# Sick and hospitalisation leave: what employers actually owe

URL: https://skillsforce.com.sg/insights/sick-and-hospitalisation-leave-singapore-employers
Title: Sick and hospitalisation leave: what Singapore employers must pay | Skillsforce
Description: The 60 days of paid hospitalisation leave include the 14 outpatient days, they do not add to them. The service scale, the two certification tests, and the payment duty.
Updated 21 August 2026. First published 21 August 2026. Author: Skillsforce (People-operations team)
Category: hr-operations

Two numbers govern paid medical absence in Singapore, 14 and 60, and a great deal of published guidance adds them together. It does not work that way: the 60 days of paid hospitalisation leave include the 14 outpatient days. Here is what the entitlement is, who may certify it, what the employer pays, and where MOM's guidance stops.

## How many days of paid sick leave and hospitalisation leave must a Singapore employer give?

An employee covered by the Employment Act with six months' service or more gets up to 14 days of paid outpatient sick leave and 60 days of paid hospitalisation leave a calendar year. The 60 include the 14, not add to them. Entitlement starts at three months, pro-rated. No government reimbursement.

## Key points

- The 60 days of paid hospitalisation leave include the 14 days of paid outpatient sick leave. MOM's own worked example: an employee who has already taken 14 outpatient days has 46 hospitalisation days left, not 60. There is no 74-day entitlement.
- Paid entitlement starts at three months of service and is pro-rated up to six: 5 outpatient and 15 hospitalisation days at three months, 8 and 30 at four months, 11 and 45 at five months, and the full 14 and 60 from six months onward.
- Certification splits into two separate tests. Any doctor registered under the Medical Registration Act or Dental Registration Act can issue a valid medical certificate that entitles the employee to paid sick leave. The employer owes the consultation fee only where the doctor was from a public medical institution or a clinic the company appointed.
- Part IV's salary caps are irrelevant to sick leave. A manager earning well above the S$2,600 Part IV line still gets the same 14 and 60 days. The only tests are Employment Act coverage and three months of service.
- Hospitalisation leave does not require a hospital bed. Day surgery, certified bed rest without being warded, quarantine under any written law, and certified rest after discharge all qualify.
- The employer pays at the gross rate of pay for hospitalisation leave, and at the gross rate of pay excluding shift allowance for outpatient sick leave. Nobody reimburses it: unlike Government-Paid Leave, there is no claim to file.
- MOM publishes no rule on carrying forward or encashing unused sick leave, and none on the consequence of a late 48-hour notification. Guidance that asserts forfeiture is stating a company policy, not a MOM rule.

Two numbers govern paid medical absence in Singapore: 14 days of paid outpatient sick leave, and 60 days of paid hospitalisation leave. A great deal of published guidance adds them together and arrives at 74. That figure does not exist, and the error costs money in both directions, because an employer who believes it either over-pays or ends up arguing with an employee who has read the same thing. This article is about the entitlement itself and the duty to pay it. The separate operational question, who keeps payroll and HR running while somebody is out for weeks, is covered in [HR and payroll cover during maternity or medical leave](/insights/hr-cover-maternity-medical-leave-singapore).

## The 60 days include the 14

MOM's wording on its [sick leave entitlement page](https://www.mom.gov.sg/employment-practices/leave/sick-leave/eligibility-and-entitlement) is direct: "The 60 days of paid hospitalisation leave includes the 14 days paid outpatient sick leave entitlement." MOM then works the example through: an employee who has already taken 14 days of paid outpatient sick leave in a year can take 46 days of paid hospitalisation leave, because 60 minus 14 is 46.

So there is one pool of 60 days, not two pools of 14 and 60. Outpatient days draw on it and hospitalisation days draw on it, and when it is empty it is empty. An employer budgeting 74 days of paid absence per employee per year is budgeting against a number nobody publishes. An employer whose handbook promises 74 has created an expectation the Employment Act does not support, which is a worse position to be in than simply having the figure wrong.

## What each length of service earns

Paid sick leave is not available from day one. The employee must have worked at least three months with the employer and be covered by the Employment Act. Below three months there is no paid entitlement at all, though nothing stops an employer granting unpaid leave or being more generous than the statute requires.

Between three and six months the entitlement is pro-rated, on a scale MOM publishes in whole months, per calendar year:

- Three months of service: 5 days of paid outpatient sick leave, 15 days of paid hospitalisation leave.
- Four months: 8 days outpatient, 30 days hospitalisation.
- Five months: 11 days outpatient, 45 days hospitalisation.
- Six months or more: the full 14 days outpatient, 60 days hospitalisation.

There is no half-step between whole months, so the figure changes on the day an employee completes the next one. Tracking each person's own service date against a calendar-year pool, and getting the pro-rated number right in the month somebody crosses from four months to five, is the sort of detail that lands in [payroll processing](/services/payroll) every cycle, and running it is the job.

## Who is covered, and why Part IV is a red herring

The [Employment Act covers all employees under a contract of service](https://www.mom.gov.sg/employment-practices/employment-act/who-is-covered), with narrow exceptions: seafarers, domestic workers, and statutory board employees or civil servants. Nearly every commercial employer's staff fall inside it.

The confusion comes from Part IV, which sets rest days, hours of work and other conditions of service. Part IV applies only to a workman doing manual labour earning a basic monthly salary of S$4,500 or less, and to an employee who is not a workman earning a basic monthly salary of S$2,600 or less. MOM says explicitly that it does not cover all managers or executives.

None of that touches sick leave. MOM's eligibility page attaches no salary ceiling and no Part IV qualifier to the entitlement; the tests are Employment Act coverage and three months of service. A manager on S$9,000 a month, with no claim to Part IV's rest-day and overtime protections, has exactly the same 14 and 60 days as anyone else. Employers who think paid sick leave stops above a salary line are importing a rule from the wrong part of the Act.

## Certification: two tests, not one

This is where most employers, and most published guidance, go wrong. There are two separate questions here with two different answers, and conflating them is the most common error in this area.

The first question is whether the employee gets paid sick leave at all. That turns on the medical certificate. The employee must be certified unfit for work by a medical practitioner registered under the Medical Registration Act or the Dental Registration Act, and any such doctor will do. For hospitalisation leave the class is narrower: certification must come from a medical practitioner who can admit patients into hospitals. Employers cannot require staff to use a particular clinic in order to qualify for paid leave, because [employees retain the right to visit any healthcare provider](https://www.mom.gov.sg/faq/sick-leave/can-employers-limit-employees-going-to-specific-clinics).

The second question is whether the employer owes the consultation fee on top of the salary. That duty is narrower. MOM requires [reimbursement of the medical consultation fee](https://www.mom.gov.sg/employment-practices/leave/sick-leave/medical-reimbursements-and-salary) only where the medical certificate came from a medical practitioner at a public medical institution or at a clinic appointed by the company, only where the employee has at least three months of service, and only where the consultation results in at least one day of paid sick leave. It is not required for cosmetic procedures.

Put the two together and the practical position is this. An employee who walks into an ordinary private GP, on no company panel, and comes out with a valid medical certificate is entitled to paid sick leave. The employer pays the salary. The employer does not owe the consultation fee. Both halves of that are true at the same time.

This is not a quiet technicality either. The Employment Act was amended with effect from 1 April 2019 to recognise medical certificates issued by any practitioner registered under those two Acts for the purpose of granting paid sick leave, and in a [written answer to Parliament dated 3 August 2023](https://www.mom.gov.sg/newsroom/parliament-questions-and-replies/2023/0803-written-answer-to-pq-on-educating-employers-on-accepting-mcs-from-registered-doctors) MOM described running guidebooks, newsletters, infographics and the Workright initiative with its tripartite partners, precisely because employers were still rejecting valid certificates that had not come from a company-nominated doctor. A leave policy that still names the company doctor as the only acceptable source of a medical certificate has been out of date since 2019.

Appointing a panel clinic remains a choice, and its real function is to control fee exposure rather than to control which certificates count. One limit is worth naming plainly, because it is a gap rather than a rule: MOM's stated position covers a public medical institution or a clinic appointed by the company, and no MOM page addresses the employer who has appointed no panel clinic at all whose employee visits an ordinary private one. Read strictly, the reimbursement duty does not reach that combination, but that is a reading of MOM's wording rather than a published MOM answer, and an employer relying on it should say so in its own policy instead of citing MOM for it.

## What counts as hospitalisation leave

Hospitalisation leave is wider than a hospital bed. An employee qualifies if they are warded in a hospital as an in-patient or for day surgery; if they are not hospitalised but require bed rest, for example for pregnancy-related complications; if they are quarantined under any written law; or if a medical practitioner who can admit patients into hospitals certifies that they require hospitalisation, further rest or medical treatment after discharge from hospital.

The consequence is worth stating plainly, because employers get this wrong in both directions. An employee does not have to be warded to be on hospitalisation leave. Somebody home by evening after day surgery is on it, and so is somebody sent home to rest after discharge on the certifying doctor's word alone. What does not convert an ordinary outpatient absence into hospitalisation leave is a GP writing "needs rest" without the ability to admit patients to a hospital, since MOM ties that certification to the admitting class of practitioner.

The type of procedure is rarely the test. Asked whether paid sick or hospitalisation leave must be granted for something like in-vitro fertilisation, MOM's answer is that if the doctor assesses the employee as unfit for work and issues a medical certificate, the employer must grant paid sick leave where the eligibility criteria are met. Fitness for work decides it, not the category of treatment. The separate exclusion of cosmetic procedures from fee reimbursement does not import a general rule that elective treatment does not count.

## What the employer pays, and who pays the employer

Two rates apply, and they are not identical. For paid hospitalisation leave, the employer pays at the gross rate of pay. For paid outpatient sick leave, the employer pays at the gross rate of pay excluding any shift allowance. Gross rate of pay is MOM's defined term and is not the same thing as basic salary; substituting one for the other is a payroll error that shows up on the payslip, which has [its own statutory content requirements](/insights/itemised-payslips-kets-singapore-employers), and eventually in a claim.

Nobody reimburses the employer. That is the sharpest contrast with parental leave, where the employer funds the salary first and then [claims the government-funded portion back](/insights/government-paid-leave-claims-singapore-employers) inside a fixed window. There is no equivalent scheme here. Sixty days of paid hospitalisation absence for one employee is sixty days of salary the business carries in full, with no claim to file and nothing to recover.

Two boundaries limit the exposure. First, an employee is not eligible for paid sick leave falling on public holidays, annual leave, rest days or non-working days, and since the consultation-fee duty depends on the consultation producing at least one day of paid sick leave, no fee is reimbursable for those days either. Second, where an employee is [entitled to paid medical leave under the Work Injury Compensation Act](https://mom.gov.sg/faq/sick-leave/i-ve-suffered-a-work-related-injury-and-am-on-medical-leave-under-wica-am-i-still-entitled-to-paid-sick-leave), they cannot also take paid sick leave for the same condition: a work injury or occupational disease runs through WICA rather than the Employment Act entitlement, and the two do not stack.

## Notice, the calendar year, and what MOM does not publish

To be eligible for paid sick leave, an employee must inform or attempt to inform the employer within 48 hours of the start of the absence, and hand the medical certificate over on returning to work. The 48 hours is a condition attached to the paid entitlement, not a courtesy. What MOM does not publish, either on the page carrying the rule or on the FAQ that asks the question directly, is what happens when that notice is late. A leave policy stating a specific forfeiture is stating the company's own position, not MOM's, and it should be written that way.

The entitlement [runs on the calendar year](https://www.mom.gov.sg/faq/sick-leave/how-is-sick-leave-and-hospitalisation-leave-calculated) rather than the employment anniversary. Leave taken in a year is deducted from that year's pool, and an absence starting in December and continuing into January is split across two years' pools. That is a real difference from annual leave, and it is where the second gap sits. MOM's guidance does not provide for carrying unused sick or hospitalisation leave into the next year the way it does for annual leave, and it does not state affirmatively that unused days lapse or that they cannot be encashed. Competing content routinely asserts forfeiture as though MOM had ruled on it. MOM has not. The honest position is that the calendar-year rule implies each year's pool stands alone, and that anything beyond that implication is the employer's own policy choice.

The same applies to the familiar question of falling ill during annual leave. MOM's annual-leave guidance on special situations does not deal with illness, medical certificates or hospitalisation during annual leave at all. Whatever a company decides about reclassifying those days, it is deciding it rather than applying a published rule, and deciding it in advance is a great deal cheaper than deciding it during a disagreement. That is one reason [written policies belong in place from the first employee](/insights/first-employee-singapore-hr-policies-checklist).

One thing MOM does publish is worth repeating in any handbook: employers should treat sick employees with compassion and should not terminate employment just for taking sick leave. An employee who believes they were dismissed for that reason has the wrongful dismissal route open to them.

## Who keeps this straight

None of the above is difficult in isolation. What makes it slip is volume and timing: the pro-rated figure in the month somebody crosses four months of service, a running balance on a single 60-day pool that two leave types draw on, the gross-rate distinction on the payslip, and a consultation fee that is owed on one certificate and not on the next. We run [HR Solutions](/services/hr) for employers who would rather not carry that themselves, including [interim cover](/services/hr/interim-cover) for the awkward case where the person who normally tracks all of it is the one on medical leave. If you would sooner keep it in-house, two fixes are worth making first: the handbook's wording on which medical certificates count, and a leave register that counts against one pool rather than two.

## Frequently asked questions

### Is hospitalisation leave 60 days on top of the 14 days of sick leave?

No. MOM states that the 60 days of paid hospitalisation leave include the 14 days of paid outpatient sick leave entitlement, and works the example through: an employee who has already taken 14 days of paid outpatient sick leave in a year can take 46 days of paid hospitalisation leave, because 60 minus 14 is 46. It is one pool of 60 days that both leave types draw on, not two pools totalling 74.

### How much paid sick leave does an employee with less than six months' service get?

It is pro-rated on MOM's published scale, per calendar year. At three months of service, 5 days of paid outpatient sick leave and 15 days of paid hospitalisation leave. At four months, 8 and 30. At five months, 11 and 45. At six months or more, the full 14 and 60. Below three months of service there is no paid entitlement under the Employment Act at all.

### Can an employer reject a medical certificate from a private GP?

No, where the doctor is registered under the Medical Registration Act or the Dental Registration Act. The Employment Act was amended with effect from 1 April 2019 to recognise medical certificates from any such practitioner for the purpose of granting paid sick leave, and employees keep the right to visit any healthcare provider. An employer may appoint panel clinics, but cannot require their use as the price of paid sick leave. Hospitalisation leave is the one narrower case: it must be certified by a medical practitioner who can admit patients into hospitals.

### When must an employer reimburse the medical consultation fee?

When three things hold together: the employee has worked at least three months for the employer, the consultation results in at least one day of paid sick leave, and the medical certificate came from a medical practitioner at a public medical institution or at a clinic appointed by the company. Reimbursement is not required for cosmetic procedures. A valid medical certificate from a private GP outside those categories still entitles the employee to paid sick leave; it simply does not oblige the employer to pay the fee.

### What counts as hospitalisation leave if the employee was never warded?

MOM treats an employee as on paid hospitalisation leave if they are warded as an in-patient or for day surgery, if they are not hospitalised but require bed rest, for example for pregnancy-related complications, if they are quarantined under any written law, or if a medical practitioner who can admit patients into hospitals certifies that they need hospitalisation, further rest or medical treatment after discharge. An overnight stay is not the test.

### What rate of pay applies during sick and hospitalisation leave?

The employer pays at the gross rate of pay for paid hospitalisation leave, and at the gross rate of pay excluding any shift allowance for paid outpatient sick leave. Gross rate of pay is MOM's defined term and is not the same as basic salary. There is no government reimbursement for either, so the employer carries the whole cost.

### Does unused sick or hospitalisation leave carry forward or get encashed?

MOM's published guidance does not provide for carrying unused sick or hospitalisation leave into the next year the way it does for annual leave, and it does not state affirmatively that unused days lapse or that they cannot be encashed. What MOM does state is that the entitlement is calculated on a calendar year, so leave taken in a year comes out of that year's pool. Anything beyond that is the employer's own policy and should be written down as such.

## Sources

- [MOM: Sick leave, eligibility and entitlement](https://www.mom.gov.sg/employment-practices/leave/sick-leave/eligibility-and-entitlement) (Accessed 21 August 2026)
- [MOM: Sick leave, medical reimbursements and salary](https://www.mom.gov.sg/employment-practices/leave/sick-leave/medical-reimbursements-and-salary) (Accessed 21 August 2026)
- [MOM FAQ: Can employers limit employees going to specific clinics](https://www.mom.gov.sg/faq/sick-leave/can-employers-limit-employees-going-to-specific-clinics) (Accessed 21 August 2026)
- [MOM: Employment Act, who is covered](https://www.mom.gov.sg/employment-practices/employment-act/who-is-covered) (Accessed 21 August 2026)
- [MOM FAQ: How is sick leave and hospitalisation leave calculated](https://www.mom.gov.sg/faq/sick-leave/how-is-sick-leave-and-hospitalisation-leave-calculated) (Accessed 21 August 2026)
- [MOM FAQ: Paid sick leave for procedures such as in-vitro fertilisation](https://www.mom.gov.sg/faq/sick-leave/are-ers-required-to-grant-paid-sl-including-hl-for-procedures-such-as-in-vitro-fertilisation) (Accessed 21 August 2026)
- [MOM FAQ: Medical leave under WICA and paid sick leave](https://mom.gov.sg/faq/sick-leave/i-ve-suffered-a-work-related-injury-and-am-on-medical-leave-under-wica-am-i-still-entitled-to-paid-sick-leave) (Accessed 21 August 2026)
- [MOM FAQ: Can your employment be terminated for taking sick leave](https://www.mom.gov.sg/faq/sick-leave/can-your-employment-be-terminated-for-taking-sick-leave) (Accessed 21 August 2026)
- [MOM: Written answer to PQ on educating employers on accepting MCs from registered doctors](https://www.mom.gov.sg/newsroom/parliament-questions-and-replies/2023/0803-written-answer-to-pq-on-educating-employers-on-accepting-mcs-from-registered-doctors) (Accessed 21 August 2026; written answer dated 3 August 2023)

## Related

- [Cover during maternity or medical leave](https://skillsforce.com.sg/insights/hr-cover-maternity-medical-leave-singapore)
- [Government-Paid Leave claims](https://skillsforce.com.sg/insights/government-paid-leave-claims-singapore-employers)
- [HR Solutions](https://skillsforce.com.sg/services/hr)
- [Interim HR cover](https://skillsforce.com.sg/services/hr/interim-cover)