Services for implementing procedures to receive insurance benefits

The Law on Social Insurance 2014 was promulgated by the National Assembly on November 20, 2014, officially taking effect from January 1, 2016. The issue of payment and fulfillment of social insurance obligations for employees is paid a lot of attention by employers, especially businesses. Performing this work well is both the responsibility of the enterprise and helping employees feel secure in their work and dedication when their rights are guaranteed according to the law. Viet An Tax Agent would like to summarize the beneficiary regimes for insurance in the article below.

Relevant regulatory documents

• Law on Social Insurance No. 58/2014/QH13 dated November 20, 2014;
• Decree No. 115/2015/ND-CP dated November 11, 2015 of the Government detailing a number of articles of the Law on Social Insurance on compulsory social insurance;
• Pursuant to the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008; Law No. 46/2014/QH13 dated June 13, 2014 amending and supplementing a number of articles of the Law on Health Insurance;
• Circular No. 59/2015/TT-BLDTBXH dated December 29, 2015 detailing and guiding the implementation of a number of articles of the Law on Social Insurance on compulsory social insurance;
• Circular No. 04/2015/TT-BLDTBXH dated February 02, 2015 of the Ministry of Labor, War Invalids and Social Affairs guiding the implementation of the employer’s compensation, allowance and medical expenses regime for employees suffering from occupational accidents and occupational diseases;
• Decision 959/dated September 9, 2015 promulgating regulations on management of social insurance, health insurance, unemployment insurance, management of social insurance books and health insurance cards;

Register for social insurance, health insurance, unemployment insurance

Employees after being recruited, accepted to work from another place or transferred from the salary-paying unit to the University must make a dossier of registration for participation in social insurance, health insurance and unemployment insurance. This process consists of 4 steps as follows:

• Step 1: After being recruited or accepted to work from another place or transferred from a salary-paying unit (based on the notice of job acceptance or the decision on receipt or transfer), the employee is responsible for contacting the finance department to sign the contract and make a declaration of participation in social insurance. Health insurance (according to form TK1-TS) within 10 days from the date of commencement of work. In case the employee is entitled to higher health insurance benefits, it must be enclosed with documents to prove it.
• Step 2: Within 15 days from the date the employee starts working, the finance department shall submit to the Principal to sign the contract and transfer the contract together with the declaration of participation in social insurance and health insurance to the Finance Department
• Step 3: After receiving the contract together with the declaration of participation in social insurance and health insurance transferred from the Finance Department, the Finance Department prepares a dossier of participation in social insurance and sends it to the social insurance agency. The dossier includes:
  • List of employees participating in Social Insurance (BHXH), Health Insurance (BHYT), Unemployment Insurance (BHTN) (Form D02 – TS)
  • Declaration of participation in Social Insurance (BHXH), Health Insurance (BHYT) (according to Form TK1 – TS); Form TK1 – TS
  • Social Insurance Book in case the employee already has a Social Insurance Book
  • List of documents serving as the basis for enjoying higher Health Insurance benefits, if any (Section II Appendix 03)
  • Payroll corresponding to the retroactive period if the increase is not reported in time within the month

• Step 4: After receiving the notice of valid dossier from the social insurance, the Finance Department shall contact the Planning and General Department to receive the returned results, including the cover of the new social insurance book (in case the employee does not have a social insurance book) or the existing social insurance book (in case of sending the process entry book) or the social insurance slip and health insurance card and the list of issuance of social insurance books.
• Step 5: Within 05 days from the date of receiving the results, the finance department shall transfer the social insurance book or the cover of the new social insurance book with the list of social insurance books to the finance department and the health insurance card to the individual employee. The Organization and Personnel Department shall certify and return the original table of the book issuance list to the Finance Department for archiving.
• Step 6: The Finance Department is responsible for updating information in the archived data.

Implement maternity benefits

The person entitled to the maternity regime is the female employee who gives birth; Female employees who are surrogacy or mothers who request gestational surrogacy; Employees who adopt children under 6 months old must pay social insurance premiums for full 6 months or more in the 12 months before giving birth.

In case a female employee gives birth and has paid social insurance premiums for full 12 months or more and has to take time off work for maternity care as designated by a competent medical facility, she must pay social insurance premiums for full 03 months or more in the 12 months before giving birth.

In case of giving birth to a child but only the father participates in social insurance, the father must pay social insurance premiums for full 06 months or more in the 12 months before giving birth (when the male employee participates in social insurance and the wife does not participate in social insurance) and is entitled to a lump-sum allowance equal to 02 times the base salary in the month of birth for each child.

For the husband of the mother who asks for gestational surrogacy, he must pay social insurance premiums for full 06 months or more within 12 months up to the time of receiving the child. (when male employees participate in social insurance, wives and gestational surrogates do not participate in social insurance).

In case a male employee who is paying social insurance premiums with his wife gives birth to a child, he or she is entitled to maternity leave (calculated within the first 30 days from the date the wife gives birth):

• 05 working days;
• 07 working days when the wife gives birth to a child who has to have surgery, gives birth to a child under 32 weeks old;
• In case of twin wives, they are entitled to 10 working days off, from triplets or more, they are entitled to an additional 03 working days off for each additional child;
• In case the wife has twins or more and has to have surgery, she is entitled to 14 working days off.

Female employees can go to work before the expiration of the maternity leave period after taking leave to enjoy the regime for at least 04 months, with prior notice and consent from the employer. In addition to the salary of working days, female employees who go to work before the expiration of the maternity leave period are still entitled to maternity benefits until the expiration of the prescribed period.

Pursuant to regulations, during the period of leave of absence to enjoy the social insurance regime, the employee is not entitled to salary.

Implement sickness

The maximum period of enjoying the sickness regime in a year for employees is calculated according to working days excluding public holidays, Tet holidays and weekly holidays and is prescribed as follows:

• Working under normal conditions, they are entitled to 30 days if they have paid social insurance premiums for less than 15 years; 40 days if the payment has been paid for between full 15 years and less than 30 years; 60 days if they have paid for full 30 years or more.
• Working in heavy, harmful, dangerous or particularly heavy, harmful, dangerous occupations or jobs on the list promulgated by the Ministry of Health or working in places with regional allowances with a coefficient of 0.7 or more shall be entitled to 40 days if they have paid social insurance premiums for less than 15 years; 50 days if they have paid from full 15 years to less than 30 years; 70 days if they have paid for full 30 years or more.
• Employees who quit their jobs due to diseases on the List of diseases requiring long-term treatment issued by the Ministry of Health are entitled to a maximum of 180 days. In case of continuing treatment after this period, they will continue to enjoy the sickness regime at a lower rate but the maximum entitlement period is equal to the time for which social insurance premiums have been paid.

The time to enjoy the regime is calculated according to working days excluding public holidays, Tet holidays, weekly holidays and is prescribed as follows:

• The period of entitlement to the regime when the child is sick for one year for each child is calculated according to the maximum number of days of child care is 20 working days if the child is under 03 years old; the maximum is 15 working days if the child is from full 03 years old to under 07 years old.
• In case both parents participate in social insurance, the time to enjoy the regime when the child is sick of each father or mother is calculated as above

Implement work-related accident and occupational disease benefits

Conditions for enjoying the work-related accident

Public employees and employees are entitled to the occupational accident regime when they have an accident and have their working capacity reduced by 5% due to an accident in one of the following cases:

Conditions for enjoying the occupational disease accident

Public employees and employees are entitled to the occupational disease regime when they are sick on the list of occupational diseases promulgated by the Ministry of Health and the Ministry of Labor, War Invalids and Social Affairs when working in an environment or occupation with toxic factors and a decrease in working capacity of 5% or more due to the above-mentioned diseases.

Dossier of request for payment of the accident

For the occupational accident regime, the dossier includes:

• Social insurance book.
• The record of occupational accident investigation, in case of a traffic accident determined to be an occupational accident, must be accompanied by a traffic accident record or a record of the scene examination and a diagram of the scene of the traffic accident.
• Certificate of discharge from the hospital after being treated for an occupational accident.
• The record of assessment of the level of working capacity impairment of the Medical Examination Council.
• A written request for settlement of the occupational accident regime.

For the occupational disease regime, the dossier includes:

• Social insurance book.
• The record of environmental measurement has harmful elements, in case the record is determined for many people, the dossier of each employee shall have a copy.
• The certificate of discharge from the hospital after treatment of occupational diseases, in case of not being treated at the hospital, must have an occupational disease examination certificate.
• The record of assessment of the level of working capacity impairment of the Medical Examination Council.
• A written request for settlement of the occupational disease regime.

If you have any difficulties or questions related to the service of carrying out the procedures for enjoying the insurance regime, please contact Viet An Tax Agent for the most specific advice.