It is known that payments when a woman goes on maternity leave are made from funds, that is, from the state budget. Moreover, if the employer is an individual entrepreneur, then in order for his employees to have the right to receive maternity payments, the employer must insure the employee in case of temporary disability and maternity.

The amount of maternity benefits for an employee of a private company depends on the number of days of maternity leave (from 140 to 194 days, depending on the nature of the pregnancy and childbirth) and the size of her official salary.

Amounts of earnings received by an employee “in an envelope” (“gray” salary) are not taken into account when calculating maternity benefits.

If an individual entrepreneur herself goes on maternity leave, she also has the right to appropriate compensation.

In what cases is it performed?

Reimbursement of maternity payments from the Fund in favor of individual entrepreneurs is made upon completion of following conditions:

• the employee is registered in accordance with all the rules established labor legislation(if the employee goes on maternity leave), and on the basis of mandatory social insurance;
• entrepreneur registered with the FSS on a voluntary basis (if the expectant mother is the founder of the company), and contributions must be accrued for a period of 6 months or more

Contributions to the Social Insurance Fund for individual entrepreneurs are fixed. Their final amount is determined as follows:

• the minimum wage established at the beginning of the financial year for which contributions are paid is multiplied by the rate of insurance premiums;
• the resulting amount is multiplied by 12 (according to the number of months in the year).

In 2015, the minimum wage will be 5,965 rubles, and the insurance premium rate will be 2.9%. Thus, the individual entrepreneur will need to pay 2,076 rubles to the Social Insurance Fund.

The contribution is paid in installments or in a lump sum until December 31 of the year in which the application for voluntary insurance was submitted. If, even if there is a concluded contract, payment is not made within the established period, then the insurance relationship is considered terminated.

Procedure, conditions and terms of compensation

Initially, the corresponding amounts are paid by the enterprise to the employee from its own funds, but later (at any time after the payment of benefits without taking into account the statute of limitations), the individual entrepreneur submits an application to the Social Insurance Fund for reimbursement of these amounts.

In this case, the funds are counted towards the mandatory insurance contributions in case of temporary disability made by the individual entrepreneur for one year, that is, the company simply will not need to make such deductions for the amount of maternity benefits, or it will be transferred in full.

After submission After submitting an application to the FSS, a decision can be made in following dates:

• no more than 10 days(usually within one working week) if the document verification gives positive results.
• within 3 months, if any problems arose when checking the documents (for example, something in them seemed strange to FSS employees and did not correspond to the real state of affairs). As a rule, this is due to the need to conduct a desk audit or request additional documents.

If the company does not have the financial capacity to pay maternity benefits in advance, then the funds are transferred directly from the Social Insurance Fund.

Required documents

To receive compensation, an individual entrepreneur must provide the following documents to the Social Insurance Fund:

• sick leave for the employee (or the founder of the enterprise);
• a report on accruals made according to this medical document;
• a copy of the employment contract;
• work book;
• time sheet;
• hiring order;
• employee's application for provision maternity leave and on the assignment of benefits;
• documents confirming the payment of benefits;
• certificates from previous places of work expectant mother;
• documents on the employee’s education;
• additional documents that the FSS may request for settlements.

It is important that the FSS reserves right to recalculate amounts and even right to refuse reimbursement.

This may occur in the following cases:

• the employee does not have the appropriate skills and qualifications;
• the employee was an employee of the company solely formally (that is, job responsibilities were not performed by her, or she did not appear at the workplace at all);
• the salary of a woman in the corresponding position is much higher than the income of other workers employed in similar positions;
• the position of a woman going on maternity leave was not on the staff list until she was employed by the company;
• the expectant mother's salary increased sharply until the time came for her to receive maternity benefits;
• maternity payments were made to the founder of the company.

In addition, the Social Insurance Fund cannot refuse payments if the employee’s length of service is insignificant, or if she was hired a month before the occurrence of the insured event. There are corresponding decisions of arbitration courts about this. Also, the presence of technical errors in the documents submitted to the FSS cannot be grounds for refusal.

Conclusion

The Social Insurance Fund is obliged to reimburse the individual entrepreneur for all expenses associated with the payment of maternity benefits.

If there is an unreasonable refusal of compensation, then it is necessary to go to court.

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Chief specialist - auditor of the Belgorod regional branch of the Social Insurance Fund of the Russian Federation

Graduated from the Moscow Academy of Labor and Social Relations
In 1994-2007 - chief specialist- auditor of the Belgorod regional branch of the Social Insurance Fund of the Russian Federation
In 2008 - chief specialist - expert of the department of methodological support of budget accounting and reporting of the Department of Finance, Accounting and Reporting of the Social Insurance Fund of the Russian Federation

Interviewed by GK correspondent A.V. Khoroshavkina

Compensation from the Social Insurance Fund: when “extra” documents may be required

Reimbursement from the Social Insurance Fund for expenses for paid benefits does not always go smoothly. Here is a quote from a letter received by the editor: “FSS auditors require copies of workers’ work records; why and on what basis is unclear.” The author asks us to figure it out. Fulfilling his request, our correspondent contacted one of the regional branches of the FSS.

Elena Mikhailovna, can the FSS require some “extra” documents from the policyholder when he applies for compensation for benefits?

E.M. Plekhova: Every time a policyholder applies for compensation, FSS specialists conduct a desk audit. But for large insurers, whose expenses will definitely be checked later during an on-site audit and for whom paying benefits is a common thing, auditors may not ask for any documents. Only an application for reimbursement of expenses in any form and calculation of insurance premiums in accordance with Form-4 of the Federal Social Insurance Fund of the Russian Federation. This calculation can also be intermediate. It contains the estimated amount of debt for territorial body The fund at the end of the reporting or settlement period must be the same as in the application.

In such cases, we check whether the calculation is completed correctly and whether there are any errors or contradictions between individual indicators. Sometimes it happens that one amount is indicated in the calculation, but another is indicated in the application. Or the amounts of expenses and accrued contributions are indicated for different months.

For example, the policyholder applies for reimbursement of expenses for January and February in March. In the calculation, it shows the amount of expenses for January and February. And the amounts of accrued insurance premiums are only for January. This is wrong, the offset principle is violated: income minus expenses equals the balance to Art. 15 of Law No. 212-FZ of July 24, 2009 (hereinafter referred to as Law No. 212-FZ). We do not accept documents and ask the accountant to find and correct the error.

When do you require additional documents?

E.M. Plekhova: We may not require it from large insurers. And for small insurers, with up to 50 people, although the report, at first glance, is filled out correctly, we almost always ask for documents. The fact is that small companies, as a rule, have many violations. Most often, this is due to the fact that this is the first time an accountant of such a small company has encountered the assignment of any benefit. Large ones, as practice shows, are much more disciplined.

Copies of documents confirming the validity and correctness of expenses for payment of benefits are specific for each type of benefit.

Many accountants, before coming to the Social Insurance Fund office for reimbursement of expenses, first call and ask what documents need to be submitted to reimburse a specific type of benefit. Our employees are always ready to provide assistance and advice.

Others find it convenient to come to a specialist for a preliminary consultation. They bring documents with them and ask to check if anything else is needed. The FSS specialist reviews all documents. If something is missing, he clearly states what is still needed.

As the policyholders themselves tell us, this is convenient for them. They know for sure that the FSS department will conduct a desk audit within 10 days and make a decision on the full allocation of funds. A refusal to allocate funds or a decision on partial allocation will no longer be an unpleasant surprise.

If the policyholder has very large amounts of expenses, and even different types benefits, we can conduct not a desk inspection, but an on-site unscheduled inspection. This is more convenient for both us and the policyholder, otherwise he would have to carry huge stacks of copies of documents. During such an on-site unscheduled inspection, we do not check everything, but only those expenses for which the policyholder has just applied for reimbursement.

Unfortunately, it is not possible to cover all “small” policyholders who spend FSS funds with scheduled on-site inspections. After all, such inspections are carried out only once every 3 years. Art. 35 of Law No. 212-FZ. And we must not miss the statute of limitations for bringing to justice for offenses when spending funds from the Social Insurance Fund.

What additional documents can be requested for reimbursement of expenses?

E.M. Plekhova: You should not think that we have some kind of limitless list of such documents. It’s just that in order to receive each benefit you must comply with certain rules of the law. Their compliance must be confirmed by the policyholder.

For example, if the policyholder repeatedly applies for temporary disability benefits to care for a sick family member, it is necessary to check whether the norm for the total maximum number of days paid in a calendar year is observed. Part 5 Art. 6 of the Law of December 29, 2006 No. 255-FZ.

That is, when the policyholder applies for reimbursement of expenses for sick leave, the auditors will ask for a register of certificates of incapacity for work. Such a register must indicate f. And. O. employee, sick leave number, period of illness, number of calendar days missed due to illness, amount of benefit at the expense of the enterprise, amount of benefit at the expense of the Social Insurance Fund.

For benefits for caring for a sick child, in addition to these indicators, you must indicate how many days the employee’s child has already been sick this year.

In order for the parent of a disabled child to be paid for 4 additional days off, a certificate from the other parent’s place of work is needed stating that he does not use such days off in the same calendar month. But if this second parent does not work, his lack of work must be documented: attach either a copy of the work book or a certificate from the authorities civil service employment of the population.

A copy of the work record is also required when benefits are assigned to a part-time worker, in order to confirm that he has a main place of work.

WE TELL YOUR PARTNERS

To an external part-time worker could receive temporary disability benefits to the maximum extent possible for him, he needs to submit, along with the sick leave, a copy of the work record book from his main place of work.

The auditor compares the employee’s age and his length of service indicated on the sick leave certificate. And there are cases when age is only slightly greater than experience, it turns out that a person began working at a very young age. Then the auditor will require confirmation of the length of service using a copy of the work record book.

Sometimes in two different sick leave certificates in the name of the same employee (for example, one for January, the other for February), the employer indicates a different number of years of insurance experience. Let's say the first one is 6 years old, and the second one is 8 years old. This is an obvious mistake; all that remains is to check in which case the accountant made a mistake. Only a work record book will help here.

Unfortunately, sometimes documents are needed from the employees (insured persons) themselves. For example, that the second parent does not receive benefits for the birth of a child and child care. If the second parent works, such a certificate must be issued to him by his employer. If it doesn't work, the organs social protection. This certificate is often confused with a certificate from the employment center. Such a certificate from the employment center must be submitted to the social security authority in order to receive the certificate that I mentioned.

One of our readers writes: regional offices The Social Insurance Fund denies child care benefits to the father or grandmother of a child up to one and a half years old if the child’s mother is unemployed, since she is already “actually caring for the child.” Are you right in in this case FSS representatives?

E.M. Plekhova: No. Right to monthly allowance child care is provided by one of the parents or other relatives who have taken out parental leave and are actually caring for the child Articles 11, 13 of the Law of May 19, 1995 No. 81-FZ; clause 39 of the Procedure, approved. By Order of the Ministry of Health and Social Development dated December 23, 2009 No. 1012n (hereinafter referred to as the Procedure).

If several people are caring for a child, any of them can apply for leave to care for him and receive benefits. pp. 39 , 42 Order. And nowhere - neither in the law nor in regulatory documents - is there a prohibition on taking parental leave for any other relative if the child’s mother is unemployed.

What violations leading to refusal of refund are most common?

E.M. Plekhova: Quite often, accountants forget to limit the amount of benefits to the level of the minimum wage for employees with a short period of insurance, less than 6 months.

If the employee previously worked for another employer, a certificate of his earnings from the previous employer must only be in the established form. approved By Order of the Ministry of Health and Social Development dated January 17, 2011 No. 4n. But in practice, they often attach some other certificates: from the employment center about payments to the unemployed; certificates in form 2-NDFL.

Sometimes, when calculating benefits for “empty” months when the employee did not receive a salary, they set his income in the amount of the minimum wage.

The Social Insurance Fund strictly controls the correctness of the assignment and calculation of benefits. But we identify not only overpayments, but also underpayments. Quite often, during desk audits, we find cases where benefits for the birth of a child, when registering with early dates pregnancy, child care up to one and a half years old are paid at the old, last year's rates, without indexation.

WE TELL THE EMPLOYEE

Salary certificate from previous employers must be in a strictly established form. Otherwise, you may not receive enough sick leave benefits.

I would also like to note that recently there have been a lot of cases when an enterprise is liquidated or simply has no money. And workers who are not paid benefits can contact the Social Insurance Fund office directly Part 4 Art. 13 of the Law of December 29, 2006 No. 255-FZ, attaching documents (for each type of benefits they are different).

FSS branches themselves request tax authorities and banks to confirm that the enterprise has actually closed or has no money in its accounts. But if the employer, wanting to help the employee receive benefits as quickly as possible, gives him documents that confirm this, we will accept them from him.

For example, this could be a certificate from the company about the availability of bank accounts and a certificate from the bank about the status of each current account of the company, a letter from the company about the reasons for which the benefit was not paid or not paid in full. If the benefit was paid partially, it is advisable to indicate for which period the benefit was assigned and paid, and for which period it was not.