Social insurance compensation. The procedure for reimbursement of funds from the social security fund. According to the pilot project “Direct Payments”

The St. Petersburg branch of the Social Insurance Fund has posted on its website a recommended list of documents required to allocate funds for reimbursement of compulsory social insurance expenses to policyholders-employers in 2018.

Which documents

The list of documents serving as the basis for making a decision on the allocation (reimbursement) of the necessary funds for the payment of insurance coverage was approved by order of the Ministry of Health of Russia dated December 4, 2009 No. 951n (taking into account changes made by order of the Ministry of Labor of Russia dated October 28, 2016 No. 585n).

So, employers need to submit:

application for the allocation of the necessary funds for the payment of insurance coverage (in the form provided by the Fund’s letter dated December 7, 2016 No. 02-09-11/04-03-27029);
Form 4-FSS (for obligations arising before 01/01/2017);
certificate - calculation and Explanation of expenses.

In addition to the above-mentioned documents, the policyholder immediately submits duly certified copies of documents confirming the validity and correctness of expenses for compulsory social insurance in case of temporary disability and in connection with maternity.

An approximate list of such documents:

documents serving as the basis for the assignment and payment of benefits (confirming the fact of an insured event);
documents confirming the correct calculation of benefits (for temporary disability and maternity benefits, monthly child care benefits);
documents confirming the existence of an employment relationship between the policyholder and the person receiving the benefit.

The list of documents depends on the specific insured event.

Temporary disability benefit

To be reimbursed for sick leave expenses, you must provide:

a certificate of incapacity for work, filled out in the prescribed manner with the benefit calculated;
a certificate (certificates) from the place of work (service, other activity) with another policyholder (other policyholders) stating that the appointment and payment of benefits by this policyholder are not carried out if the insured person at the time of the insured event is employed by several policyholders, and in two in previous calendar years was occupied by other policyholders, or by both these and other policyholders (another policyholder).

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).

Birth benefit

When reimbursing funds for the payment of a lump sum benefit for the birth of a child, the following must be presented:

a child’s birth certificate issued by the civil registry office;
a copy of the child's birth certificate;
a certificate stating that the benefit was not assigned from the place of work (service) of the other parent, or the social protection body at the place of residence, if the father (mother, both parents) of the child does not work (does not serve) or is studying full-time in professional educational organizations, educational organizations of higher education, educational organizations of additional professional education and scientific organizations, and the other parent of the child works (serves);
certificate of divorce, if the marriage between the parents is dissolved;
a copy of the child’s birth certificate issued by a consular office of the Russian Federation outside the territory of the Russian Federation - if a child is born on the territory of a foreign state.

a document and its copy confirming the fact of birth and registration of a child, issued and certified with an “apostille” stamp by the competent authority of a foreign state, with a translation into Russian certified in accordance with the procedure established by the legislation of the Russian Federation - at the birth of a child on the territory of a foreign state party to the Convention abolishing the requirement of legalization foreign official instruments, concluded at The Hague on October 5, 1961;
a document and its copy confirming the fact of birth and registration of a child, issued by a competent authority of a foreign state, translated into Russian and legalized by a consular office of the Russian Federation outside the territory of the Russian Federation - at the birth of a child on the territory of a foreign state that is not a party to the above Convention;
a document and its copy confirming the fact of birth and registration of a child, issued by the competent authority of a foreign state, translated into Russian and affixed with an official seal - at the birth of a child on the territory of a foreign state that is a party to the Convention on Legal Assistance and Legal Relations in Civil, Family and Criminal Matters cases concluded in the city of Minsk on January 22, 1993;
an extract from the decision to establish guardianship over the child (a copy of the court decision on adoption that has entered into legal force, a copy of the agreement on the transfer of the child (children) to a foster family) - for the person replacing the parents (guardian, adoptive parent, adoptive parent);
a document confirming the cohabitation of a child with one of the parents on the territory of the Russian Federation, issued by an organization authorized to issue it - if the marriage between the child’s parents is dissolved.

Monthly child care allowance

To reimburse the costs of paying monthly child care benefits, employers submit:

application for parental leave;
application for benefits;
birth (adoption) certificate of the child being cared for, or an extract from the decision to establish guardianship over the child;
birth (adoption, death) certificate of the previous child (children). In the case of the death of a previous child - a death certificate;
a certificate from the place of work (service) of the mother (father, both parents) of the child about not using monthly parental leave and about not receiving child care benefits;
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;
order on the assignment of benefits;
a certificate from the social security authorities at the place of residence (place of stay, actual residence) of the child’s mother (father) about non-receipt of monthly child care benefits if the child’s father (mother, both parents) does not work (does not serve) or is studying full-time form of training in professional educational organizations, educational organizations of higher education, educational organizations of additional professional education and scientific organizations (also for persons actually caring for the child instead of the mother (father, both parents) of the child);
certificate (certificates) about the amount of earnings from which the benefit should be calculated, from the place (places) of work (service, other activity) with another policyholder (other policyholders) 182n;
a certificate (certificates) from the place of work (service, other activity) with another policyholder (other policyholders) stating that the appointment and payment of monthly child care benefits by this policyholder are not carried out if the insured person is employed by several at the time of the insured event policyholders;
a birth certificate of a child issued by a consular office of the Russian Federation outside the territory of the Russian Federation - at the birth of a child on the territory of a foreign state;

In cases where the registration of the birth of a child is carried out by the competent authority of a foreign state:

a document and its copy confirming the fact of birth and registration of a child, issued and certified with an “apostille” stamp by the competent authority of a foreign state, with a translation into Russian certified in accordance with the procedure established by the legislation of the Russian Federation, - at the birth of a child on the territory of a foreign state party to the Convention that abolishes the requirement legalization of foreign official documents, concluded in The Hague on October 5, 1961;
a document and its copy confirming the fact of birth and registration of a child, issued by a competent authority of a foreign state, translated into Russian and legalized by a consular office of the Russian Federation outside the territory of the Russian Federation - at the birth of a child on the territory of a foreign state that is not a party to the above Convention;
a document and its copy confirming the fact of birth and registration of a child, issued by the competent authority of a foreign state, translated into Russian and affixed with an official seal - at the birth of a child on the territory of a foreign state that is a party to the Convention on Legal Assistance and Legal Relations in Civil, Family and Criminal Matters cases concluded in the city of Minsk on January 22, 1993.

Funeral benefit

To be reimbursed for funeral benefits, you must submit:

application for benefits;
death certificate issued by the civil registry office;
a copy of the death certificate.

Let us remind you that from February 1, 2018, the amount of the funeral benefit is 5,701.31 rubles.

What else

To verify the correctness of the assignment, calculation and payment of benefits, the Social Insurance Fund also has the right to request additional information and documents. For example:

an employment contract, as a document confirming the existence of an employment relationship and the status of the employee as an insured person, since, according to Part 1 of Article 2 of Law No. 255-FZ, citizens working under employment contracts are subject to compulsory social insurance;
duly certified copies of work books for employees working on an external part-time basis, due to the fact that according to Article 283 of the Labor Code of the Russian Federation, when applying for an external part-time job, it is not necessary to present a work book, but in the event of an insured event due to temporary disability and in connection with maternity, an external part-time worker, to confirm his insurance coverage, must submit to the insured's accounting department a certified copy of the work record book from his main place of work;
orders for employment (transfer) to verify the data contained in the work book and employment contract;
staffing table - to check the compliance of the established salaries specified in employment contracts. In the absence of a staffing table, explanations from the policyholder are requested with information on salary amounts;
provisions on remuneration and bonuses;
job descriptions of employees;
a working time sheet to check the compliance of the data with the accrued amounts in the pay slips (number of working days to match the accrued salary, etc.), certificates of incapacity for work (the number of days of incapacity in the report card must correspond to the number of days in the certificate of incapacity for work). Maternity leave and childcare leave until the child reaches the age of 3 years must be reflected in work time sheets and correspond to the data of orders for the provision of these leaves;
payroll statements to verify accrued amounts in accounting and the correctness of their inclusion in the calculation of benefits;
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;
orders for payment of financial assistance;
orders for the assignment of benefits in relation to each insured person;
expense cash orders, payslips for wages, payment orders for transfers of benefits.

To reimburse expenses for benefits for periods starting from 2017, the company needs to submit two new documents to the Social Insurance Fund: a certificate of calculation and a breakdown of expenses. How to compile them and where to submit them - to the tax office or to the fund?

Note. The Ministry of Labor provided an updated list of documents that are needed to reimburse the costs of benefits in order No. 585n dated October 28, 2016

From January 1, control over contributions for compulsory insurance in case of temporary disability and in connection with maternity passed to the Federal Tax Service. But the FSS remains responsible for checking the expenditure part of this type of insurance. Moreover, both for periods before January 1, 2017, and for insured events that occurred after this date.

Where to go and what documents to submit

In all cases, you must still apply for compensation to the Social Insurance Fund. What documents to submit depends on the period for which you want to reimburse the costs of paying benefits.

If benefits were paid before January 1, 2017

If a company applies for reimbursement of expenses that it incurred before January 1, the old scheme applies.

In order to reimburse the excess of expenses for payment of benefits over accrued contributions, you must submit papers to the Social Insurance Fund according to the old list (in accordance with the appendix to the order of the Ministry of Health and Social Development of December 4, 2009 No. 951n in the old version).

application for reimbursement (there was no official form; each regional branch of the Social Insurance Fund developed its own form);
calculation of 4-FSS;
copies of documents that confirm the validity and correctness of expenses for compulsory social insurance. These include certificates of incapacity for work for sick leave and maternity leave and calculations of the amounts of payments for these benefits; certificates from the antenatal clinic, child birth certificate, etc. - for other types of benefits.

The fund must transfer the money to the organization’s current account within 10 calendar days from the date of submission of these documents (Part 3, Article 4.6 of the Federal Law of December 29, 2006 No. 255-FZ).

Note! The fund will not return money without verification.

In practice, the FSS does not allocate money without an inspection (desk or unscheduled documentary). As part of this verification, the company must submit additional documents that confirm the validity of the assignment and payment of benefits (Part 4, Article 4.6 of Law No. 255-FZ).

The fund makes a decision on the allocation of funds based on the results of the audit.

The period of the desk audit cannot exceed three months from the day the 4-FSS calculation and application were submitted (Part 2 of Article 34 of the Federal Law of July 24, 2009 No. 212-FZ).

Exit - two months from the day the fund made a decision on her appointment (Part 11, Article 35 of Law No. 212-FZ).

The overexpenditure that occurred as of January 1, 2017 must be taken back to the Social Insurance Fund. It cannot be counted towards the payment of contributions to the Federal Tax Service in 2017 (perhaps something will change, but for now it is so).

If benefits were paid after January 1, 2017

Note. To reimburse benefits for 2017, submit a statement of calculation and breakdown of expenses with your application.

If a company applies for compensation for insured events that occurred after January 1, it must submit new documents (FSS letter dated December 7, 2016 No. 02-09-11/04-03-27029):

an application for the allocation of the necessary funds for insurance payments in the approved form;
certificate of calculation (Appendix 1 to the application for the allocation of the necessary funds for payment of insurance coverage);
breakdown of expenses for compulsory social insurance and expenses due to interbudgetary transfers from the federal budget (Appendix 2 to the application).

Companies submit a statement of payment only when they receive money for periods starting from January 1, 2017. Please indicate the amount:

the company's debt on contributions at the beginning and end of the reporting (calculation) period;
accrued contributions for payment, including for the last three months;
additional accrued contributions;
expenses not accepted for offset;
funds received from territorial bodies of the Social Insurance Fund to reimburse expenses incurred;
returned (credited) overpaid (collected) contributions;
funds spent for the purposes of compulsory social insurance, including for the last three months;
paid contributions, including for the last three months;
written off debt of the policyholder.

Why was it necessary to introduce new forms?

Note! The new contribution calculation is not suitable for reimbursement of expenses from the Social Insurance Fund

All these documents appeared due to the fact that in the new calculation, which organizations will begin submitting to the Federal Tax Service in the first quarter of 2017, there is no information for compensation.

In particular, the amounts of incoming and outgoing balances (debt owed by the policyholder or fund) that must be taken into account.

There is also no opportunity to submit calculations for insurance premiums to the Federal Tax Service in the middle of the quarter.

In fact, the calculation certificate and breakdown of expenses is a piece of section 1 from the old form 4-FSS.

Can expenses be offset against future payments?

In 2017, in regions that are not included in the pilot areas, it will remain possible to offset expenses against upcoming contribution payments. But only after the fund confirms these expenses.

How would this happen?

The company will indicate the assigned benefits in the new contribution calculation.

The Federal Tax Service will transfer the data on benefits to the fund (no later than five days from the day they received the calculation in electronic form and no later than 10 days from the day it was received on paper).

Based on this information, the FSS will conduct an inspection. Fund specialists will either confirm the expenses or refuse credit.

In any case, the fund will report its decision to the tax office within three days from the date it comes into force.

If the Social Insurance Fund confirms the expenses and their amount exceeds the contributions, the fund will return the difference or the Federal Tax Service will count it against future payments.

This procedure will remain in place until all regions switch to direct payments of benefits from the fund.

What is the procedure for contributions for injuries?

Note. The procedure by which the fund reimburses expenses for injuries has not changed since January 1.

For this type of insurance, there are few checks in connection with compensation. Basically, all companies use the offset principle.

It has been applied since the first quarter of 2017. Only .

How to Reimburse Benefit Costs in 2017

1. If you are applying for reimbursement of expenses for sick leave and maternity benefits for periods before January 1, 2017, submit an application using the form recommended in your region. And the calculation of 4-FSS according to the form that was valid until 2017.
In the same manner, reimburse the costs of injury contributions.

2. If you are applying for reimbursement of expenses for sick leave and maternity benefits for periods starting from January 1, 2017, submit an application using the approved form. And instead of 4-FSS - a new certificate of calculation and breakdown of expenses.
For contributions for injuries, the procedure remains the same, but instead of the old form 4-FSS, submit its new form.

This benefit is paid by the employer. But does the employer himself have the right to return the money paid? Let's consider in what situations the social insurance fund returns funds, what are the procedures and terms of compensation, and also whether there are cases when the organization cannot return the funds paid.

Dear readers! The article talks about typical ways to resolve legal issues, but each case is individual. If you want to know how solve exactly your problem- contact a consultant:

It's fast and FOR FREE!

Who can receive

The current legislation of the Russian Federation defines the following categories of citizens who can count on payment of benefits:

Employed women. Receive funds directly from the employer;
Military employees. They receive money at the place of duty;
Students. A girl can receive maternity benefits at a university if she studies full-time.

A woman can receive the money she is entitled to directly from the Social Insurance Fund if:

There is a pilot project for direct payments in the region of residence;
The organization refuses to pay benefits or does not have the opportunity to do so.

In both cases, you must contact the fund no later than six months after the end of your maternity leave. Money can be transferred either to a bank card or by postal order.

What are working women entitled to?

Working women in a position are entitled to the following benefits:

Maternity benefit. Only the employee receives the money. The payment is calculated based on average earnings for the last two years before going on maternity leave;
Cash payment for early registration. Only a woman can receive money;
One-time cash payments at the birth of a child. Both the mother and the father (necessarily living in the family) of a newborn can receive funds;
Care allowance for up to 1.5 years. Any family member who actually cares for the child can receive money. The amount of the benefit is calculated as 40% of the employee’s average salary (but not more than the maximum amount and not less than a certain minimum);
Care allowance for up to 3 years. The payment comes from the employer’s own funds in the amount of fifty rubles monthly and is not reimbursed by the fund.

All benefits, except the last one, can be reimbursed by the organization from social insurance.

Video: All about deadlines

How it happens

Initially, having paid the employee maternity benefits, the company has the right to subsequently claim them back from the social insurance fund.

In order to receive reimbursement from the Social Insurance Fund for maternity benefits, you need to write an application indicating:

Should the money paid be counted towards mandatory contributions to the fund in case of disability and maternity, which are made by the organization within 1 year;
Should the funds be credited in full and transferred to the organization's current account?

Terms and Conditions

If the organization employs a small number of employees or the insurance transfers are small, then it is advisable to ask social insurance to transfer the entire amount of payments to the enterprise’s account, since when this amount is credited, the organization must compensate for the costs during the year. And this may not be possible, since there are few workers.

After the application is submitted, social insurance must make a decision on payment within ten working days. At this time, all documents provided by the organization are checked.

If the outcome is positive, the fund transfers the money. If, during the reconciliation of documents, it seemed to the fund employee that the data did not correspond to reality (for example, there is a suspicion that the documents provided were fictitious, or that wages were inflated immediately before maternity leave), then the decision to pay the money can take up to three months.

This is due to desk checks or requests for additional certificates or statements.

Required documents for reimbursement of maternity benefits to the Social Insurance Fund

Reimbursement of maternity benefits from the Social Insurance Fund is possible if the following package of documents is collected:

, where it says:
1. Full name and details of the legal entity;
2. Registration number of the organization;
3. Full amount to be refunded;
Calculation for the corresponding period of accrued contributions for compulsory social insurance in case of illness or maternity, as well as accident insurance and expenses for insurance payments:
1. Original documents – 2 copies. (the first sheet indicates the reporting period, stamp, signature);
Register of expenses. Benefits are indicated here, specifying the amount of the amount that needs to be reimbursed for the corresponding period;
Certified copies of documents confirming the correctness and validity of expenses:
1. Employee's certificate of incapacity for work;
2. Calculation;
3. Work record book of the employee;
4. Employment contract;
5. Order on acceptance to a position;
6. Working hours sheet;
7. on the provision of maternity leave.

When it's not possible

The Social Insurance Fund may refuse compensation if:

The employee does not have the appropriate skills and qualifications required to work in the position provided. According to FSS workers, a woman should work either in her own or in a similar specialty that does not require additional education, certain skills or knowledge;
The employee was registered at the workplace formally;
The salary does not correspond to the position that the employee holds and is much higher than the salaries of other employees in the same positions. On the one hand, the legislation of the Russian Federation does not establish legal norms that prohibit increasing an employee’s wages or giving her bonuses. But, on the other hand, the fund’s employees do not approve of a sharp increase in the salary of a pregnant employee and demand from the employer explanations and documentary evidence of this need;
The position of the employee who is going on maternity leave did not exist in the organization until that moment. The creation of a new position is considered suspicious, while in recent years the company has managed well without it. Moreover, the fund will categorically refuse compensation if, after the employee goes on maternity leave, the position is abolished, and the employee’s responsibilities are easily divided among other employees;
The employee's salary increased sharply until she went on maternity leave. On the one hand, the legislation of the Russian Federation does not establish legal norms that prohibit increasing an employee’s wages or giving her bonuses. But, on the other hand, the fund’s employees do not approve of a sharp increase in the salary of a pregnant employee and demand from the employer explanations and documentary evidence of this need;
The employee combined several positions. The fund insists that a pregnant employee simply physically cannot combine several positions. By law, a certain number of hours must be spent on each of the duties. And if it is proven that the employee received money for the combination, but did nothing, the FSS will not return the money paid;
The founder of the organization received cash payments.

Sample calculation

An employee of a certain organization is going on maternity leave. For the previous two years, she worked at the enterprise, and social security received information about her salary during this time in the amount of 718 thousand rubles.

In the year preceding the maternity leave, she was on sick leave for a total of 39 days, which is also documented.

Maternity leave is 140 days.

How is maternity pay calculated in this case??

Two accounting years before maternity leave are 730 days (assuming that none of them was a leap year);
The period of illness must be subtracted from the total number of days. That turns out to be 691 days;
Next, the average daily earnings of the employee are calculated: 718,000:691 = 1039.07 rubles;
Before calculating the payment amount, the accountant must find out whether the received amount of daily earnings corresponds to the minimum established for the current year, as well as the maximum allowable;
Next comes the calculation of maternity benefits: 1039.07*140=145469.8 rubles.

It is this amount that the employer must pay to his employee, and in the future her organization can claim it from the Social Insurance Fund.

If an employee does not trust the organization’s accounting department, she can try to independently calculate her benefits on the social insurance fund’s website.

To do this you need:

Go to the FSS website, where the calculation calculator is provided;
Enter the data from the certificate of incapacity for work;
Select the billing period;
Fill in the fields in the “Calculation Conditions” tab;
Click on the “Calculate” tab and see the result.

Accounting

The organization's accountant must reflect the accrued and paid maternity benefits as follows:

Debit 69 Credit 70 (subaccount “Settlement with the Social Insurance Fund for social insurance contributions”): maternity benefits accrued;
Debit 70 Credit 50 or 51: funds issued for pregnancy and childbirth.

Let's look at an example. An employee of the Client-Service organization went on maternity leave.

The accounting department paid her a sum of money in the amount of 125,365.25 rubles. and made the following entries:

Debit 69 Credit 70: RUB 125,365.25. – maternity benefits have been accrued to the employee;
Debit 70 Credit 51: RUB 125,365.25. – the benefit is transferred to the employee’s card.

Of course, the fund is obliged to reimburse the employer for all the benefits that he once paid to a woman who went on maternity leave. But at the same time, the employer is obliged to approach this kind of payments responsibly and honestly.

APPLICATIONS AND CALLS ARE ACCEPTED 24/7 and 7 days a week.

Since 2017, there have been some changes in benefit reimbursement. Now you need to apply for compensation not only to the Social Insurance Fund. In addition, when benefits are offset against insurance premiums, the tax office acts as an intermediary. In this article, we will look in detail at how benefits are reimbursed from the Social Insurance Fund, as well as the documents that will need to be submitted for reimbursement.

What's new in 2017

As you know, since 2017, contributions that were previously paid to the Social Insurance Fund have been transferred to the tax department. Only contributions for injuries were not affected by the changes; they are paid as before by the Social Insurance Fund. However, despite the fact that contributions are controlled by the Federal Tax Service, benefits are also checked by the Social Insurance Fund.

The procedure for reimbursement of benefits has changed. First, you will need to report the costs of paying for insurance coverage using a single calculation to the tax office, and then the tax office will independently report the data to the Social Insurance Fund. The main decision in this case is made by the FSS - to approve the offset of funds or to refuse the offset. The reason for the refusal will also be available from the FSS; the tax office is only an intermediary in these matters.

If the decision of the Social Insurance Fund is positive, it will be possible to count expenses against contributions, as happened before the reform. And if expenses exceed, the difference is returned or offset against future payments.

Reimbursement of benefits from the Social Insurance Fund

Initially, the organization will need to determine what the funds that are planned to be reimbursed were spent on. You can reimburse funds spent on payment:

Sick leave;
Maternity benefits;
Child care benefits up to 1.5 years;
Funeral benefits.

After determining the purpose of the funds, the amount of contributions must be reduced by the benefits paid. At the same time, if the amount of benefit contributions is exceeded, they can be offset in full.

If the amount of the benefit exceeds the contributions, then the difference can be reimbursed, for which you will need to prepare documents with the Social Insurance Fund.

Reimbursement of benefits from the Social Insurance Fund

In order to reimburse the Social Insurance Fund for payment of benefits, you need to do the following:

Write an application for a refund and submit this application to the Social Insurance Fund.
Prepare a statement of calculation, as well as the necessary supporting documents and attach them to the application.
Wait for the FSS check.
After the FSS checks and approves the reimbursement, it will transfer the funds to the organization’s account.

The algorithm of actions is quite simple; the employer needs to correctly draw up an application, as well as prepare the required documents.

Documents for reimbursement of benefits

First, we’ll look at how to make an application to the Social Insurance Fund for reimbursement of benefits. Until recently, the application was drawn up in any form. Since 2017, it has been compiled according to the form approved by the FSS, and it must contain the following information:

Name of the organization and its address;
Registration number of the organization;
Details of the organization's current account;
The amount of funds needed to pay benefits.

Important! All details in the application must be indicated without errors, otherwise the Social Insurance Fund will not return the funds.

The calculation certificate is a new document that appeared only in 2017. He came to replace the 4-FSS calculation and repeats one of the sections of this form. The procedure for filling out the certificate is similar to the procedure for filling out the form, and all benefits and contributions must be deciphered.

The calculation certificate must contain the following information:

The amount of debt incurred by the Social Insurance Fund;
The amount of contributions accrued by the organization for payment;
Additional accrued amount of contributions;
The amount of expenses that are not accepted when offsetting expenses;
The amount received from the Social Insurance Fund for reimbursement of expenses;
The amount of fees returned or overpaid (including those collected);
The amount of funds spent on OSS;
Amount of contributions paid;
Amount of debt written off.

Example of reimbursement of benefits from the Social Insurance Fund

Continent LLC had no debts on insurance premiums at the beginning of 2017. For the first quarter, Continent LLC accrued contributions in the following amounts:

January – 15,510 rubles;

February – 15,210 rubles;

March – 15,620 rubles.

Total for the first quarter: 46,340 rubles

Payment of contributions to LLC "Continent" is established in the month following the month of their accrual. Accordingly, for the first quarter the company's debt to the Social Insurance Fund will amount to 15,620.25 rubles. Expenses for benefits paid from the Social Insurance Fund for the first quarter amount to 153,485 rubles. At the beginning of the second quarter, this amount exceeds the debt on contributions by the amount:

153,485 – 15,620 = 137,865 rubles

Based on these data, we will draw up a certificate - calculation. The table is filled in rubles.

Indicator name	Code	Sum	Indicator name	Line code	Sum
“Debt owed by the policyholder at the beginning of the billing period”	1	0,00	“Debt owed by the territorial body of the Fund at the beginning of the billing period”	11	0,00
“Accrued for payment of insurance premiums, total”	2	46 340,00	“Expenditures for the purposes of compulsory social insurance, total”	12	153 485,00
	3	46 340,00	“including for the last 3 months of the reporting period"	13
2 month	4	15 210,00	2 month	14
3 month	5	15 620,00	3 month	15	153 485,00
“Additional insurance premiums accrued”	6		"Insurance premiums paid"	16	30 720,00
“Not accepted as expenses”	7		“including for the last 3 months of the reporting period"	17
			2 month	18	15 510,00
			3 month	19	15 210,00
“Received from the territorial body of the Foundation in reimbursement of expenses incurred”	8		“The amount of the insured’s debt written off”	20
“Refund (offset) of amounts of overpaid (collected) insurance premiums”	9		“The amount of the insured’s debt written off”	20
“Debt owed by the territorial body of the Fund at the end of the reporting (calculation) period”	10	137 865,00	“Debt owed by the policyholder at the end of the reporting (calculation) period”	21

The breakdown of expenses is the second table of the first section of Form 4-FSS, which organizations submitted until 2017. The transcript must indicate the following information: paid for funds from the Social Insurance Fund for sick leave, maternity and child benefits.

Lines 1-6, 12 must contain information about the number of days that the organization paid at the expense of the Social Insurance Fund.

Lines 9-11 should contain information about the number of payments.

Lines 7, 8 and 14 – the number of benefits, the line “Total” – the total amount of benefits (not the one reimbursed by the fund).

Supporting documents

As supporting documents that are submitted with the application and the calculation certificate, the organization must submit copies of certificates of incapacity for work, birth certificates and other documents. Such documents need to be submitted in two situations:

With reduced tariffs that the organization applied until the end of 2016;
When an organization applies a zero tariff from the beginning of 2017.

Only in the listed cases will it be necessary to confirm the organization’s expenses; in other situations this is not required.

Reimbursement period for FSS funds

Reimburse FSS benefits within 10 calendar days. The countdown begins from the day the organization submits an application and other necessary documents to the Social Insurance Fund.

The period may be extended by decision of the social insurance authorities. For example, if fund employees have doubts about the correctness of the calculations made. In this case, the FSS has the right to require additional documents to carry out the necessary verification. Only after such a check has been carried out will social insurance transfer money to the organization. The FSS will send a copy of the decision on reimbursement of funds to the Federal Tax Service.

The legislative framework

Legislative act	Content
Law No. 255-FZ of December 29, 2006	“On compulsory social insurance in case of temporary disability and in connection with maternity”
FSS letter No. 02-09-11/04-03-27029 dated	“On sending forms of documents that must be submitted by the policyholder for the territorial body of the Federal Insurance Fund of the Russian Federation to make a decision on the allocation of the necessary funds for the payment of insurance coverage”
Article 431 of the Tax Code of the Russian Federation	“The procedure for calculating and paying insurance premiums, the procedure for reimbursing the amount of insurance premiums”

The transfer of administration of social insurance contributions to the Federal Tax Service did not remove the function of the Social Insurance Fund for reimbursement of costs to employers. The fund continues to control expenses for disability insurance, maternity benefits, and monthly child care payments to employees. If costs exceed contributions, the Social Insurance Fund provides employers with funds to reimburse expenses ( Let's look at the current features for 2018).After checking the documents, the amount of the overpayment is returned to the employer's bank account.

Need for social insurance reimbursement

The employer has the right to reduce the amount of contributions to the budget by the amount of accrued benefits. When expenses exceed deductions, a budget debt arises to the enterprise. The employer applies to the Social Insurance Fund for compensation of funds paid for insured events if an overpayment occurs. The excess of payments over contributions accrued based on employee income is covered by the Social Insurance Fund.

Example for determining the amount of reimbursement of expenses

Enterprise IP Novikov M.M. has a staff of hired workers, pays remuneration for labor, and pays insurance premiums. In the second quarter of 2017, the individual entrepreneur accrued the amount of wages to employees in the amount of 1,390,000 rubles, the amount of deductions for which to OSS amounted to 40,310 rubles. IP Novikov M.M. in the 2nd quarter, he made payments for social insurance expenses in the amount of 55,000 to pay for leave under the BiR, disability benefits in the amount of 79,000 rubles (including the amount of payment at the expense of the enterprise in the amount of 3,000 rubles). Based on the results of the quarter, the individual entrepreneur made the following calculation:

Determined the amount of expenses incurred at the expense of the Social Insurance Fund: C = 55,000 + (79,000 – 3,000) = 131,000 rubles.
I calculated the amount due for reimbursement from the Social Insurance Fund: C2 = 40,310 – 131,000 = (90,690) rubles.

Reimbursement of expenses is made upon the application of the employer accompanied by documents confirming payments.

The calculation certificate submitted by the employer when submitting an application for reimbursement of funds has replaced the intermediate form 4-FSS. The need to draw up a certificate when contacting the regional branch of the fund is that the Social Insurance Fund does not have information on accrued and paid contributions. Reporting form 4-FSS since 2017 has been submitted only according to data on deductions for insurance against injuries (accidents and occupational diseases).

Information reflected in the calculation certificate

Information on insurance premiums and their movement, necessary for the FSS to reimburse the amounts to the employer, is obtained from the calculation certificate. Details of the list of information included in the calculation certificate are defined in the Order.

The calculation certificate form has not been approved at the legislative level. Employers independently develop a form for submission to the institution, subject to indicating the data required for reimbursement. The document must contain information about the amounts:

Social Insurance Fund debts to the employer at the beginning and end of the period.
Accrued, additionally accrued, paid and spent insurance premiums by the employer, including the amounts of the last 3 months.
Refunded, offset and not accepted for offset funds.
Written off amounts of debt of the employer (policyholder).

If it is necessary to monitor the accuracy of the data, the FSS may request information from the Federal Tax Service.

List of documents confirming the right to compensation

The validity of the employer's expenses for paying for insurance claims is confirmed by the documents submitted as an appendix to the application. The list of documents depends on the type of insured event and is adjusted by the territorial office. Submit copies:

A document confirming the legal relationship between the employer and the employee - a work book with a record of employment.
A ballot issued in connection with incapacity for work, leave under the BiR.
Birth certificates of a child, if there is more than one child, in case of reimbursement of monthly benefits - certificates of all children.
Applications from an employee for leave for employment and labor, for child care and for the provision of benefits.
Certificate from the second parent’s place of employment confirming non-provision of leave, benefits or additional days off. If there is no work, a copy of the spouse’s work record book is provided.
Certificates from a medical institution confirming that the employee is registered.
Calculation of the benefit amount based on the income previously received by the employee.
Certificates confirming a child’s disability, applications for additional days off.
Payment documents for payments made.

The list contains copies of orders of the head of the relevant appointment. The order must be signed by the manager and the employee. An order is not required when paying for a period of incapacity for work on a general basis or a one-time benefit. The documents are listed in the application as an attachment. Copies are certified in the prescribed manner. The document is marked with the entry “Copy is correct”, the name of the enterprise, the signature of the manager or individual entrepreneur with a transcript. The record is certified by a seal provided that it is used by the enterprise in office work.

Time limit established for the reimbursement procedure

The promptness of the return of expenses to the enterprise depends on the absence of errors in the submitted documents. If there are no complaints from the fund’s specialists, the funds will be returned within the allotted time frame.

The FSS has the right to conduct a desk audit to confirm the legality of the insured's expenses. As part of the audit, the FSS may require a number of documents relating to expenses incurred. The documents stated in the request must be submitted within 10 days from the date of receipt of the request. If this is not possible, the employer must give a written refusal. For each missing document a fine of 200 rubles is imposed.

Based on the results of the control exercise, the FSS sends a decision to confirm expenses or refuse reimbursement. After receiving a positive decision, the Federal Tax Service Inspectorate issues an order to the Federal Treasury branch. After 3 days, the amount is transferred to the bank account of the organization or individual entrepreneur.

Reimbursement of enterprise expenses for the pilot project

A number of regions have implemented a pilot project, which began in 2011. According to the established procedure, the enterprise:

Pays only the first 3 days of insurance claims for disability associated with illness or injury of the employee himself. Amounts paid by the Social Insurance Fund are transferred directly to the insured person.
Provides documents allowing the regional branch of the fund to calculate and pay insurance amounts.
Provides the employee with documents for self-submission to the fund to receive payments.

As part of the pilot project, the employer submits a register of certificates of incapacity for work, copies of ballots, and a certificate of income received by the employee before the occurrence of the insured event. Within 5 days from the date of the insured event, the employer is obliged to submit a complete package of documents to the fund. Refusal to pay for the submitted certificates of incapacity for work is carried out in the event of a discrepancy between these documents. The accuracy of the data on the certificate of incapacity for work issued by the medical institution must be verified by the responsible person of the employer.

Question No. 1. Can an individual receive the amount for a certificate of incapacity for work directly from the Social Insurance Fund?

The fund pays amounts for insured events if the organization does not have funds to pay for certificates of incapacity for work. Insufficient funds arise due to liquidation, bankruptcy proceedings, or lack of information about the location of the enterprise. The period of incapacity for work is paid from the Social Insurance Fund, starting from the 4th day.

Question No. 2. Do the calculations of insurance premiums indicate the amounts reimbursed by the Social Insurance Fund for the period before 2017?

In the reporting of insurance premiums submitted to the Federal Tax Service, only the amounts of compensation received for excess expenses starting from 2017 are indicated. Amounts received for an earlier period are not reflected in the statements.