Lists of documents required by the Social Insurance Fund for reimbursement of benefits in 2021

On October 10, 2021, our legislators issued FSS order No. MMB-7-11-551. It explains how to calculate insurance premiums and what reporting employers must provide to government agencies. You should receive compensation from the Social Insurance Fund if expenses for sick leave and other social benefits occurred before 2017. Now the tax service is in charge of returning the money, but the FSS still accepts documents for compensation from policyholders and carries out a desk audit.

Tax officials will transfer funds only after representatives of the fund give permission

List of documents

To return funds spent on sick leave payments, you must provide the following documents to the territorial office of the fund:

• a correctly executed sick leave certificate for the employee, indicating the validity of the money spent;
• a calculation that indicates how many contributions were made to the budget and how much money was transferred to the employees of the enterprise;
• a written request for the allocation of funds to reimburse sick leave.

Sick leave for the benefit recipient

In addition to the mandatory documents listed above, officials may require additional papers:

• a document that can prove that the person receiving the benefit is actually employed by the policyholder;
• a certificate of the employee’s income from the previous employer for the last two years (certificate in form 182n);
• confirmation of a certain duration of insurance coverage.

Deadlines for returning money from the Social Insurance Fund

As soon as the employer prepares the necessary documents and submits them to the fund, the countdown begins for the period during which the Social Insurance Fund must reimburse the benefit. The law allocates 10 calendar days for this procedure (Part 3, Article 4.6 of Law No. 255-FZ of December 29, 2006).

But, as a rule, after receiving documents from the policyholder, fund inspectors conduct a desk audit, which should determine whether the organization (or individual entrepreneur) has the right to reimbursement of expenses for insured events.

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If the FSS decides to conduct an audit, then the decision to allocate funds to the employer will be postponed until its completion. The deadline is being moved:

• for 3 months upon desk inspection;
• 2 months for on-site inspection.

Such deadlines are established in paragraph 2 of Art. 26.15, paragraph 9 of Art. 26.16 of the Law of July 24, 1998 No. 125-FZ, Part 1 of Art. 4.7 of the law of December 29, 2006 No. 255-FZ.

Calculation

Previously, employers reported using Form 4-FSS. In 2021, the report must be completed on the calculation certificate form.

Since recently the tax service has been accepting insurance contributions, FSS employees no longer have information about how much money a particular employer has transferred to the budget. The policyholder reflects this data in the calculation certificate. FSS employees can request information from the tax service and verify the accuracy of the information specified in the certificate.

According to the order of the Ministry of Labor of the Russian Federation No585H dated October 28, 2016, the calculation document must contain the following information:

• the exact amount of debt on contributions at the beginning of the period;
• the exact amount of debt at the end of the period;
• the amount of costs accepted for calculation;
• how much insurance premiums are charged;
• how much additional insurance premiums have been charged;
• compensation received from the insurance fund;
• how much is spent on social security.

Example of filling out a calculation certificate

Reimbursement mechanism

According to the law, the return of maternity benefits from the Social Insurance Fund is based on the principle of offset. So, if the benefit is paid from the employer’s funds, then the amount of money spent is counted towards the repayment of insurance premiums accrued in the corresponding reporting period.

If there is a significant gap between the amount of the benefit and current contributions, an application for reimbursement is submitted for the difference between these indicators.

This application must be accompanied by a set of supporting documentation. The list of documents for reimbursement of maternity benefits from the Social Insurance Fund is approved by law.

The amount of the benefit in question is regulated by Art. 11 of Law No. 255-FZ. As a general rule, this should be 100% of the average earnings of a pregnant woman.

Written appeal

The application form for reimbursement of expenses for hospital and other social benefits is not approved by law. But the fund, using an internal letter, clarified what the application form should look like and how to fill it out correctly.

At the top of the document there must be data from the FSS body to which the application is being submitted:

• name of the branch;
• last name, first name, patronymic of the head of this department.

Below is information about the employer who acts as the insurer of his employees:

• Business name;
• legal address of the organization;
• TIN;
• checkpoint;
• insurance number.

The following are attached to the application:

• certificate of settlement;
• a document proving the validity of sick leave expenses.

Example of a refund application

How to submit a contribution report to the tax service

Before submitting documents for compensation, you must provide a tax report on contributions. The filling out procedure is regulated by Appendix No. 2 to the Order of the Tax Service dated October tenth two thousand and sixteen No. MMB-7-11/551. This document consists of a title page and three sections. The calculation is filled out strictly in black, blue or purple ink. Letters must be capitalized only. If the document is filled out electronically, use Courier New font, size 16-18. Then the completed sheet must be printed.

Payments must be submitted by the thirtieth day of the month following the reporting month. For example, for nine months of 2021, the document must be received by the tax service no later than October 30, 2021.

If the company has more than twenty-five employees, the report should be submitted strictly electronically. For small companies, you can fill out a paper version of the document.

Report form

There are two ways to submit a report to the tax office:

• the head of the organization or his authorized representative personally visits the Federal Tax Service;
• A registered letter with a list of attachments is sent to the address of the tax service.

Tax authorities transmit to the Social Insurance Fund information about how many contributions have been accrued and paid for social security within the following time frames:

• no later than 5 days from the date of submission of the electronic report;
• no later than 10 days from the date of submission of the report on paper.

When will expenses be reimbursed?

To ensure that the costs indicated in the application are justified, fund employees conduct a reconciliation. If fund employees have any doubts, they have the right to request additional documents. Control can also be carried out by visiting officials to the enterprise.

As a result of the reconciliation, the fund may decide:

• pay money;
• refuse to issue compensation for social benefits due to unreasonable costs.

According to Article 4.6 F3 No. 255 dated December twenty-nine two thousand and six, money for the return of funds spent on sick leave will be transferred to the company’s account within ten days from the date of filing a written appeal.

Article 4.6. The procedure for financial support for the expenses of policyholders for the payment of insurance coverage from the budget of the Social Insurance Fund of the Russian Federation

Benefit payment

The system of social guarantees for the population is enshrined in current Russian legislation. It is implemented through benefits and targeted financial assistance. Payment of funds from the FSS resources occurs:

1. Upon the occurrence of a certain insured event.
2. If there are documents confirming this fact (one of them is pregnancy and childbirth).

Law of July 16, 1999 No. 165-FZ “On the basis of compulsory social insurance” establishes the employer’s obligations to provide its employees with social benefits. It allows such transfers to be made not only from the Social Insurance Fund, but also from the enterprise’s own resources. The right of employers to offset benefits paid to staff against insurance premiums is enshrined in Art. 4.6 of the Law of December 29, 2006 No. 255-FZ “On compulsory social insurance in case of temporary disability and maternity” (hereinafter referred to as Law No. 255-FZ).

An excess of the benefit amount over the amount of calculated contributions is the basis for generating a request for compensation from the Social Insurance Fund.

Here's how to get reimbursement from the Social Insurance Fund for maternity benefits in 2021: you need to contact the branch of the Social Insurance Fund, which serves the employer at the place of its registration. The fund's specialists check the package of documentation presented to them and make a decision on whether there is a basis for reimbursement of maternity benefits (or other payments) to the Social Insurance Fund. If compensation is denied, the fund draws up a written response providing reasons in favor of its negative decision.

Credit for the amount of insurance premiums

The easiest way to reimburse the cost of sick leave is to subtract social costs from the amount that the employer transfers monthly to the social insurance fund.

The employer can compensate for his sick leave expenses through contributions to the insurance fund.

An enterprise has the right to deduct from contributions not only sick leave, but also other social benefits:

• in connection with the death of a close relative of an employee;
• in honor of the birth of a newborn;
• funds paid to the employee in connection with her pregnancy and childbirth;
• caring for a minor under one and a half years old;
• a pregnant woman who registered with a medical institution in the early stages of pregnancy (up to twelve weeks).

Maternity benefit

To be reimbursed for the B&R benefit and the benefit for registration in the early stages of pregnancy, the following must be submitted:

• a certificate of incapacity for work, filled out in the prescribed manner, with the benefit calculated;
• application of the insured person for maternity leave;
• order on granting maternity leave and granting benefits;
• certificate(s) about the amount of earnings from another policyholder(s) 182n;
• documents confirming insurance experience;
• cards for individual accounting of the amounts of accrued payments and other remunerations and the amounts of accrued insurance premiums to verify the correctness of determining the taxable base and the calculation of insurance premiums;
• a certificate (certificates) from the place of work (service, other activity) from another insured (other insureds) stating that the appointment and payment of benefits by this insured are not carried out if the insured person at the time of the insured event is employed by several insureds, and in two in previous calendar years was occupied by other policyholders, or by both these and other policyholders (another policyholder);
• a certificate from the antenatal clinic or other medical organization that registered the woman in the early stages of pregnancy (up to 12 weeks).

If the cost of social benefits is greater than the contribution

The reduction of contributions by the amount of sick leave within the reporting period (1st, 2nd, 3rd quarter) occurs on the basis of the Tax Code of the Russian Federation, paragraph 2, article 431. Federal Tax Service employees will automatically transfer the excess to the account of the next month.

But, if excess expenses for benefits were revealed at the end of the reporting period (1st, 2nd, 3rd quarter, year), one should be guided by the ninth paragraph of the same article of the Tax Code of the Russian Federation.

In such a situation, there are two solutions:

• contact the Social Insurance Fund for the missing amount;
• leave the excess amount towards future installments.

How to register

If Social Security costs exceed your contribution, the excess can be withdrawn in cash or used to pay future contributions. To do this, submit to the Social Insurance Fund the same papers as to receive the full amount:

• reference calculation;
• sick leave;
• a written request to offset the excess against the payment of future contributions or to issue the excess amount in cash.

Example of a written request

The set of papers listed above can be submitted without waiting for the end of the quarter.

When considering a written request for compensation, FSS employees request information from the tax service from the reports that the applicant previously submitted. Representatives of the fund can also carry out an on-site inspection and verify the legality of the funds spent. During the inspection, the FSS may request additional documents from you about the expenses you incurred. As a result, the fund issues either a positive or negative response.

If, based on the results of the audit, fund employees do not find any violations, the Social Insurance Fund informs the tax office about confirmation of expenses. The fiscal service offsets the excess against the payment of future contributions or transfers money to the account you specified. If FSS employees discover that you have paid sick leave unreasonably, a report will be drawn up. This document is provided to you for your review. You can challenge it. Otherwise, the fund makes a decision to reject the request. You will be notified of this decision within three working days. A copy of this document will also be sent to the tax office. Thus, an arrear of contributions will arise and the Federal Tax Service will issue you a demand for payment.

If the amount accepted for offset is less than the insurance premium, the difference must be paid within the time limits established by law.

Is it possible to submit documents to the tax office and not to the Social Insurance Fund?

The employer has the right to submit a written request for reimbursement of sick leave not only to the Social Insurance Fund, but also to the territorial office of the tax inspectorate. Information exchange and document flow are well established between services.

In this case, inspection staff notify the fund of the received application. In addition, tax authorities transmit the information necessary for decision-making from a unified reporting form. The Social Insurance Fund, in turn, checks the validity of expenses for sick leave and other social benefits. In controversial situations, a joint inspection by the tax office and the Social Insurance Fund can be carried out with a visit to the policyholder.

If the policyholder has committed an offense, tax authorities have the right to make a decision on whether to hold the person liable. This is also reported to the fund.

What other documents should I submit to the FSS?

Compliance with the limits is not enough; in order to confirm the financial support of preventive measures, it is necessary to attach to the application a whole package of documents justifying the need for costs. These include:

• financial plan;
• a copy of the list of measures to improve the working conditions and safety of workers, developed based on the results of a special assessment of working conditions;
• an extract from the collective agreement (agreement on labor protection) between the employer and the representative body of workers on labor protection measures in the organization;
• copies of orders to send workers to labor safety training and lists of these persons;
• a copy of the training agreement with an authorized organization;
• other papers confirming the intended purpose and the need for financing.

If the application is drawn up correctly, the limits are met and the package of documents is sufficient, the FSS will send the policyholder a decision to provide financing. If something is missing or made with errors, or if the expenses raise doubts among the Fund's employees, the employer will receive a justified refusal.

Legal documents

• Order of the Ministry of Labor of Russia No. 764n dated December 3, 2018

Documents to confirm expenses for other social benefits

If you want to receive reimbursement of expenses not only for sick leave, but also for other types of social benefits, you must provide supporting documents.

Table. Types of social benefits, the costs of which are subject to reimbursement

Sets of documents for individual cases of compensation

For each type of benefit for which the employer plans to receive compensation from the Social Insurance Fund, in addition to the application, calculation certificate and breakdown of expenses, a special set of documents must be prepared and submitted to the Social Insurance Fund. Let's look at them.

Compensation for sick leave

Periods of incapacity for work are paid jointly by the Social Insurance Fund and the company. The employer is responsible for paying for the first three days of illness; payment for the remaining days is the responsibility of the fund. The Social Insurance Fund reimburses expenses to the employer for the period from the fourth day of illness of the employee after receiving and verifying the following additional documents:

This is what a set of additional documents looks like for sick leave compensation in the Social Insurance Fund in 2021.

Reimbursement of benefits for Birth and Birth (pregnancy and childbirth)

A set of additional documents for reimbursement of maternity benefits includes:

A ready-made solution from the reference and legal system “ConsultantPlus” will tell you how maternity benefits are paid during the implementation of the “Direct Payments” project. To view the material, get free online access to the system.

Reimbursement of child benefits

To reimburse the child care allowance for a child up to 1.5 years old, the following set of documents must be submitted to the fund:

• document on the birth/adoption of a child;
• documents on the birth/adoption of previous children;
• a certificate from the second parent’s place of work stating that they did not receive this benefit;
• a document confirming the status of a single parent;
• an employee’s application to the employer for parental leave (this is usually written by mothers, but other family members also have the right to do so);
• an order to provide an employee with parental leave until he reaches 1.5 years.

If necessary, inspectors may request other documents that the employer will need to submit.

Reimbursement of funeral benefits

Funeral benefits are paid to the relatives of the deceased (deceased) employee. A set of additional documents for reimbursement from the Social Insurance Fund in 2020–2021 includes:

• death certificate from the registry office;
• a copy of the death certificate;
• application for benefits.

Despite the fact that from 2021 a direct payment mechanism will operate throughout the country, which we will discuss at the end of our article, it will not affect the funeral benefit. This benefit will be paid based on the death certificate received by the employer. The latter must submit an application and a copy of the certificate to the Social Insurance Fund, which will transfer funds to the employer’s bank account within two days from the date of the decision to pay benefits.

Who has the right to receive a funeral benefit and what is its amount this year, experts looked into the ready-made K+ solution. Sign up for a free trial access to the system and read all the latest and useful information.

Reimbursement of employer expenses for paying four extra days off to care for disabled children

The rules for providing additional paid days off for caring for disabled children were approved by Decree of the Government of the Russian Federation dated October 13, 2014 No. 1048.

Additional documents submitted to the FSS include: