SSS Claims Procedures for Maternity and Sickness Benefits

When claiming maternity and sickness benefits from the SSS, it’s important to follow strict deadlines. Missing these deadlines can lead to the forfeiture of the benefit – whether you’re the employer or the employee.

 

To help you in navigating the process, here’s a look at the claims procedures for maternity and sickness benefits

 

Maternity Benefits

 

 

  • Notification

 

 

It’s crucial to provide the SSS with a notification of pregnancy. If you’re an employee, self-employed, or voluntary member, failure to provide notification of your pregnancy to your employer or to the SSS can result in the denial of your maternity claims.

 

If you’re an employer, it is your responsibility to submit an employee’s pregnancy notification to the SSS. If you fail to do so, you may be required to pay the employee’s maternity benefits out of your own pocket.

 

For employees – You must give your employer notice of your pregnancy and expected childbirth date at least 60 days from the date of conception. An SSS Maternity Notification Form must be completed and submitted, along with a proof of pregnancy (typically an ultrasound) and two valid IDs.

 

For self-employed/voluntary members – Submit the completed notification form directly to the SSS

 

For employers – Submit the employee’s notification form and proof of pregnancy to the SSS immediately after the employee provides these to you

 

 

  • Claiming maternity benefits

 

 

For employees – Complete the Maternity Reimbursement Form and submit this to your employer along with a proof of birth and delivery method. You should also include a stamped and received copy of your Maternity Notification Form and two valid IDs.

 

Your employer will advance the payment to you within 30 days from the time you submitted your application. The employer will, in turn, file for reimbursement with the SSS.

 

For self-employed/voluntary members/separated from employment – Submit the needed documents directly to the SSS, who will deposit the payment to your personal account in an SSS-accredited bank

 

For employers – SSS will reimburse 100% of the maternity benefits you paid to your employee, to be deposited into the bank account you enrolled in the “Sickness and Maternity Benefits Payment thru-the Bank Program” (SMB-PTB). All SSS employer members are required to enroll in this program.

 

Sickness benefits

 

SSS members can claim sickness benefits from the SSS under the following conditions:

 

  • They are unable to work and are confined in a hospital or at home for a minimum of four days
  • They have paid at least three months of contribution in the preceding 12-month period
  • They have used up all their vacation leaves with pay
  • The proper notification was provided to the SSS within the prescribed period

 

 

  • Notification and reimbursement

 

 

As with maternity benefits, providing the SSS with notification of your sickness is an important part of the claims process. Failure to notify your employer or the SSS about the sickness can disqualify you from receiving benefits.

 

For employees –  You must notify your employer about your sickness within 5 calendar days from the start of your sickness. If you were confined in a hospital, you need to claim for sickness benefits within one year from your last day of confinement. If you were confined at home, you can claim benefits within one year from the start of your sickness.

 

Your sickness benefits are paid in advance by your employer, which then files for reimbursement from the SSS.

 

  • For self-employed/voluntary members/separated from employment – You must notify the SSS directly about your sickness no later than five days after the start of sickness or, if you were confined in a hospital, no later than one year from the start of confinement

 

  • For employers – You must file for reimbursement with the SSS within one year from the start of the employee’s sickness. The SSS will only reimburse the benefit amount that falls within the year immediately preceding the date the application for claims or reimbursement is received by the SSS.

 

Reimbursements will be deposited at the employer’s bank account opened under the SSS’s SMB-PTB program.

 

If you need more information about the SSS’s sickness or maternity benefits, get in touch with FilePino by calling +1.806.553.6552 (USA) or +63.917.892.2337 (Philippines).