New rules for calculating benefits for temporary disability, pregnancy and childbirth, and monthly child care benefits. New rules for calculating benefits for temporary disability, pregnancy and childbirth, and monthly child care benefits

Article 4.6. Order financial security expenses of insurers for payment insurance coverage at the expense of the budget of the Social Insurance Fund Russian Federation

1. The insurers specified in Part 1 of Article 2.1 of this Federal Law pay insurance coverage to the insured persons against the payment of insurance contributions to the Social Insurance Fund of the Russian Federation, with the exception of the cases specified in paragraph 1 of Part 2 of Article 3 of this Federal Law, when the payment of insurance provision is carried out at the expense of policyholders.

2. The amount of insurance contributions to be transferred by the policyholders specified in Part 1 of Article 2.1 of this Federal Law to the Social Insurance Fund of the Russian Federation is reduced by the amount of expenses incurred by them to pay insurance coverage to the insured persons. If the insurance premiums accrued by the policyholder are not enough to pay the insurance coverage to the insured persons in full, the policyholder applies for the necessary funds to the territorial body of the insurer at the place of his registration.

2.1. If the territorial body of the insurer, in accordance with Part 4 of Article 13 of this Federal Law, assigned and paid benefits to the insured person for temporary disability, pregnancy and childbirth, monthly allowance for child care, then when the insured person receives from the policyholder the amounts of the specified benefits in connection with the cessation of circumstances, the presence of which was the basis for the assignment and payment of the corresponding benefits territorial body insurer, the amount of insurance premiums payable by such policyholder to the Social Insurance Fund of the Russian Federation is not subject to reduction by the amount of expenses incurred by the policyholder to pay benefits to the insured person to whom the territorial body of the insurer paid this benefit.

3. The territorial body of the insurer allocates the necessary funds to the policyholder for payment of insurance coverage within 10 calendar days from the date the policyholder submits all necessary documents, except for the cases specified in part 4 of this article. The list of documents that must be submitted by the policyholder is determined federal body executive power, carrying out the functions of developing public policy and legal regulation in the field of social insurance.

3.1. In case of insufficiency Money on the policyholder's accounts in credit institutions To satisfy all requirements presented to the accounts, the territorial body of the insurer makes a decision to refuse to allocate to the policyholder necessary funds for payment of insurance coverage.

4. When considering the insured’s request for the allocation of the necessary funds for the payment of insurance coverage, the territorial body of the insurer has the right to verify the correctness and validity of the insured’s expenses for the payment of insurance coverage, including an on-site inspection, in the manner established by Article 4.7 of this Federal Law, and also request that the policyholder additional information and documents. In this case, the decision to allocate these funds to the policyholder is made based on the results of the audit.

4.1. A copy of the decision to allocate funds to the policyholder is sent by the territorial body of the insurer to tax authority within three working days from the date of entry into force of the said decision. The procedure and timing for sending this information are determined by the agreement on information exchange concluded between the Social Insurance Fund of the Russian Federation and the federal executive body exercising the functions of control and supervision of compliance with the legislation of the Russian Federation on taxes and fees.

5. In case of refusal to allocate the necessary funds to the insured for the payment of insurance coverage, the territorial body of the insurer makes a reasoned decision, which is sent to the insured within three days from the date of the decision.

6. The decision to refuse to allocate the necessary funds to the policyholder for the payment of insurance coverage may be appealed by him to a higher body of the insurer in the manner established by this Federal Law, or to court.

7. Funds for payment of insurance coverage (with the exception of payment of benefits for temporary disability in case of loss of ability to work due to illness or injury for the first three days of temporary disability) to insured persons who work under employment contracts concluded with organizations and individual entrepreneurs for which they apply reduced tariffs insurance premiums in the amount of 0 percent in accordance with the legislation of the Russian Federation on taxes and fees are allocated to these organizations and individual entrepreneurs territorial bodies of the insurer in the manner established by parts 3 - 6 of this article, at the place of their registration as policyholders.

1. The assignment and payment of temporary disability benefits, maternity benefits, and monthly child care benefits are carried out by the insurer at the place of work (service, other activity) of the insured person (except for the cases specified in parts 3 and 4 of this article).

2. If the insured person at the time of occurrence insured event employed by several policyholders and in the two previous calendar years was employed by the same policyholders, temporary disability benefits, maternity benefits are assigned and paid to him by the policyholders for all places of work (service, other activities), and a monthly child care benefit - by the insured at one place of work (service, other activity) at the choice of the insured person and are calculated on the basis of average earnings determined in accordance with Article 14 of this Federal Law for the duration of work (service, other activity) with the insured who assigns and pays the benefit.

2.1. If the insured person at the time of the insured event is employed by several policyholders, and in the two previous calendar years was employed by other policyholders (another policyholder), temporary disability benefits, maternity benefits, and monthly child care benefits are assigned and paid to him by the policyholder at one of the last places of work (service, other activity) at the choice of the insured person.

2.2. If the insured person at the time of the insured event is employed by several policyholders, and in the two previous calendar years was employed by both these and other policyholders (another policyholder), benefits for temporary disability, pregnancy and childbirth are assigned and paid to him or her in accordance with Part 2 of this article by the insured for all places of work (service, other activity) based on the average earnings during work (service, other activity) with the insurer assigning and paying the benefit, or in accordance with Part 2.1 of this article by the insured for one of last place of work (service, other activity) at the choice of the insured person.

3. An insured person who has lost his ability to work due to illness or injury within 30 calendar days from the date of termination of work under an employment contract, official or other activity, during which he was subject to compulsory social insurance in case of temporary disability and in connection with maternity, temporary benefits disability is assigned and paid by the policyholder at his last place of work (service, other activity) or by the territorial body of the insurer in the cases specified in part 4 of this article.

4. The insured persons specified in Part 3 of Article 2 of this Federal Law, as well as other categories of insured persons in the event of termination of activity by the policyholder on the day the insured person applies for temporary disability benefits, maternity benefits, monthly child care benefits, or in the event that it is impossible for the policyholder to pay them due to insufficient funds in his accounts with credit institutions and the use of the order of debiting funds from the account provided for Civil Code Russian Federation, or if it is not possible to establish the location of the insured and his property, which may be subject to foreclosure, if there is a court decision that has entered into legal force establishing the fact of non-payment of benefits by such insured to the insured person, or if on the day of the insured person’s application for the specified benefits in relation to the policyholder, the procedures applied in the bankruptcy case of the policyholder are carried out; the assignment and payment of the specified benefits, with the exception of temporary disability benefits paid at the expense of the policyholder in accordance with paragraph 1 of part 2 of article 3 of this Federal Law, are carried out by the territorial body insurer.

5. The assignment and payment of benefits for temporary disability, pregnancy and childbirth are carried out on the basis of a certificate of incapacity for work issued by a medical organization in the form of a paper document or (with the written consent of the insured person) generated and posted in information system insurer in uniform electronic document, signed using enhanced qualified electronic signature medical worker and a medical organization, if the medical organization and the policyholder are participants in the information exchange system for the purpose of generating a certificate of incapacity for work in the form of an electronic document. To assign and pay these benefits, the insured person submits a certificate (certificates) about the amount of earnings from which the benefit should be calculated from the place (places) of work (service, other activity) with another policyholder (other policyholders), and for the appointment and payment of the specified benefits by the territorial body of the insurer - a certificate (certificates) on the amount of earnings from which the benefit should be calculated, and determined by the federal executive body exercising the functions of developing and implementing state policy and legal regulation in the field of labor and social protection population, documents confirming insurance experience. The form, procedure for issuing and procedure for issuing certificates of incapacity for work, as well as the procedure for generating certificates of incapacity for work in the form of an electronic document are established by the federal executive body exercising the functions of developing and implementing state policy and legal regulation in the field of healthcare, in agreement with the federal executive body , which carries out the functions of developing and implementing state policy and legal regulation in the field of labor and social protection of the population, and the Social Insurance Fund of the Russian Federation. The procedure for information interaction between the insurer, policyholders, medical organizations and federal state institutions of medical and social expertise for the exchange of information for the purpose of generating a certificate of incapacity for work in the form of an electronic document is approved by the Government of the Russian Federation.

5.1. In the cases specified in parts 2.1 and 2.2 of this article, the insured person, when applying for benefits for temporary disability, pregnancy and childbirth to the policyholder at one of the last places of work (service, other activity) at the choice of the insured person, also submits a certificate (certificates ) from the place of work (service, other activity) with another policyholder (other policyholders) that the assignment and payment of benefits is not carried out by this policyholder.

6. To assign and pay a monthly child care benefit, the insured person submits an application for the appointment of the specified benefit, a birth (adoption) certificate of the child being cared for, and a copy of it or an extract from the decision to establish guardianship over the child, a birth certificate (adoption, death) of the previous child (children) and its copy, a certificate from the place of work (service) of the mother (father, both parents) of the child stating that she (he, they) does not use parental leave and does not receive monthly child care benefits, and if the mother (father, both parents) of the child does not work (does not serve) or is studying full-time for basic educational programs in organizations carrying out educational activities, a certificate from the social protection authorities at the place of residence (place of stay, actual residence) of the child’s mother (father) about non-receipt of a monthly child care benefit. To assign and pay a monthly child care benefit, the insured person also submits, if necessary, a certificate(s) about the amount of earnings from which the benefit should be calculated. To assign and pay a monthly child care allowance in accordance with Part 4 of this article, a certificate (information) from the social protection authorities at the place of residence (place of stay, actual residence) of the father, mother (both parents) of the child about non-receipt of a monthly child care allowance for the child is requested by the insurer from the authorized executive body of the constituent entity of the Russian Federation, which has such information at its disposal. The insured person has the right, on his own initiative, to submit the specified certificate for the assignment and payment of benefits. The insurer's interdepartmental request for documents (information) is sent within three calendar days from the date of receipt of the application for payment of monthly child care benefits in accordance with Part 4 of this article. The period for preparation and sending by the authorized executive body of a constituent entity of the Russian Federation a response to the specified interdepartmental request cannot exceed five calendar days from the date of receipt of the interdepartmental request by the specified bodies.

7. An insured person employed by several insurers, when applying to one of these insurers of his choice for the appointment and payment of a monthly child care benefit, along with the documents provided for in Part 6 of this article, submits a certificate (certificates) from his place of work (service) , other activities) from another policyholder (from other policyholders) that the assignment and payment of monthly child care benefits is not carried out by this policyholder.

7.1. The insured person, instead of the original certificate of the amount of earnings, from which benefits for temporary disability, pregnancy and childbirth, and monthly child care benefits should be calculated, may submit a copy of the certificate of the amount of earnings, certified in the prescribed manner.

7.2. If the insured person is unable to submit a certificate(s) of the amount of earnings from which the benefit should be calculated from the place(s) of work (service, other activity) with another policyholder(s) due to termination of activity by this policyholder (these policyholders) or for other reasons, the policyholder assigning and paying benefits, or the territorial body of the insurer assigning and paying benefits in the cases specified in parts 3 and 4 of this article of this Federal Law, at the request of the insured person sends a request to the territorial organ Pension Fund of the Russian Federation on the provision of information on wages, other payments and remunerations of the insured person from the corresponding policyholder (corresponding policyholders) based on information from individual (personalized) accounting in the mandatory pension insurance. The form of the said application of the insured person, the form and procedure for sending the request, the form, procedure and deadlines for submitting the requested information by the territorial body of the Pension Fund of the Russian Federation are established by the federal executive body exercising the functions of developing state policy and legal regulation in the field of social insurance.

8. The policyholder pays temporary disability benefits, maternity benefits, monthly child care benefits to the insured person in the manner established for payment to insured persons wages(other payments, rewards).

9. Payment of benefits for temporary disability, pregnancy and childbirth, monthly child care benefits in the cases provided for in part 4 of this article is carried out in the established amounts by the territorial body of the insurer that assigned these benefits, through the federal postal service, credit or other organization at the request of the recipient.

10. Information on the assignment and payment to insured persons in the cases provided for in part 4 of this article, temporary disability benefits, maternity benefits, monthly child care benefits is posted in the Unified State Information System social security. The placement and receipt of this information in the Unified State Social Security Information System is carried out in accordance with Federal Law of July 17, 1999 N 178-FZ “On State Social Assistance”.

The main law that regulates the procedure for payments for sick leave is Law No. 255-FZ.

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In order to correctly make all calculations and do necessary payments, you need to carefully monitor changes that may be adopted.

What the law says

This one was specifically designed to exist regulatory regulation and the legal framework for making sick leave payments.

The latter is issued in the event of illness of the employee himself, his relatives who require care, and in connection with upcoming motherhood.

The main points of this Law are as follows:

1. The procedure for issuing a certificate of incapacity for work.
2. How to correctly calculate benefits for the period of temporary disability of an employee.
3. For what reasons should compensation be made?
4. What is the basis for issuing the document?
5. Some benefits provided to employees.
6. Provisions relating to the provision of maternity leave and payment for this period.

It is precisely the period of pregnancy and childbirth, as well as the subsequent period, that many provisions of this Law are devoted to.

This Law states that a woman has the right to:

In addition, a woman has the right to issue a sick leave certificate if her child falls ill.

The period of absence from work will also be paid, but when calculating, slightly different rules will be applied than when calculating maternity benefits.

When came into effect

This law was developed and finalized throughout 2006. The main reasons for constant discussions are women's rights related to motherhood and their protection.

But, on December 20, 2006, Federal Law No. 255 was adopted by the State Duma, and a week later it was approved by the Federation Council.

The new Federal Law No. 255-FZ has entered into force legal force December 29, 2006.

Changes made to the Federal Law

Since then, many changes have been made to the document. So in 2020, some nuances and improvements came into force. In just 12 years of the law, about 25 changes were made to it.

The document has never changed fundamentally; only some adjustments have been made to it regarding the introduction of modern technologies.

The last changes were made on 03/07/2020. They touched upon the new rules for issuing sick leave and making payments to women during pregnancy and childbirth, and for child care.

The procedure for providing a certificate of temporary incapacity for work

Now you can receive a certificate of incapacity not only on paper, but also in in electronic format.

This innovation has greatly simplified the lives of workers and employers.

The employee now does not have to worry that the document may become wrinkled, lost or destroyed due to insurmountable circumstances, since it is quite difficult to obtain a duplicate.

The scheme of operation of electronic certificates of incapacity for work is as follows:

This single base tied together the employee - the employer - the FSS inspector. Now the interaction between these parties has become much more transparent and understandable.

Calculation criteria

Temporary disability benefits are calculated using the following formula:

Benefit = average earnings for 1 day of work * duration of the period.

To calculate the average earnings for 1 day of work for a specific employee, it is necessary to take into account all of his labor income for the last 2 years.

If the period of incapacity for work fell in 2020, then for the calculation you need to use data for 2017 and 2016, respectively.

All periods during which the employee officially received labor income and the employer made contributions to the Social Insurance Fund for him are taken into account.

This value must be divided by 730 (this is the number of days in 2 years) or 731 (if one of previous years was a leap year).

The resulting quotient will be the average daily earnings of a particular employee.

To know how much the employee will receive, you need to multiply average daily earnings by the number of days of temporary absence from work.

Benefit payment procedure

The amount of benefits an employee will receive depends on the reason for absence from work and the employee’s length of service.

If the situation is standard, that is, the employee himself gets sick, then he will receive:

In some cases, sick leave is paid based on the minimum wage. These are cases such as:

From 01.01.2020, the federal minimum wage was set at 9,489 rubles, but from 01.05.2020 there was another increase to living wage. Now the minimum wage is 11,163 rubles.

Regardless of length of service, sick leave is paid:

Payment period

The faster an employee submits a sick leave certificate to the employer’s accounting department, the faster he will receive his temporary disability benefits. But, he has six months from the moment the sick leave ends to provide it.

As soon as the certificate of incapacity for work is submitted to the accounting department, employees of this service begin calculating benefits.

It must be assigned within 10 days from the moment the document was received by the employee. The same period is required for the Social Insurance Fund to consider the situation regarding payments.

If an electronic sick leave certificate has been issued, then even fewer disputes arise. It immediately appears in a single database, and calculations can be made.

The employee must receive the entire amount in the coming days of salary payment at the enterprise.

List of reasons for reducing the amount of compensation

In Art. 8 of Law No. 255-FZ provides the grounds on which the amount of temporary disability benefits may be reduced.

Such circumstances include:

If these circumstances exist, payment for the period of incapacity for work occurs based on the minimum wage, which is set at federal level at the time of occurrence of these circumstances.

Federal Law 255 Federal Law as amended on social insurance regulates the provision of benefits in cases of temporary disability in connection with maternity. It came into force on December 29, 2006, and 2017 will mark the start of important changes. For a better understanding, Federal Law 255 can be studied with comments.

Federal Law 255 Federal Law on compulsory social insurance - description of the law

Russian Federal Law 255 with its amendments and comments on compulsory social insurance determines the procedure, conditions, and amounts of provision of benefits in cases of maternity and temporary disability.

According to the Russian Federal Law 255 as amended, each benefit depends on the duration of the existing length of service when passing the state (civil) municipal service, work under any employment contract, other activities.

According to federal law the amount of the required disability benefit will be 100% of the average earnings for people with 8 years of experience, when the experience is within 5-8 years, the assistance will be 80%, and sick leave a person working for less than 5 years will be paid at the rate of 60%, the amount cannot be less.

The Federal Law on Compulsory Social Insurance specifies that maternity benefits should be 100% of the available average earnings, but only when the woman has more than six months of experience. In any other case, assistance will not exceed 1 minimum wage.

The maximum amount of all benefits is determined by the state for each fiscal year separately. Temporary disability benefits in accordance with Federal Law 255 are accrued in the following situations:

• 1. In case of illness or injury of the insured person;
• 2. If you need to care for any family member;
• 3. When quarantine is necessary for an insured person, a child under 7 years old;
• 4. When prosthetics are performed;
• 5. If you need further treatment in sanatoriums of the Russian Federation.

This legislative act on compulsory insurance indicates that any disability benefit must be paid until the person regains his ability to work or is recognized as disabled (in which case he will receive other monthly payments). All benefits are assigned within 10 days from the date of the person’s application.

Changes to Federal Law 255

This law was supplemented with important changes in 2017. So the average earnings included all types of remuneration and payments in favor of each insured person.

In addition, all powers to control the payment of contributions are transferred from the FSS, other off-budget funds To tax office, the exception will be making contributions for injuries. In view of this, in tax code a new chapter will appear. 255 of the Federal Law in the new edition with amendments indicates that the Federal Tax Service will receive the right to conduct desk, on-site inspections policyholders.

14 Article 255 Federal Law

The current Article 14 specifies how benefits should be calculated. Based on this article, payments should be calculated on the basis of the so-called average earnings, and for the last 2 years. When a woman spent one of these years on maternity leave, then, at her request, an earlier period of time can be taken for calculation if this leads to an increase in benefits. Even after dismissal, the average earnings of the previous policyholder must be taken into account when calculating benefits.

Article 15 255 Federal Law

Article 15 of the law on compulsory social insurance (255 Federal Law) specifies the terms for payment of money in case of temporary disability, pregnancy, childbirth, and when caring for a baby. Thus, 255-FZ with comments indicates that assistance is accrued, and necessarily, within ten days from the date of the person’s application necessary documents. If at the time of application there is not sufficient information about the person’s earnings for last years, then the calculation is still carried out, but on the basis of available data, with subsequent recalculation.

According to the law, payment of money occurs on the payday, and the nearest one. Payments are non-refundable, but with the exception of cases of dishonesty of the insured person or accounting errors. In these cases, according to this legislative act on compulsory social insurance, a refund is made, but the withheld portion should not exceed 20% of the payment amount. For such actions, an organization order is required.