Calculation of disability benefits in the Pilot Project. Implementation in 1C programs

Pilot project of direct payments from the Social Insurance Fund - what is it?

A pilot project for the payment of benefits and sick leave directly from the Social Insurance Fund has been operating in Russia since 2012. Initially (in the first half of 2012) it was used only in 2 regions of Russia - Karachay-Cherkessia and the Nizhny Novgorod region.

The number of participants in the pilot project increases every year. Regions participating in the project

, are prescribed in paragraph 2 of the Russian Government Decree No. 294 dated April 21, 2011.

According to the Resolution, which regulates the rules for direct payment of benefits, the pilot project is valid from 01/01/2012 to 12/31/2020; at the end of the project, all regions will be transferred to the new payment regime, provided that these regions have positive results.

Back in 2021, the Government decided that a pilot project for direct payments of benefits and sick leave would be introduced throughout Russia from 2021.

That is, starting next year, Russian accountants will not calculate, accrue and pay almost any payments, except for salaries and incentive payments.

Participants in the pilot project do not pay benefits for temporary disability or child care, and do not offset insurance premiums against payment.

The only thing that has remained unchanged regarding hospital payments is the accrual of temporary disability benefits for the first 3 days of illness

.

Payments for sick leave or child care are transferred directly from the Social Insurance Fund to the employee within 10 calendar days after the date of receipt of the documents necessary for calculating benefits. If an employee has questions regarding the transfer of funds, the employee must be directed to the Social Insurance Fund.

It should be noted that the pilot project of direct payments from the Social Insurance Fund concerns only sick leave, maternity leave and benefits related to the birth of a child. The employer, as before, calculates and pays:

• funeral benefit;
• additional days off to care for a disabled child.

Moscow and the Moscow region are switching to “Direct payments”

In accordance with Article 431, Part 2 of the Tax Code of the Russian Federation, from January 1, 2021, the assignment and payment of insurance coverage for compulsory social insurance to insured persons in Moscow and the Moscow region will be carried out directly by the territorial body of the Social Insurance Fund.

Until 2011, benefits from the Social Insurance Fund were paid under the so-called offset system. The employer transferred money to the employee from his own funds, and then reduced the amount of tax contributions to the Social Insurance Fund by the amount of benefits paid. At times, this benefit scheme has resulted in delayed payments due to employers' financial difficulties. 9 years ago, the Social Insurance Fund launched a pilot project “Direct Payments”, which made it possible to finally solve this problem. Since July 1, 2021, the system has become fully operational in 77 regions of the country.

From January 1, 2021, the entire country, including Moscow and the Moscow region, should switch to the direct payment mechanism. Many employers in the Moscow region managed to appreciate the benefits of the new insurance payment scheme even before the official start of the project. Companies used the direct payment mechanism to pay sick leave benefits to employees 65+ during self-isolation due to the pandemic.

To date, over 700 thousand policyholders-employers have been registered with the Moscow branch of the Social Insurance Fund of the Russian Federation, employing more than 7.3 million insured citizens. More than 13 thousand enterprises have already taken advantage of the direct payment mechanism. More than 240 thousand policyholders-employers and over 2.6 million insured workers are registered in the Moscow region. More than 8.5 thousand companies have already paid benefits using the direct payment mechanism.

For employers from the Moscow region who are just preparing to switch to the direct payment mechanism, the Fund’s branches and its branches are now providing online training on how to work with the service that accompanies this mechanism. Despite the restrictions associated with the coronavirus pandemic, this year the branches and branches of the FSS have already held more than 400 webinars, in which more than 15 thousand employers of the capital took part, about 10 thousand companies took advantage of training videos and presentations posted on the website of the Fund branches and on pages on social networks.

In the Moscow region, FSS training webinars are held on the VLSI platform, Kontur. In addition, representatives of the Fund’s branches and branch directors organize face-to-face meetings with the management staff of city district administrations; branches of the Fund’s branches regularly conduct training seminars with the participation of representatives of large entrepreneurs.

You can find out about the schedule of webinars and sign up for training on the official website of the Fund’s branch www.r77.fss.ru for Moscow or www.r50.fss.ru for the Moscow region in the section “Direct payments”, “Webinars”.

All employed citizens of our country have the right to receive benefits from the Social Insurance Fund. This includes benefits for temporary disability, including due to an occupational disease or injury at work, maternity benefits, and child care benefits for up to 1.5 years.

With the help of the direct payment mechanism, funds will reach the employee much faster. The advantage of the new mechanism was once again confirmed by the situation with the closure of companies due to self-isolation due to the pandemic. Many employers are faced with a lack of available cash. With an offset system, workers would have to wait until the company had money for payments. With the new system this need no longer exists. According to the law, no more than 10 calendar days are allocated for direct payments of social benefits from the Social Insurance Fund. Now citizens will not have to worry that the receipt of funds for treatment or maternity leave will be delayed.

At the same time, the employee himself does not need to take any additional actions to receive benefits in connection with the implementation of the direct payment mechanism. Traditionally, you simply need to provide your HR department with documents confirming your right to receive payments, and also fill out a special application, indicating the details by which you want to receive money (Mir card, bank account or postal order). Within 5 calendar days, the employer will transfer information about the employee to the territorial office of the Social Insurance Fund, and funds will be received directly from there in due time.

The direct payment mechanism is very convenient not only for the employee, but also for the employer. The new approach to benefit payments increases the financial stability of companies; they no longer need to withdraw funds from circulation. In addition, the accounting department will no longer have to waste time processing and calculating benefits due to employees. At the same time, the new mechanism ensures complete transparency of payments and the correctness of their accrual, as it is controlled strictly in accordance with the law, which allows us to avoid violations and errors that arose earlier.

Benefit payments in 2021

Since, in accordance with Decree of the Government of the Russian Federation No. 294, the pilot project ends on the last day of 2020, from January 1, 2021, all regions will switch to direct payments of temporary disability and child care benefits from the Social Insurance Fund. That is, the employer will only need to send a package of documents to the Social Insurance Fund and pay for the first 3 days of sick leave at his own expense.

Currently, amendments to the Government of the Russian Federation No. 294 are under consideration, which involve extending the pilot project for another 1 year

. In accordance with the amendments, starting next year, all regions will switch to direct payments of benefits at the expense of the Social Insurance Fund. But next year will be considered a “trial” year, and the obligation to switch to direct payments will come into force in 2022. The amendments have not yet been approved at the legislative level; they are being discussed in the Russian Government.

Despite possible amendments to the Resolution, all employers will be transferred to the new payment regime from 2021

. That is, next year the work of accountants in relation to the calculation and payment of benefits will change greatly.

What will an accountant need to do in 2021 to pay sick leave and maternity leave?

In order for the employee to receive his payments, the accountant will have to, after receiving an application for sick leave or benefits, no later than 5 calendar days, transfer the necessary package of documents to the regional office of the Social Insurance Fund

.

The Ministry of Labor is considering the possibility of reducing the period for sending documents for the calculation and accrual of direct payments from the Social Insurance Fund from 5 calendar days to 3 working days. However, the draft Federal Law that provides for this change has not yet been submitted to the State Duma of Russia and is at the stage of public discussion.

The list of documents required to calculate direct payment depends on the type of benefit. We will tell you more about the package of documents in the next paragraph of this article.

Information necessary for calculating benefits can be sent to the Social Insurance Fund office on paper only if the average number of employees of the enterprise does not exceed 25 people

. In other cases, a package of documents is sent to the FSS via electronic communication channels.

If an organization plans to reimburse from the Social Insurance Fund the costs of paying for additional days off to care for a disabled child, funeral expenses, or expenses for preventive measures to reduce injuries, the accountant must send a certain package of documents to the Social Insurance Fund.

To reimburse payment for additional days off to care for a disabled child

the package of documents consists of:

1. an application, the form of which is approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578;
2. a certified copy of the order to provide additional days off to the employee.

To get money back for funeral benefits

The accountant sends to the Social Insurance Fund:

1. an application from a relative of a deceased employee, the form of which was approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578;
2. a copy of the death certificate of the former employee.

To reimburse expenses aimed at minimizing injury incidents

at production, the following documents should be submitted to the Social Insurance Fund:

1. an application, the form of which is approved by Order of the Ministry of Health and Social Development of Russia dated July 11, 2011 No. 709n;
2. copies of documents confirming payment of the company's expenses (agreement, check, certificate of completion, delivery note or other strictly reporting forms).

Documents used by pilot project participants

First, the employer must obtain from employees applications and documents necessary for the assignment and payment of benefits, and transfer the information to the Social Insurance Fund.

The forms of documents used for payment of insurance coverage in the constituent entities of the Russian Federation participating in the implementation of the pilot project were approved by Order of the Federal Insurance Service of the Russian Federation dated November 24, 2017 No. 578. In particular, this order approved:

• application for payment (recalculation) of benefits (vacation pay);
• a list of applications and documents necessary for the appointment and payment of relevant types of benefits to insured persons;
• application for reimbursement of expenses for temporary disability benefits;
• notification of the provision of missing documents or information;
• decision to refuse to assign and pay temporary disability benefits;
• application for reimbursement of expenses for payment of social benefits for funeral;
• an application for reimbursement of expenses for additional paid days off for one of the parents (guardian, trustee) to care for disabled children;
• application for reimbursement of the cost of a guaranteed list of funeral services;
• decision to refuse to consider documents (information);
• certificate of calculation of the amount of vacation pay.

The list of documents (copies thereof) that must be submitted for an employee to receive benefits and other payments depends on the type of benefit (payment):

Employers in those regions who join the pilot project in 2021 should inform their employees about the innovations in advance. This primarily applies to persons who receive child care benefits. To receive benefits for January on time, applications had to be submitted to the Social Insurance Fund in mid-January. For those who join the pilot project from July 1, 2019, outreach work with staff should be carried out in June.

To reimburse your expenses from the Social Insurance Fund, you need to submit documents to the territorial body depending on the type of expenses:

Within five calendar days, the employer must transfer the collected package of documents to the fund. The information necessary to assign insurance benefits in case of temporary disability and in connection with maternity must be submitted in the form of an electronic register.

Forms for registers of information necessary for the appointment and payment of relevant types of benefits, as well as the procedure for filling them out, are approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 579.

Policyholders whose average number of individuals in whose favor payments and other remunerations are made for the previous billing period exceeds 25 people submit an electronic register of information. If the company has a smaller staff, you can submit a set of documents on paper (inventory, application, documents on the basis of which benefits are paid).

If the employer does not provide all the information in the register or does not submit all the documents necessary for the assignment and payment of benefits, the Social Insurance Fund will send him a notice. Within five working days from the date of receipt, the employer must submit the missing documents (clause 7 of the Regulations on the assignment and payment of benefits during the implementation of the pilot project, clause 6 of the Regulations on payments for accident insurance).

If the employer does not submit a package of documents for benefits on time or submits such a package of documents with errors, the territorial body of the Social Insurance Fund will demand reimbursement of expenses for illegally paid benefits. In addition, an official of the organization faces a fine of 300 to 500 rubles. (Part 4 of Article 15.33 of the Code of Administrative Offenses of the Russian Federation).

The deadline for payment of sick leave and other social benefits by the Social Insurance Fund is ten calendar days from the date of receipt of documents from the employer.

The money is transferred to the employee’s bank account or through the federal postal service or another organization at the request of the employee (clause 9 of the Regulations on the assignment and payment of benefits during the implementation of the pilot project).

The legislation does not provide for the obligation of the territorial body of the Social Insurance Fund to inform the employer or recipient of benefits about the amount of the assigned temporary disability benefit before its actual payment.

If the employer has submitted to the FSS all the necessary documents for assigning a benefit, but the employee has not received the benefit, then the employer should check the accuracy of the information specified in the application (for example, full name, bank details), as well as the fact that the information was transferred to the FSS to assign benefits. In addition, to clarify the terms of payment, the employer has the right to contact the territorial body of the Social Insurance Fund in writing, indicating the full name. O. of the employee, his SNILS, date of transfer of documents to the territorial body of the Social Insurance Fund, number of the certificate of incapacity for work.

On the FSS website you can check its status by the number of the certificate of incapacity for work. To do this, the employer must enter the registration number of the policyholder and the number of the certificate of incapacity for work, and the individual must enter SNILS and the number of the certificate of incapacity for work.

Should the Social Insurance Fund pay benefits if the policyholder has not submitted the original sick leave certificate? In Resolution No. A43-30419/2017 dated August 27, 2018, the Supreme Military District Administration dealt with a situation where the employer did not submit the original sick leave, and the Social Insurance Fund tried to recover the benefits paid from him.

The arbitrators did not support the fund: in their opinion, the Social Insurance Fund should pay the woman maternity benefits, as well as a lump sum benefit for the birth of a child, even if the policyholder did not present sick leave.

Having examined and assessed the evidence presented in the case, the arbitrators concluded that the fact of the occurrence of insured events and the right of the insured person to receive maternity benefits and a one-time benefit for the birth of a child were confirmed (the employer presented an exchange card, an individual card for a pregnant and postpartum woman indicating the issue a certificate of incapacity for work for a certain period, an application for the assignment of a lump-sum benefit for the birth of a child, a certificate of birth of a child, a certificate from the other parent’s place of work stating that a lump-sum benefit was not assigned for the birth of a child).

The Supreme Court, in Ruling No. 307KG18-14530 dated September 27, 2018, indicated that you can confirm the insured event and the legality of payment of benefits with other documents (a copy of the sick leave itself, a child’s birth certificate, a birth certificate, etc.). The essence of the matter was as follows. During the on-site inspection, the employer provided the Social Insurance Fund with answers from medical institutions instead of lost sick leave certificates. They contained information about issued sick leave with series and numbers, F.I. O. those to whom the documents were issued, as well as copies of the counterfoils. The FSS did not accept these documents. However, the arbitrators indicated that this information was sufficient to confirm the legality of the payment of benefits.

Source:

Ayudar Info

Heading:

Social benefits

temporary disability benefit FSS certificate of incapacity for work

• E. L. Dzhabazyan, editor of the magazine “Tourist Services: Accounting and Taxation”

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A package of documents for submission to the Social Insurance Fund for direct payments

The list of documents that must be submitted to the Social Insurance Fund for the calculation of direct payments depends on the type of benefit.

To calculate a one-time benefit for a woman who registered for pregnancy in the early stages

, the employer must send to the Social Insurance Fund:

1. application in any form;
2. a certificate from the antenatal clinic with the seal of the medical institution and the signature of the doctor.

To calculate maternity benefits

on sick leave for 140 days or more, the accountant is required to send to the regional office of the Social Insurance Fund:

1. application in any form;
2. certificate of incapacity for work;
3. certificate of earnings for the pay period.

It is worth noting that if the sick leave was issued electronically, the accountant must redirect it to the Social Insurance Fund.

At the birth of a child, one of the parents is entitled to a lump sum benefit,

the amount of which from 02/01/2020 is 18,004 rubles 12 kopecks (indexed annually). To appoint him, the accountant sends the following documents to the regional office of the Social Insurance Fund:

1. application in any form;
2. a copy of a certificate from the registry office about the birth of a child or another document confirming the birth of a child, provided that the birth took place in another country;
3. a copy of a document confirming that the child’s second parent did not apply for a one-time benefit at the birth of the child (issued by the employer or the social security department, provided that the second parent is unemployed).

Provided that the marriage of the child’s parents was dissolved

, the accountant must request from the applicant for a one-time benefit upon the birth of a child and additionally submit to the Social Insurance Fund:

1. a copy of the divorce certificate;
2. a certificate confirming the fact of cohabitation with the child.

After the maternity sick leave expires, the employer sends a package of documents to the Social Insurance Fund for calculating child care benefits for children up to 1.5 years old.

, which includes:

1. an application, the form of which was approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578;
2. a copy of the child's birth certificate;
3. copies of birth or death certificates of previous children (if available);
4. certificate of earnings for the billing period;
5. a document from the second parent’s place of work confirming the fact of non-receipt of child care benefits for a child under 1.5 years of age.

If the applicant works in several jobs, then it is additionally necessary to submit documents confirming that he did not submit a similar application for child care benefits for children up to 1.5 years old from other employers

(for example, if the employee works part-time somewhere else).

The package of documents for receiving child care benefits does not change depending on who will apply for the benefits: mother, father or grandmother

.

To calculate temporary disability benefits

, the accountant will have to send to the regional office of the Social Insurance Fund:

1. an application, the form of which was approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578;
2. a copy of the certificate of temporary incapacity for work (or electronic sick leave);
3. certificate of earnings for the pay period.

Provided that the employee was injured at work, then in addition to the above documents, a copy of the accident report or copies of all materials from the production investigation are sent to the Social Insurance Fund, provided that the case has not yet been completed.

To calculate payment for additional leave for treatment

employee, the employer sends to the Social Insurance Fund:

1. a copy of the application for the provision and payment of leave;
2. a copy of the leave order;
3. a certificate calculating the amount of vacation pay, the form of which was approved by Order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578.

It is worth noting that in the application for any type of benefit it is necessary to indicate the method of receiving the payment. This could be a bank account or postal order. If the applicant plans to receive payments to a bank card, then in the application you can indicate the current account of any card (not necessarily a salary card) of any payment system. But from October 1, 2021, all benefits will be accrued only to bank cards of the MIR payment system.

How are “Direct Payments” of benefits processed?

So, the sequence of processing and receiving payments for temporary disability is as follows:

1. The insured completes and submits a package of documents to his employer.

The employee must fill out and submit an application to the policyholder. And attach to it documents confirming the citizen’s rights to receive payments, which depend on the type of benefit itself:

It is worth noting that sick leave remains relevant for six months. And from 2021, in addition, at the birth of a child, you will need a certificate from the registry office about his birth, as well as a certificate from the employer stating that such benefits have not previously been received. At the same time, the ability to provide documents electronically is added.

2. The organization sends the received documents to the Social Insurance Fund.

The method of transferring documentation to the Fund depends on the number of personnel on staff of the employer:

• If there are no more than 25 employees, then you can use the electronic method or on paper;
• If the staff is larger, then documents are sent only electronically.

The employer is given 5 calendar days to check and transfer documents to the Fund. In addition, an inventory must be drawn up on them according to the established template. If an organization does not submit a complete set of documents, it will receive a corresponding notification from the Social Insurance Fund. Then the missing papers must be provided no later than 5 days from the date of receipt of such notice.

3. The Social Insurance Fund reviews the documents and decides to refuse or pay benefits.

The Fund's specialists check the accuracy of the documents provided, as well as their completeness and correctness. The FSS is given 10 calendar days from the date of receipt of the complete set to evaluate and make a final decision.

4. The benefit is transferred.

Depending on the chosen method:

• Postal transfer,
• To a personal account at a banking institution,
• To the card of the MIR payment system

the insured citizen receives direct benefit payments directly from the Social Insurance Fund, and not from the employer, as was previously the case.

Direct benefit payment scheme:

If on the day the insured person applies for benefits, the employer has ceased its activities or it is not possible to establish the location of its actual location, then the citizen has the right to apply to the territorial Social Insurance Fund directly. To do this, he needs to write an application and collect a package of required documents.

It is worth noting that monthly direct payments for childcare for children not older than 1.5 years are transferred during the first 15 days of the month following the billing month (for which the payment is transferred).

Responsibility for failure to provide information for calculating benefits to the Social Insurance Fund

For late submission of documents for calculating benefits to the Social Insurance Fund, the employer may be held administratively liable in the form of a fine in the amount of 300 to 500 rubles.

Provided that the employer sends a package of documents with errors or incomplete information to the Social Insurance Fund, the Social Insurance Fund branch will send a notice to the organization about the need to make corrections. Consequently, the employee will receive benefits with a delay.

It is worth noting that if the employer provides inaccurate information that directly affects the amount of the benefit, the organization will have to reimburse the excess expenses incurred by the Social Insurance Fund.

This situation may occur if the employer does not promptly submit information to the Social Insurance Fund about the termination of the accrual of benefits in relation to the employee.

. The FSS department will calculate and pay benefits for which the payment period has already ended. The employer will have to reimburse the overpaid benefit amount, since the Social Insurance Fund does not have the right to make deductions from the insured person’s wages.

A similar situation can occur if the employer knowingly provides information according to which the employee will be entitled to an increased amount of benefits (unreliable indication of the amount of wages, actual time worked or the period of official employment). After identifying inaccurate information, the FSS department will issue a claim for reimbursement of excessive expenses to the general director.

The Ministry of Labor has currently prepared a draft Federal Law providing for stricter liability of employers for failure to provide data or inaccurate information

in the package of documents. It should be noted that this draft Federal Law has not yet been submitted to the State Duma for consideration; it is at the stage of general discussion.

It provides for the following types of employer liability:

• a fine of 200 rubles for each document not submitted if the employer refuses to send the required documents;
• full reimbursement of excessively incurred expenses for payment of benefits, provided that the employer did not promptly inform the Social Insurance Fund about the termination of payment of benefits or provided distorted data for the accrual of sick leave and maternity leave;
• a penalty of 20% of the amount of excess expenses incurred for the payment of benefits in the amount of no less than 1,000 rubles and no more than 5,000 rubles if false data is provided or if the Social Insurance Fund office is not notified in a timely manner about the termination of accrual and payment of benefits;
• a fine of 5,000 rubles if the deadline for submitting a package of documents necessary for calculating benefits is violated.

Rules for filling out reports on insurance premiums and Form 4-FSS from 2021

In addition to the fact that from 2021, accountants will stop calculating benefits for temporary disability and child care, the rules for filling out reports on insurance premiums will also partially change

.

Since the employer will no longer accrue and pay benefits (almost all) to its employees, in reporting on insurance premiums from 2021 it will not be necessary to fill out Appendices 3 and 4 to Section 1. Since they are filled out only in the case of accrual and payment of benefits. An exception can only be if the region joins direct payments not from the beginning of the year, but for example, from the middle, provided that amendments to Russian Government Decree No. 249 are adopted (the pilot project will be extended until the end of 2021).

For a similar reason, accountants will fill out Form 4-FSS differently.

. Since the employer does not pay benefits, the following are not filled out in Form 4-FSS:

1. line 15 of table No. 2 (dash);
2. table No. 3.

Exception

– if the region joins direct benefit payments not from the beginning of 2021 (provided that the pilot project itself will be extended until the end of 2021).