Question:
Please provide us with the formula for calculating sick leave benefits. Our company operates from Monday to Saturday, with Sunday as the day off, averaging 26 working days a month. According to the social insurance formula, we take the monthly salary for insurance calculation from the previous month before the sick leave. Should we divide this amount by 24 or by 26?
Additionally, is the calculation of insurance benefits determined by the business or the insurance agency, and what are the necessary documentation and procedures for a business to declare and receive insurance benefits to submit to the insurance agency?
Answer:
Based on the provisions of Article 4, Clause 28 of the Social Insurance Law No. 58/2014/QH13 dated November 20, 2014, the daily sick leave benefit is calculated by dividing the monthly sick leave benefit by 24 days.
So, if your organization operates with a weekly day off on Sundays and has an average of 26 working days a month, if an employee becomes sick and needs to take sick leave for medical treatment, the sick leave benefit for that employee is calculated by the social insurance agency when disbursing the sick leave benefit as the monthly sick leave benefit divided by 24.
Your organization is responsible for collecting the required documents according to the regulations and creating a C70a-HD list to request payment of sick leave benefits for employees, ensuring that all necessary information is recorded on the list. The social insurance agency is responsible for calculating the amount of benefits for the employee and transferring the funds to your organization for disbursement to the employee.
You can refer to the documentation and procedures for sick leave benefits, as outlined in Form 601 for submission on the website of the Social Insurance Agency of Ho Chi Minh City under the section “One-Stop Procedures/Procedures for Handling Social Insurance Documents/Form 601 – Submission of Documents.”
Question:
I am currently registered for medical examination and treatment at Hospital 175 – Ministry of National Defense in Ho Chi Minh City. However, due to the nature of my job, I frequently travel to other provinces, sometimes staying away for 2-3 months before returning to Ho Chi Minh City for a few days and then leaving again. When traveling to different provinces, I often experience minor illnesses due to changes in weather conditions (not to the extent of needing emergency care). Can I still enjoy the health insurance benefits when seeking medical treatment at healthcare facilities in those provinces? How can I ensure that I receive full health insurance benefits as I do when I receive medical treatment at Hospital 175 – Ministry of National Defense in Ho Chi Minh City?
Answer:
Since January 1, 2016, the Health Insurance Law allows for “district-level referral,” which means individuals with health insurance cards can seek medical examination and treatment at any district-level hospitals and healthcare facilities nationwide, without being restricted to the initial address stated on the card.
Therefore, when you are traveling for work outside Ho Chi Minh City and need medical care, you can visit the nearest district-level hospital or healthcare facility for examination and treatment. If your condition requires more advanced care, they will refer you to a provincial-level hospital as needed.
Question:
Employees request sick leave or child care leave due to illness with valid medical certificates and receive health insurance benefits as per the law. However, some employees still have unused annual leave days, and they request to use these annual leave days for their sick leave or child care leave covered by health insurance. Can they use annual leave for these sick leave or child care leave days? Will they still be entitled to the sick leave or child care leave benefits provided by the C65 form from the health insurance agency?
Answer:
According to the provisions of Article 3 of the Health Insurance Law No. 58/2014/QH13 dated November 20, 2014, health insurance is intended to replace or compensate for a portion of an employee’s income when they suffer from illness, maternity, occupational accidents, occupational diseases, reach the retirement age, or die. This is based on contributions made to the social insurance fund.
Furthermore, based on Point c, Clause 2, Article 3 of Circular No. 59/2015/TT-BLĐTBXH dated December 29, 2015, it states that health insurance benefits will not be provided for cases of sickness or accidents, other than occupational accidents, when the employee is on annual leave, special leave, unpaid leave in accordance with labor laws, or maternity leave according to social insurance regulations.
Therefore, if an employee in your organization takes sick leave or child care leave with a valid medical certificate but chooses to use their annual leave for these days, they will not be eligible for health insurance benefits, and there is no need to request payment from the health insurance agency in such cases.
