Direct benefit payments from the Social Insurance Fund: answers to frequently asked questions

On December 1, 2021, Order of the Ministry of Health No. 925n dated September 1, 2021 came into force. There are many innovations in it: a new procedure for issuing and filling out temporary disability certificates, special rules for issuing temporary disability certificates during quarantine, changes in the rules for issuing sick leave for part-time work and child care. We tell you what has changed in the work of an accountant.

What are direct payments?

This is a payment scheme in which insured persons (employees) receive almost all benefits directly from the Social Insurance Fund. Employers act as intermediaries - they submit documents to social insurance for the assignment and calculation of benefits.

The Social Insurance Fund pays directly to employees:

sick leave for illness or injury, starting from the 4th day of incapacity for work;
sick leave due to an accident at work and (or) occupational disease;
maternity benefits;
a one-time benefit for women when registering in the early stages of pregnancy;
lump sum benefit for the birth of a child;
monthly child care allowance;
leave for an employee injured at work (in addition to the annual paid one).

Since 2021, direct payments are valid throughout Russia; the credit system has been abolished for everyone. If, for example, you pay an employee’s sick leave in full, you will not be able to reimburse such expenses from social insurance. It will not be possible to reduce the accrued insurance premiums on them.

How to reimburse the amount of excess expenses from the Social Insurance Fund

Regions that will soon join the Direct Payments project could still have an overpayment on the transition date—the cost of paying benefits exceeded the amount of insurance premiums. In this case, they have the right to receive reimbursement from the Social Insurance Fund for the amount of overspending or to offset it against upcoming payments.

To do this, the policyholder must contact the territorial office of the Social Insurance Fund at the place of registration for a refund and submit:

an application for reimbursement or allocation of funds for the payment of insurance coverage for each type of insurance separately;
a statement of calculation, which is submitted when requesting money for payment of insurance coverage or a 4-FSS report;
copies of documents confirming the validity and correctness of expenses.

If you have taken advantage of the credit, keep track of its balance to avoid falling behind on contributions to VNiM.

What benefits does the employer pay?

Organizations and individual entrepreneurs continue to accrue and pay at their own expense:

the first 3 days of sick leave in case of illness or injury of an employee;
funeral benefit;
4 additional days off to care for disabled children.

As before, employers can reimburse their expenses for funeral benefits paid and additional days off. To do this, you need to contact the FSS with an application and supporting documents. Within 10 working days, social insurance will make a decision on reimbursement of expenses to the policyholder. Then, within two more working days, the money will be transferred to the employer’s bank account.

sick pay for the first three days .

What is the period for providing a certificate of incapacity for work after dismissal?

According to the law, an employee has the right to apply for benefits to a former employer if the case of incapacity for work occurs within thirty calendar days from the date of dismissal.

It does not matter for what reason the employment contract was terminated, you will be paid 60% based on average earnings. However, if you first get sick and then quit, then the benefit is due in full.

How can an employee get paid for sick leave?

The employee submits the certificate of incapacity for work to his employer. If an electronic sick leave is issued, its number is reported. Depending on the situation, the employee will be required to provide certificates from other places of work, details for transferring money, etc.

The certificate of incapacity for work must be submitted no later than six months from the date of its closure. If you miss the deadlines, you will no longer be able to send sick leave to the Social Insurance Fund through your employer. The employee will have to independently contact social insurance with an application. The benefit will be paid if the deadlines are missed for valid reasons.

For the first three days of illness, the employer must calculate the benefit. There are 10 calendar days for this. The due date for payment of this part of the sick leave is the day closest to the payment of benefits after the calculation of benefits, established for the payment of wages (including advance payments).

For the remaining days of sick leave, money will be received from social insurance after:

the employer will send documents to the Social Insurance Fund for calculating benefits - no later than 5 calendar days from the date of their receipt from the employee;
Social insurance will check the documents within 10 days and make a decision on granting benefits.

The money will be transferred to the employee using the details he provided to the employer. This could be a bank account (not necessarily a salary account), a Mir card, or an address for a postal transfer.

From July 1, 2021, benefits related to maternity can only be received on cards of the Mir payment system.

Basic Concepts

According to Art. 183 of the Labor Code of the Russian Federation, the employer is obliged to pay compensation during the period of incapacity for work of the employee. According to the law, persons who have entered into official agreements, government officials, lawyers, private entrepreneurs, and farmers have the right to issue sick leave. The procedure for providing a document is carried out on the basis of Federal Law No. 323, Labor Code of the Russian Federation, Order of the Ministry of Health No. 624. It is permissible to issue a ballot during a period of temporary incapacity for work:

deterioration of the employee’s well-being;
caring for a sick minor child or adult close relative;
pregnancy, childbirth;
Occupational Illness;
days of quarantine;
stationary prosthetics;
treatment in a sanatorium.

The law does not establish a minimum period of suspension from official duties. Based on Order No. 624, the permitted time on paid leave if health deteriorates is 15 days for outpatient treatment without staying in a health facility. By decision of the commission, the period may be extended. The duration of the sick leave depends on the form of the pathology. The maximum permissible period of suspension from official duties is 12 months from the date of application to the clinic.

Attention! The amount of the benefit is determined by the average income, insurance experience, and the length of the citizen’s forced rest. Depending on the region, the head of the organization may take into account the minimum wage in a particular entity.

Does the calculation of benefits change with direct payments?

The procedure for calculating sick leave has not changed due to the transition to direct payments.

But from January 1, 2021, a new minimum wage is in effect - 12,792 rubles, that is, the minimum benefits have increased.

As in 2021, sick leave for a full month of incapacity should not be lower than the federal minimum wage, regardless of the length of insurance coverage and the employee’s actual earnings.

When calculating benefits for the first 3 days of illness:

calculate the benefit taking into account the employee’s insurance record in the usual manner;
calculate the benefit based on the new minimum wage, taking into account the regional coefficient;
compare the calculation results, select the largest value and multiply by 3 days of incapacity.

The minimum wage amount is taken on the date of opening the certificate of incapacity for work.

The free “My Business” service will help you calculate employee salaries and benefits quickly and without errors.

The procedure for generating and sending benefits

To start working with FSS benefits, on the main page of the system, select the desired organization at the top of the page and go to the “FSS” section > in the “Benefits and ELN” section, click on the “All documents” button.

If the item “FSS benefits and certificates of incapacity for work” is missing, make sure that the organization of one of the regions participating in the pilot project is indicated at the top of the page.

How to transfer information to the Social Insurance Fund for the assignment and payment of benefits

If the average number of employees for the last year is more than 25 people, an electronic register must be submitted to the Social Insurance Fund - a special form with information for the assignment and payment of benefits. You will need an electronic signature and an accounting program or service with the ability to exchange information with social insurance.

The online accounting system “My Business” has already set up an exchange with the Social Insurance Fund. You can create and send registers of sick leave directly from the service.

For different insured events there are three forms of the register; they are given in the FSS order No. 579 dated November 24, 2017:

for temporary disability benefits, maternity benefits, when registering in the early stages of pregnancy - in Appendix No. 1;
for benefits at the birth of a child - in Appendix No. 3;
for child care benefits - in Appendix No. 5.

The register must be sent within five calendar days, counting from the date of receipt of sick leave from the employee.

If the average number of employees for the past year was 25 people or less , the employer can choose how to transfer information for sick leave payments to the Social Insurance Fund.

Electronic register.
In paper form. An inventory according to the form from Appendix No. 2 to FSS order No. 578 dated November 24, 2017 is attached to the set of documents for granting benefits.

How does the organization submit information: electronically or on paper?

Companies whose average number of employees for the previous billing period exceeds 25 people submit to the Social Insurance Fund at the place of registration the information necessary for the appointment and payment of benefits in electronic form in the formats established by the Fund.

Companies with an average number of employees of 25 people or less have the right to provide information on paper to the Social Insurance Fund.

How to proceed with direct payments to the Social Insurance Fund

Procedure for payment of benefits from the Social Insurance Fund from January 1, 2021.

The employer receives from the employee documents for assigning and calculating benefits: a certificate of incapacity for work - a paper form or electronic sick leave number, a child’s birth certificate, certificates from other places of work, etc.
No later than the fifth calendar day, he transfers to the FSS a package of documents with an inventory or sends information using an electronic register.
The FSS checks for errors. If something is wrong with the documents, he sends a notice to the employer within five working days - by mail or via electronic communication channels. Corrections must also be made within five days.
When the FSS receives all the necessary information, it will make a decision on the assignment and payment of benefits within 10 calendar days.
If the decision is positive, the money will be transferred to the employee’s account within 10 calendar days from the moment social insurance receives all documents.
If a payment is denied to an employee, the Social Insurance Fund will receive a decision within two working days.

From 01/01/2021, the employee provides information for calculating benefits when hiring. When an insured event occurs, he only needs to bring the missing documents (clause 2 of the Regulations, approved by Government Decree No. 2375 of December 30, 2020).

What else has changed in sick leave?

It was clarified that a duplicate sick leave can be obtained if benefits have not yet been paid for it. Moreover, if you have lost or damaged a paper form, you can duplicate it electronically. By agreement with the patient or his legal representative, medical institutions that specialize in oncology, psychiatry-narcology, dermatovenereology, HIV infection, tuberculosis, and mental disorders may indicate other positions of doctors, for example, “attending physician,” “paramedic.”

If the employer made a mistake when filling out his section of the electronic sick leave, he must enter the correct information and indicate the reasons for the corrections. When sending again, the signatures of the chief accountant and the manager are also affixed.

How to receive child care payments from 01/01/2021

In order for employees to continue receiving benefits, they must send to the Social Insurance Fund:

package of documents for accrual and payment (or electronic register);
information on the calculation of benefits at the time of parental leave for a child up to 1.5 years old.

You do not need to submit this information monthly. The amount of benefits assigned before 01/01/2021 does not change. The Social Insurance Fund transfers money from the 1st to the 15th of the month following the month for which the child care benefit was accrued.

Section "Calculation of benefits"

In this section, fill in the data necessary to assign benefits to an employee by the regional branch of the Social Insurance Fund. All required fields will be highlighted in red.

1. “Information attribute” - you should select the “Primary information” item if the benefit is sent to the Social Insurance Fund for the first time. The “Recalculation” item is selected if the benefit has been sent and adjustments need to be made.

2. “Date of submission of documents to the policyholder” - the date when the benefit recipient submitted the application and additional documents to the employer should be indicated.

3. Indicate the regional coefficient, rate, insurance period, year and amount of earnings.

If you need to specify information about replacing billing years, you should check the “Fill in information about replacing years” checkbox. Additional fields will appear to indicate the years to be replaced.

4. “Benefit payment period” - you should select whether the benefit is paid entirely at the expense of the employer or whether there is a period for which the benefit is paid at the expense of the Social Insurance Fund. In the second case, in the field “Benefit at the expense of the Social Insurance Fund for the period”, be sure to indicate the beginning and end of the period for which the benefit is accrued at the expense of the Social Insurance Fund.

5. The “Benefit Calculation” section is completed; click the “Check and Submit” button.

Procedure for registration and closure of sick leave

If the certificate of incapacity for work is submitted on time, the employee will be assigned and paid benefits for days of absence due to illness, injuries, the prenatal period of pregnancy and after childbirth.

Medical organizations that have the appropriate licenses, upon recovery of the person seeking help, fill out a unified form of a certificate of incapacity for work, which provides for the doctor to indicate:

period of treatment and periodic examinations;
discharge dates.

The attending physician can conduct a course of treatment for up to 15 calendar days. If a person is not yet ready to return to work due to health reasons, the decision to extend sick leave is made by a medical commission.

When closing the certificate of incapacity for work, they indicate the date when the person can begin performing his work duties.

Speaking about the deadline for submitting sick leave to the employer, you need to take into account that, first of all, the submitted document will confirm the presence of good reasons why the employee was absent. As a rule, immediately after returning to work, sick leave is taken.

Period of reimbursement of expenses to the employer

At its own expense, an organization acting as a legal entity or an entrepreneur using the labor of hired workers will take into account expenses only 3 days of absence of a subordinate.

The remaining period, how many days of sick leave the employer will have to pay until the employee fully recovers, will be compensated by the Social Insurance Fund.

The employer pays from his own funds only the first three days of illness

How much sick leave is paid per year largely depends on the reasons for its registration. For example:

if the employee undergoes treatment himself, he is guaranteed payments for all days (there is an exception only for persons recognized as disabled);
when care is required for an unhealthy child, his age matters (see table):

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How to reimburse the costs of financial support for preventive measures from the Social Insurance Fund

The employer pays for preventive measures at his own expense, and then receives compensation from the Social Insurance Fund budget within the amount agreed with the Fund’s department.

To do this, before August 1 of this year, you need to submit an application for permission to finance preventive measures and prepare documents justifying the need for the measures. And before December 15, you need to submit an application for reimbursement of expenses incurred.

“The debt of the Fund branch to the policyholder, formed due to the excess of expenses over accrued insurance premiums as of July 1, 2019, is subject to compensation at the request of the policyholder. The policyholder has the right to direct up to 20% of the amounts of insurance premiums accrued by him for the previous calendar year to financially support preventive measures. This could be mandatory periodic medical examinations (examinations) of employees whose work is associated with harmful and (or) dangerous production factors,” explains Natalya Vladimirovna Matveeva, acting. O. deputy manager, head of the inspection department of the State Administration - regional branch of the Federal Social Insurance Fund of the Russian Federation for the Republic of Karelia.

Ekaterina Slobozhanina and Elena Kulakova, experts of the online reporting system Kontur.Extern

For how long is sick leave issued in case of quarantine and epidemic?

The period of the certificate of incapacity for work depends on the medical history, diagnosis and condition of the patient - from 3 to 15 days. To extend for a longer period, you will need the approval of the head physician or medical council. This rule applies to all diseases with complications. What should an employee do in the event of an epidemic or forced quarantine due to coronavirus?

Rospotrebnadzor determined how many days the minimum sick leave for coronavirus is 14 days until complete recovery (Decree No. 15 of May 22, 2020). Citizens infected with coronavirus are discharged with permission to begin work duties after receiving one negative test for COVID-19. If a positive test is obtained during the control, the patient will be discharged only after receiving a second negative result. A repeat test will be done no earlier than after 3 days (RPN Decree No. 35 of November 13, 2020).

Citizens who have been in contact with a coronavirus patient are required to remain in isolation or observation for 14 days. If during this period they do not show COVID symptoms, their sick leave will be closed and they will be allowed to start work. If the contact person falls ill, he will be given a certificate of incapacity for work at the moment of complete recovery, after receiving a negative test.

Missing a sick leave deadline

The law obliges working citizens to submit documents for the calculation of social insurance payments within 6 months from the day when:

the attending physician has made a decision about the person’s ability to return to work;
a specially created medical commission established permanent disability and recognized a working or non-working disability group, recommending light work in special conditions.

But what to do if the deadline is missed and the employer does not accept documents for payment?

For a good reason

The list of grounds that can be considered valid in case of missing time for taking sick leave is approved by Order of the Ministry of Health and Social Development No. 74, current as amended on October 5, 2009. These include:

unforeseen circumstances that cannot be prevented (natural disasters such as earthquakes, hurricanes, floods, fires, etc.);
if the course of treatment of an illness or rehabilitation after injuries took a longer period than 6 months;
relocation of the interested person to a new place of residence;
recognized illegal dismissal of an employee or removal from his position, as a result of which he was forced to be absent from work;
loss of loved ones due to death or the need to provide outside care for them due to deteriorating health;
circumstances recognized by a court decision as preventing the provision of documents for payment.

If there are documents confirming the presence of any of these factors that prevented a timely application when the employer must pay sick leave, an application with originals or copies attached is submitted to the territorial Social Insurance Fund (FSS).

For no good reason

If the applicant cannot explain in any way the reason for the delay in submitting documents from a medical institution confirming the completion of treatment or rehabilitation, he will be denied social benefits.

An interested person has the right to challenge the decision of the employer or the Social Insurance Fund through the court or the territorial labor inspectorate.