Conditions for receiving, benefit levels, and documents for receiving social insurance sickness benefits in 2023

Summary of frequently asked questions about the 2023 Social Insurance sickness regime that accountants, human resources and employees need to pay attention to in order to apply in specific cases.

Điều kiện hưởng, mức hưởng, hồ sơ hưởng chế độ ốm đau BHXH 2023

What are the conditions for receiving sick leave?

According to the guidance in Article 3 of Circular 59/2015/TT-BLDTBXH, employees are entitled to sick leave benefits in the following cases:

- Employees who are sick or have an accident that is not a work-related accident or are being treated for a recurring injury or illness due to a work-related accident or occupational disease must take time off work and have confirmation from a competent medical examination and treatment facility as prescribed by the Ministry of Health.

- Employees must take time off work to take care of sick children under 7 years old and have confirmation from a competent medical examination and treatment facility.

- Female employees return to work before the end of maternity leave and fall into one of the above cases.

Sickness benefits are not provided in the following cases:

- Employees who are sick or have an accident and must take time off work due to self-harm, drunkenness or use of drugs or drug precursors according to the List issued with Decree 82/2013/ND-CP and Decree 126/2015/ND-CP.

- Employees take first leave for treatment due to work accident or occupational disease.

- Employees who are sick or have an accident that is not a work-related accident during their annual leave, personal leave, unpaid leave according to the provisions of labor law; or maternity leave according to the provisions of the law on social insurance.

What is the maximum number of days of sick leave in a year?

(1) Time to enjoy sick leave for the employee himself:

Pursuant to Article 26 of the Law on Social Insurance 2014, the maximum period of sick leave in a year for employees is as follows:

- Working under normal conditions, you are entitled to 30 days if you have paid social insurance for less than 15 years; 40 days if you have paid from 15 years to less than 30 years; 60 days if you have paid from 30 years or more;

- Working in a heavy, toxic, dangerous or especially heavy, toxic, dangerous occupation or job on the list issued by the Ministry of Labor - Invalids and Social Affairs, the Ministry of Health or working in a place with a regional allowance coefficient of 0.7 or higher, is entitled to 40 days if having paid social insurance for less than 15 years; 50 days if having paid from 15 years to less than 30 years; 70 days if having paid from 30 years or more.

Employees who take leave due to illness on the List of illnesses requiring long-term treatment issued by the Ministry of Health are entitled to sick leave benefits as follows:

- Maximum 180 days including holidays, Tet holidays, and weekly days off;

- After the above-mentioned period of sick leave is over and treatment continues, the sick leave benefit will continue to be enjoyed at a lower level but the maximum benefit period is equal to the period of social insurance contribution.

(2) Time to enjoy sick leave when child is sick:

Pursuant to Article 27 of the Law on Social Insurance 2014, the time to enjoy the regime when a child is sick in a year for each child is calculated based on the number of days of child care, maximum 20 working days if the child is under 3 years old; maximum 15 working days if the child is from 3 years old to under 7 years old.

In case both father and mother participate in social insurance, the time to enjoy the regime when the child is sick of each father or mother is according to the above regulations.

Note: The maximum time to enjoy sick leave in a year is calculated by working days, excluding holidays, Tet holidays, and weekly holidays as prescribed. This time is calculated from January 1 to December 31 of the calendar year, regardless of the time the employee starts participating in social insurance.

How much is the sick leave benefit?

According to the provisions of Article 28 of the Law on Social Insurance 2014, employees who receive sick leave benefits will receive a monthly benefit equal to 75% of the salary subject to social insurance contributions of the month immediately preceding the leave.

In case an employee has just started working or an employee who has previously paid social insurance, then has a work interruption and has to take sick leave in the first month of returning to work, the benefit level is equal to 75% of the salary paid for social insurance of that month.

In particular, in the case of employees whose sick leave period has expired due to illness on the List of illnesses requiring long-term treatment but continue to receive treatment, the benefit level is prescribed as follows:

- Equal to 65% of the salary for social insurance contribution of the month immediately preceding the leave of absence if the social insurance contribution has been made for 30 years or more;

- Equal to 55% of the salary for social insurance contribution of the month immediately preceding the leave of absence if the social insurance contribution has been made for 15 years but less than 30 years;

- Equal to 50% of the salary for social insurance contribution of the month immediately preceding the leave of absence if the social insurance contribution has been less than 15 years.

Note: The daily sickness benefit is calculated by dividing the monthly sickness benefit by 24 days.

How much is the daily allowance for recuperation and health recovery after illness?

Pursuant to Article 29 of the Law on Social Insurance 2014, employees who have taken sick leave for a sufficient period of time in a year as prescribed, and whose health has not yet recovered within the first 30 days of returning to work, are entitled to take 5 to 10 days of rest and recuperation in a year.

The time off for recuperation and health recovery includes holidays, Tet holidays, and weekly days off. In case there is time off for recuperation and health recovery from the end of the previous year to the beginning of the following year, that time off will be counted for the previous year.

The number of days of leave for recuperation and health recovery is decided by the employer and the Executive Board of the grassroots trade union. In case the employer does not have a grassroots trade union, it is decided by the employer as follows:

- Maximum 10 days for employees whose health has not recovered after a period of illness due to a disease requiring long-term treatment;

- Maximum 07 days for employees whose health has not recovered after a period of illness due to surgery;

- 05 days for other cases.

The level of health care and recovery allowance after illness per day is equal to 30% of the basic salary.

What documents are required for sick leave benefits?

Pursuant to Article 100 of the Law on Social Insurance 2014, the following documents are required for the sick leave benefit application:

- Original or copy of hospital discharge papers for employees or employees' children receiving inpatient treatment. In case employees or employees' children receive outpatient treatment, there must be a certificate of leave from work to receive social insurance.

- In case the employee or the employee's child receives medical examination or treatment abroad, the above documents shall be replaced by a Vietnamese translation of the medical examination or treatment certificate issued by the medical examination or treatment facility abroad.

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