Conditions, benefit levels and calculation of new social insurance sickness regime

Let’s find out now: Subjects and conditions for receiving sick leave benefits. How to calculate sick leave benefits under social insurance & procedures and documents for receiving long-term sick leave benefits.

I. Subjects entitled to sick leave benefits

1. For employees who are Vietnamese citizens

• Employees are Vietnamese citizens participating in compulsory social insurance;
• Employees signing indefinite or fixed-term labor contracts, labor contracts with a term from 3 months to less than 12 months;
• Employees working continuously with labor contracts from 1 month to less than 3 months;
• Cadres, civil servants, officers, police, public employees, and people receiving salaries as military personnel;
• Managers and operators of enterprises and cooperatives receive salaries;
• Part-time workers in wards, communes, towns…

2. For employees who are foreign citizens

Employees who are foreign citizens working in Vietnam with a practice certificate or work permit issued by a competent authority in Vietnam will be eligible to participate in social insurance according to regulations. However, the contribution rate for foreign employees is different from that of Vietnamese citizens.

➤ Refer to Article 3 of Circular 59/2015/TT-BLDTBXH

Employees who are sick or have an accident that is not a work-related accident or occupational disease and must take time off work or have a relapse of illness must have confirmation from a medical facility. The time to enjoy sick leave in a year is calculated by working days, excluding holidays – Tet – weekly leave as follows:

• Workers working in normal working conditions: 

      – 30 days if paying social insurance for less than 15 years;
      – 40 days if paying social insurance for 15 years but less than 30 years;
      – 60 days if paying social insurance for 30 years or more.

• Doing heavy, toxic and dangerous work or working in a place with a regional allowance coefficient of 0.7 or higher:

      – 40 days if paying social insurance for less than 15 years;
      – 50 days if paying social insurance for 15 years but less than 30 years;
      – 70 days if paying social insurance for 30 years or more. 

• Employees taking leave to take care of sick children under 7 years old + with a certificate from a medical facility:

      – According to Clause 1, Article 27 of the Social Insurance Law 2014, the maximum time to receive social insurance benefits when a child is sick is 20 days/year if the child is under 3 years old. If the child is 3 years old or older – under 7 years old, the maximum leave is 15 working days;
      – If both parents participate in social insurance – and take leave to take care of the child, both parents will be entitled to benefits when the child is sick. 

• Female employees returning to work before maternity leave must meet the following conditions: 

      – There is confirmation from the medical facility that the employee is returning to work early but is not harmful to the employee’s health;
      – Must notify in advance and have the employer’s consent;
      – After maternity leave, the employee has enjoyed the regime for at least 04 months.
➥ Thus, in addition to the salary, female employees who return to work before maternity leave are still entitled to maternity regime and social insurance regime.

• Employees taking leave due to long-term illness: 

      – Refer to the List of diseases requiring long-term treatment in Circular 46/2016/TT-BYT;
      – Employees are entitled to a maximum of 180 days off (including holidays, Tet holidays, and weekly days off). If treatment continues beyond day 181, they will receive sick leave benefits = a lower level but up to a maximum of the time participating in social insurance.

➤ Cases where social insurance does not resolve sick leave benefits 

• Social insurance does not cover sickness and accident benefits for people who quit their jobs due to self-harm, drunkenness, use of stimulants, drugs, etc.;
• Employees who are sick but not due to work-related accidents and are on annual leave, personal leave, unpaid leave, or maternity leave;
• Employees who take time off work for the first time due to occupational disease or accident. In this case, if the employee meets the conditions, he/she will be entitled to occupational accident benefits – Refer to Point c Clause 1-2 Article 45 of the Law on Safety, Hygiene and Labor.

>> See more: How to calculate occupational accident and disease benefits.

III. Benefits during illness

➤ Employees take sick leave according to the provisions of the Law on Social Insurance (Clause 1, Articles 26 and 27)

Level of benefits for days off not included in the month

=

(Social insurance contribution salary of the month immediately before leaving work: 24)

x

Sickness benefit rate (%)

x

Number of days off with sick leave

In which the sickness rate is: 

• 75%: sick leave period in the first 180 days. After 180 days, if treatment is still required, it is calculated as follows:
• 65%: Employees have paid social insurance for 30 years or more;
• 55%: Employees who have paid social insurance for 15 years to less than 30 years;
• 50%: Employees paying social insurance for less than 15 years.

IV. Procedures for registration to receive social insurance

1. Application for sick leave and social insurance benefits

Profile details include:

• Original social insurance leave certificate certified by medical authority;

• List of sick leave requests – Form 01B-HSB;
• Sickness benefit application receipt form – Form PGNHS 201.

2. How to submit sick leave application for social insurance

For direct application:

• Step 1A: The enterprise fills in Form 01B – HSB in Section A: Sickness regime; fill in the number of days entitled to social insurance according to the certificate issued by the health authority;

• Step 2A: The enterprise submits Form 01B-HSB and attaches the PGNHS 201 Form Delivery Note + Original Social Insurance Certificate to the Social Insurance Management Agency by post.

For online applications:

• Step 1B: Enterprise logs into social insurance account => Select file number 630a => Similar to filling out paper application;

• Step 2B: The Social Insurance Agency receives and processes the application and sends an email confirming the electronic application.

The enterprise renders the 630A file form + the original social insurance leave certificate + prints the social insurance receipt notice and sends it to the email. Then send the file set to the social insurance by post.

• Step 3: The Social Insurance Agency receives the application and will return the results within 06 working days;
• Step 4: Receive results – Employees receive benefits.

Note :

In case the sick leave application has been approved by the Social Insurance but the enterprise itself discovers errors. For example, incorrect number of sick leave days, incorrect information about account number, account name. The enterprise submits an adjustment application – fill in section 2 (applicable to both paper application form 01B-HSB and online application form – Form 630A).

V. Conditions for receiving health care benefits after returning to work

Refer to Article 26 of the Social Insurance Law 2016.

The level of health care and recovery benefits after illness of employees is equal to 30% of the basic salary.

The time to enjoy the convalescence regime after illness if the employee has paid social insurance for 1 year will be from 5 – 10 days:

• Employees with illnesses requiring long-term treatment: maximum 10 days;
• Employees requiring surgery: maximum 07 days;
• Other cases: 5 days.

VI. Related questions about social insurance sickness benefits for employees