
Steps to Calculate SSS Sickness Benefits
- Determine Average Daily Salary Credit (ADSC):
The ADSC is calculated based on the member’s contributions over the last 12 months. You can find this information through your SSS contribution records. - Calculate Daily Sickness Allowance:
The daily sickness allowance is 90% of the ADSC.
Daily Sickness Allowance=0.90×ADSC - Identify the Number of Days of Confinement:
You must have been confined for at least four days in a hospital or at home due to illness or injury to qualify for benefits. - Calculate Total Benefit Amount:
Multiply the daily sickness allowance by the number of days you are unable to work due to your illness (up to a maximum of 120 days per calendar year).
Total Sickness Benefit=Daily Sickness Allowance×Number of Days Claimed
What is Not Covered by the SSS Pension?
It’s important to have a clear understanding of what the SSS Pension covers and what it doesn’t. While it provides coverage for many medical conditions and illnesses, there are certain exclusions to keep in mind.
Here are a couple of things that the SSS Pension doesn’t cover:
- Pre-existing conditions: If you had a medical condition before joining the SSS program, it won’t be covered by the pension plan.
- Cosmetic procedures: Cosmetic procedures such as plastic surgery, non-emergency dental care, and vision correction surgeries are typically not included in SSS plans. These are considered elective rather than medically necessary procedures.
It’s essential to be aware of what the SSS Pension doesn’t cover so that you can plan accordingly and seek out additional coverage for any exclusions.
Conclusion
Having a clear understanding of the list of sicknesses covered by SSS and how to file a claim can make a significant difference in your healthcare journey. It is also important to be aware of what is not covered by the SSS Pension, so you can plan and budget accordingly.
If you have any questions or concerns about your SSS coverage, don’t hesitate to reach out to a pension expert or SSS representative at your nearest branch or contact the SSS Online Help Desk for assistance.
I was diagnosed with Cervical Spondilosis. If I claim a disability benefit does this mean I can no longer be employed?
To qualify for SSS financial support for spondylosis, you must prove that your symptoms are severe enough that you become PARTially or totally incapacitated for work. You can be employed, but according to the physical limitations that have been provided for SS. I would also suggest verifying the information with your insurance agent.
Good Day! I am 53 years old. I undergone operation (Hystercetomy due to Myoma enlargement) last Jul 26, 2024. And hospitalized for 4 days @ Angeles University Foundation Medical Center, Pampanga.
How can I avail and claim sickness benefits with SSS program?
Good day! If you’re an employee in the Republic of the Philippines and happen to fall ill for more than five days, you need to fill out an SSS sickness notification form.
Can a pensioner apply for sickness/hospitalization claim? Thanks
Yes, he/she can do that. This includes chronic illnesses (such as hypertension, arthritis, diabetes, and cancer) and if you have an illness or injury that results in disability.
NOT covered by SSS are pre-existing medical conditions (if you had a medical condition before joining the SSS program) and cosmetic procedures.
Hello, may claims po ba na makukuha or benefits kapag may cancer si member. If yes, how po. TYSM
Yes, in the Philippines, members of the SSS may be entitled to certain benefits and assistance in the event of a cancer diagnosis:
1. Disability Benefits: If cancer affects a member’s ability to work, they can apply for disability benefits. A medical certificate confirming the diagnosis and the degree of disability will be required.
2. Sickness Benefits: If a member is temporarily unable to work due to cancer treatment, they can apply for sickness benefits. A medical certificate is also needed for this.
3. Health Care Benefits: Members can access medical services through the SSS Health Care Benefits program, which may help cover some treatment costs.
Is Bells Palsy covered by SSS Benefits?
Bell’s Palsy may be covered under the SSS benefits, particularly under the disability benefits program. To qualify for these benefits, an individual must provide medical documentation proving that the condition significantly impairs their ability to work.
if the member is on chemo session bale ilang beses po puede mag file if same illness or same reason ang pag leave?
The specific number of times a member can file for leave due to the same illness is not explicitly stated in the available regulations, but generally, members are entitled to a maximum of 120 days of sickness benefits within a year for any illness.
I was dignosed lumbar spondylosis and straightened cervical lordosis. I am unemployed, i decided to resigned last June due to back pain. Can i file it at the sss? And what kind of benefit can i get? Thanks
If your condition prevents you from working, you may qualify for a sickness benefit from SSS. If your back pain and related conditions are severe enough to be classified as a disability, you may also be eligible for disability benefits. In either case, you will need to provide medical documentation to show that your condition limits your ability to perform work-related tasks. I recommend that you consult with an insurance professional regarding your eligibility and benefit amount.
Hello po,
Anong pwede kong makuhang benefits sa SSS po for my monthly meds and quarterly laboratories pag may papillary carcinoma po ako for 8 yrs na po? Thank you
If you have papillary thyroid carcinoma, you may be eligible for sickness or disability benefits. Papillary thyroid carcinoma is included in the SSS Compassionate Allowance (CAL) program, which is designed to expedite the application approval process for applicants with certain serious medical conditions. If your application is submitted through the CAL program, it can be approved in as little as 2 weeks.
if motor vehicle accident can claim sss sickness benefits?
If you are involved in a motor vehicle accident and suffer injuries that prevent you from working, you may be eligible for sickness benefits from SSS.