One time social insurance in case of serious illness

Social insurance is a partial compensation for employees’ income when they are sick, pregnant, have a work accident, or occupational disease, reach the end of their working age, or die. In particular, the one-time social insurance regime due to serious illness is one of the benefits that social insurance participants enjoy. The article below Viet An Law will provide information related to receiving one time social insurance in case of serious illness.

Legal basis

• Social Insurance Law 2014;
• Circular 56/2017/TT-BYT detailing the implementation of social insurance law and occupational safety and hygiene law in the field of health, as amended and supplemented by Circular 18/2022/TT-BYT.
• Circular 59/2015/TT-BLDTBXH detailing and guiding the implementation of several articles of the social insurance law on compulsory social insurance, as amended and supplemented by Circular 06/2021/TT-BLDTBXH.
• Decision No. 166/QD-BHXH promulgates the process for handling social insurance benefits, payment of social insurance benefits, and voluntary insurance, as amended and supplemented at every time.

In case of serious illness, you are entitled to one-time social insurance

According to Circular No. 18/2022/TT-BYT, from February 15, 2023, some cases of serious illness are entitled to one time social insurance, divided into 2 cases:

• The first case is people who are suffering from one of the life-threatening diseases such as cancer, polio, cirrhosis, ascites, leprosy, severe tuberculosis, and HIV infection that has progressed to AIDS.

Records include the original or a valid copy of the hospital discharge certificate or summary of medical records showing the above illness. The application documents for this case have been greatly streamlined based on Circular 18/2022/TT-BYT of the Ministry of Health effective from February 15. According to the new regulations, groups of workers with diseases such as cancer, polio, cirrhosis, ascites, leprosy, severe tuberculosis, and HIV infection that have progressed to the AIDS stage will be entitled to one-time social insurance benefits.

This regulation removes the accompanying condition of “not having self-control or not being able to independently perform the activities of walking, dressing, personal hygiene and other things that serve daily personal needs that are necessary.” “People are watching, assisting, and taking care of you completely” like before. This creates more favorable conditions for workers with serious illnesses to receive one-time social insurance.

• The second case is the case of other diseases.

The dossier is a medical examination record that must conclude that you have diseases and disabilities that reduce your working capacity by 81% or more and are unable to self-control or perform self-service activities. Daily personal needs that require someone to monitor, assist, and take full care of.

Note: When suffering from these diseases, those people cannot control or perform the activities of walking, dressing, personal hygiene, and other activities that serve daily personal needs. They need someone to monitor, assist, and take care of for one-time social insurance benefits.

Procedures for expertising the level of work capacity loss for other diseases

If the patient does not suffer from the listed diseases but is in poor health, carry out the procedure for expertising the level of work capacity decline as follows:

According to Clause 6, Article 5, Circular 56/2017/TT-BYT, the appraisal dossier includes:

• Request for medical examination according to the form specified in Appendix 2 attached to Circular 56/2017/TT-BYT.
• Original or valid copies of the following medical examination and treatment documents:

• Summary of medical records (obstetric or other medical records)
• Disability certificate
• Hospital checkout
• Health records
• Copy of Occupational Disease Record
• Minutes of occupational disease assessment
• Accidents for people who have been examined for occupational diseases or occupational accidents;

From February 15, 2023, in addition to the above documents, employees can also use originals or copies of other documents:

• Medical bill
• Paraclinical results form
• Prescriptions from medical examination and treatment facilities

• One of the following photo documents: Identity card; Citizen identification card; Passport is still valid. In case the above documents are not available, there must be a Certificate of Confirmation from the Commune Police with a photo attached, bordered on the photo and issued within no more than 03 months from the time of request for medical examination.

The application to withdraw one-time social insurance is an important procedure, beneficiaries need to prepare all necessary documents when submitted to the Provincial Medical Examination Council.

Procedures for enjoying one time social insurance in case of serious illness

The application dossier for receiving one-time social insurance will be different between Vietnamese workers and foreign workers.

For Vietnamese workers

• Social insurance book
• Original Application (Form No. 14-HSB)
• For people settling abroad: submit a copy of the competent authority’s confirmation of renunciation of Vietnamese nationality or an authenticated or notarized Vietnamese translation of one of the following documents:
• Passport issued by foreign country
• Visa issued by a competent foreign agency confirming permission to enter the country for the reason of residing abroad
• Documents certifying that you are applying for foreign citizenship; Certificate or permanent residence card, valid for 5 years or more issued by a competent foreign agency.
• For people with life-threatening diseases: submit an original copy/summary of medical records showing the inability to self-serve.
• If you suffer from other diseases, replace it with the original copy of the Medical Examination Council’s report of a decrease in working capacity of 81% or more, showing your inability to self-serve.
• For the person paying the medical assessment fee: submit the original invoice, and assessment fee collection document along with the original list of assessment contents from the facility performing the assessment.
• For officers, soldiers, and military soldiers: submit an original personal declaration about the time and area of service in the Army with regional allowances (Form No. 04B-HBKV) (if any). The social insurance book does not show complete information as a basis for calculating regional allowances.

For foreign workers

• Original Application (Form No. 14-HSB)
• If you have life-threatening diseases: have an original copy/summary of medical records showing your inability to self-serve.
• If suffering from other diseases: replace with the original copy of the Medical Examination Council’s report of a decrease in working capacity of 81% or more, showing the inability to self-serve.
• If paying the medical assessment fee: include the original invoice, and assessment fee collection document along with the original list of assessment contents from the facility performing the assessment.

Calculation of one-time social insurance benefits in Vietnam

Pursuant to Clause 4, Article 19, Circular 59/2015/TT-BLDTBXH stipulates that one-time social insurance benefits are paid based on the time the employee participates in social insurance and the average monthly salary. social insurance contribution.

The formula for calculating the one-time social insurance benefit is as follows:

Benefit level = (1.5 x Average salary x time participating in social insurance before 2014) + (2 x average salary x time participating in social insurance since 2014)

Note :

• In case you have not paid for 1 full year, the benefit level is equal to the amount paid, and the maximum level is equal to 02 months’ average salary.
• Odd period of participating in social insurance: from 1-6 months calculated as ½ year; From 7-11 months counts as 1 year.
• The one-time social insurance benefit does not include the amount of money the State supports paying for voluntary social insurance (except in cases of serious illness).

However, the average salary of the employee will depend on whether the employee is paying social insurance according to the state coefficient or according to the salary level of the private employer.

For employees who pay social insurance according to the state coefficient, the average salary by state sector:

Average salary = Total monthly salary paid for social insurance (coefficient x base salary) of the last T years before quitting /(Tx12 months)

For employees subject to the salary regime decided by the employer:

Average salary = Total monthly salary paid for social insurance/Total number of months paid for social insurance.

Thus, with the one-time social insurance calculation as shared above, employees can be more proactive in calculating the one-time social insurance benefit if withdrawn. Besides, employees can also use the online one-time social insurance calculation system to calculate quickly and accurately.

Clients who need advice on the regulation or support to calculate one time social insurance in case of serious illness, please get in touch with Viet An Law Firm for the best support.