SSS Confirms Sickness Benefit Rules for 2025 – Eligibility, Filing Rules and Payment Details

If you’ve ever been forced to miss work due to flu, surgery, or injury, you know illness affects more than your health it hits your wallet too. Bills don’t wait for recovery. That’s why the Sickness Allowance in the Philippines, formally called the SSS Sickness Benefit, plays a crucial role. As of September 2025, this program remains a vital safety net for employees, self-employed workers, and overseas Filipinos who can’t work due to illness or injury.

The Purpose Behind the Program

The Social Security System (SSS) was created in 1957 to give workers financial protection in times of hardship—whether due to retirement, maternity, disability, or sickness. The sickness allowance was one of its earliest programs, designed to bridge the gap between health recovery and financial stability. It ensures workers have some income replacement when temporary illnesses prevent them from earning their wages.

What Exactly Is the Sickness Allowance?

In simple terms, the SSS sickness allowance is a cash benefit that replaces part of a worker’s daily income when illness or injury prevents them from working. Unlike private-sector sick leave, which many employers in the Philippines do not provide, this benefit is a government-mandated backup funded by contributions from workers and employers.

Eligibility Criteria for September 2025

To qualify for the sickness allowance, claimants must:

• Be unable to work for at least four days (hospitalized or confined at home).
• Have made at least three monthly contributions within the 12 months before the semester of illness.
• Notify their employer within five calendar days (for employees) or notify SSS within 60 days (for self-employed, voluntary members, and OFWs).
• Use up all company-provided sick leave with pay before claiming (except for sea-based OFWs).

Failing to meet any of these requirements can result in disqualification.

How the Benefit Amount Is Calculated

The formula is straightforward: 90% of the Average Daily Salary Credit (ADSC).

Step-by-step computation:

• Exclude the semester of sickness.
• Take the 12 months before that period.
• Identify the six highest monthly salary credits (MSCs).
• Add them up and divide by 180 to get the ADSC.
• Multiply the ADSC by 90% to get the daily sickness allowance.

The maximum MSC is ₱20,000, which caps the benefit amount even for higher earners.

Example Scenarios

• Average Earner:
• Monthly Salary Credit: ₱15,000
• 6 months × ₱15,000 = ₱90,000
• ₱90,000 ÷ 180 = ₱500 ADSC
• 90% of ₱500 = ₱450 per day
• 10 sick days = ₱4,500 benefit
• High Earner:
• Monthly Salary Credit: ₱25,000 (capped at ₱20,000)
• 6 months × ₱20,000 = ₱120,000
• ₱120,000 ÷ 180 = ₱666.67 ADSC
• 90% = ₱600 per day
• 10 sick days = ₱6,000 benefit

Rules and Maximum Days Covered

• Daily rate: 90% of ADSC
• MSC cap: ₱20,000
• Maximum coverage: 120 days per calendar year, up to 240 days for the same illness or injury

What’s New in September 2025?

While the rules remain unchanged, the biggest improvement is in filing. The My.SSS portal and mobile app now allow members to submit and track claims online. This digital-first system cuts down on long lines at SSS branches and speeds up processing times.

Step-by-Step Guide to Filing a Claim

Gather Requirements: Sickness Notification Form, medical certificate, hospital records, and employer certification (if employed).

Notify Employer or SSS:

• Employees: Notify employer within 5 days.
• Self-employed/OFWs: Notify SSS within 60 days.

File the Claim:

• Employers file on behalf of employees.
• Others file directly at SSS branches or online via My.SSS.

Wait for Processing: Claim status can be tracked digitally, with payments credited directly to the bank.

Common Mistakes to Avoid

• Missing the 5- or 60-day notification deadline.
• Submitting incomplete documentation.
• Falling behind in contributions.
• Entering incorrect bank details.

Real-Life Examples

• Liza, 30-year-old BPO worker: Contracted dengue, confined for 7 days, received ₱3,780 from SSS to cover medication and groceries.
• Juan, 40-year-old seafarer: Suffered a leg injury, filed directly, and received ₱12,000 for 20 days of leave, which sustained his family until recovery.

Why It Matters in Today’s Economy

With healthcare costs rising, the sickness allowance is more than a benefit—it is a safeguard against debt and financial instability. For low and middle-income families, even a few thousand pesos can mean paying for medicine, covering utilities, or buying groceries while the breadwinner is out of work.

FAQs on SSS Sickness Allowance September 2025

Q1: How much will I receive under the sickness allowance?
You will receive 90% of your Average Daily Salary Credit (ADSC), capped at ₱20,000 MSC.

Q2: How many days are covered per year?
The maximum is 120 days per year, and up to 240 days for the same illness.

Q3: What documents are required to file a claim?
You need a Sickness Notification Form, medical certificate, hospital records, and employer certification (if employed).

Q4: Can OFWs claim the sickness allowance?
Yes. Sea-based OFWs do not need to use company sick leave before claiming; they can file directly with SSS.

Q5: How do I file my claim online?
Log in to your My.SSS account, submit the required documents digitally, and track your claim status through the portal or mobile app.