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.

However, the payments can help you cover the costs of medication, doctor visits, and other medical expenses.

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.

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:

  1. Pre-existing conditions: If you had a medical condition before joining the SSS program, it won’t be covered by the pension plan.
  2. 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.


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.

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