Theo điều 4 Quyết định 166/QĐ-BHXH quy định thủ tục hồ sơ chế độ thai sản cụ thể như sau:
1. Thủ tục hồ sơ hưởng chế độ thai sản gồm:
Đối với chế độ thai sản của người đang đóng BHXH: Hồ sơ theo quy định tại Điều 101 Luật BHXH; khoản 1, 2, 3, 4, 5 Điều 5 Nghị định số 115/2015/NĐ-CP; Điều 15, 18, 21 Thông tư số 56/2017/TT-BYT; Điều 7 Nghị định số 33/2016/NĐ-CP và khoản 2 Điều 15 Nghị định số 143/2018/NĐ-CP, gồm:
——————————————————————————————-
Doanh Nghiệp chuẩn bị:
– Mẫu 01B-HSB Danh sách đề nghị hưởng trợ cấp thai sản (Quyết định số 166/QĐ-BHXH ngày 31/01/2019 của BHXH Việt Nam)
– Báo giảm lao động theo mẫu: Mẫu danh sách lao động tham gia BHXH, BHYT Mẫu D02-TS
—————————————————————————————–
Người lao động chuẩn bị (Tùy từng trường hợp giấy tờ hồ sơ sẽ khác nhau, cụ thể như sau):
a. Đối với lao động nữ đang đóng BHXH sinh con:
– Sổ BHXH
– Bản sao giấy khai sinh hoặc trích lục khai sinh hoặc bản sao giấy chứng sinh của con.
+) Trường hợp con chết sau khi sinh:
– Ngoài hồ sơ nêu trên cần có thêm bản sao giấy chứng tử hoặc trích lục khai tử hoặc bản sao giấy báo tử của con;
– Trường hợp con chết ngay sau khi sinh mà chưa được cấp giấy chứng sinh thì thay bằng trích sao hoặc tóm tắt hồ sơ bệnh án hoặc giấy ra viện của người mẹ hoặc của lao động nữ mang thai hộ thể hiện con chết.
+) Trường hợp người mẹ hoặc lao động nữ mang thai hộ chết sau khi sinh con:
– Thì có thêm bản sao giấy chứng tử hoặc trích lục khai tử của người mẹ hoặc của lao động nữ mang thai hộ.
+) Trường hợp người mẹ sau khi sinh hoặc người mẹ nhờ mang thai hộ sau khi nhận con mà không còn đủ sức khỏe để chăm sóc con:
– Thì có thêm biên bản GĐYK của người mẹ, người mẹ nhờ mang thai hộ.
+) Trường hợp khi mang thai phải nghỉ việc để dưỡng thai theo quy định tại khoản 3 Điều 31 Luật BHXH:
– Thì có thêm một trong các giấy tờ sau:
+ Trường hợp điều trị nội trú: Bản sao giấy ra viện hoặc tóm tắt hồ sơ bệnh án thể hiện việc nghỉ dưỡng thai.
+ Trường hợp điều trị ngoại trú: Giấy chứng nhận nghỉ việc hưởng BHXH thể hiện việc nghỉ dưỡng thai.
+ Trường hợp phải GĐYK: Biên bản GĐYK.
+) Trường hợp lao động nữ mang thai hộ sinh con hoặc người mẹ nhờ mang thai hộ nhận con:
– Thì có thêm bản sao của bản thỏa thuận về mang thai hộ vì mục đích nhân đạo theo quy định tại Điều 96 của Luật Hôn nhân và Gia đình năm 2014;
– Văn bản xác nhận thời điểm giao đứa trẻ của bên nhờ mang thai hộ và bên mang thai hộ.
————————————————————————
b. Đối với lao động nữ đi khám thai, bị sảy thai, nạo, hút thai, thai chết lưu hoặc phá thai bệnh lý; người lao động thực hiện biện pháp tránh thai, hồ sơ gồm:
Trường hợp điều trị nội trú:
– Sổ bảo hiểm xã hội.
– Bản sao giấy ra viện của người lao động;
Trường hợp chuyển tuyến khám bệnh, chữa bệnh trong quá trình điều trị nội trú thì có thêm Bản sao giấy chuyển tuyến hoặc bản sao giấy chuyển viện.
Trường hợp điều trị ngoại trú:
– Giấy chứng nhận nghỉ việc hưởng BHXH mẫu C65-HD
– Hoặc bản sao giấy ra viện có chỉ định của y, bác sỹ điều trị cho nghỉ thêm sau thời gian điều trị nội trú.
—————————————————————————————————-
c. Đối với người lao động nhận nuôi con nuôi dưới 6 tháng tuổi:
– Bản sao Giấy chứng nhận nuôi con nuôi.
—————————————————————————————————
d. Đối với lao động nam hoặc người chồng của lao động nữ mang thai hộ nghỉ việc khi vợ sinh con:
– Sổ BHXH
– Bản sao giấy chứng sinh hoặc bản sao giấy khai sinh hoặc trích lục khai sinh của con.
—————————————————————————————————
+) Trường hợp sinh con phải phẫu thuật hoặc sinh con dưới 32 tuần tuổi mà giấy chứng sinh không thể hiện thì có thêm giấy tờ của cơ sở khám bệnh, chữa bệnh thể hiện việc sinh con phải phẫu thuật, sinh con dưới 32 tuần tuổi.
+) Trường hợp con chết sau khi sinh mà chưa được cấp giấy chứng sinh thì thay bằng trích sao hoặc tóm tắt hồ sơ bệnh án hoặc giấy ra viện của người mẹ hoặc của lao động nữ mang thai hộ thể hiện con chết.
—————————————————————————————
e. Lao động nam hoặc người chồng của người mẹ nhờ mang thai hộ hưởng trợ cấp một lần khi vợ sinh con:
– Sổ BHXH
– Bản sao giấy chứng sinh hoặc bản sao giấy khai sinh hoặc trích lục khai sinh của con.
+) Trường hợp con chết sau khi sinh mà chưa được cấp giấy chứng sinh thì thay bằng trích sao hoặc tóm tắt hồ sơ bệnh án hoặc giấy ra viện của người mẹ hoặc của lao động nữ mang thai hộ thể hiện con chết.
+) Trường hợp lao động nam đồng thời hưởng chế độ do nghỉ việc khi vợ sinh con và hưởng trợ cấp một lần khi vợ sinh con thì tiếp nhận một lần hồ sơ như trên điểm d.
——————————————————————————————————–
Một số lưu ý:
– Đối với chế độ thai sản của người sinh con, nhận con, nhận nuôi con nuôi trong thời gian bảo lưu thời gian đóng BHXH do đã thôi việc, phục viên, xuất ngũ trước thời điểm sinh con, nhận con, nhận nuôi con nuôi (áp dụng cho cả trường hợp sinh con, nhận con, nhận nuôi con nuôi trong thời gian đang đóng BHXH kể từ ngày 01/01/2018 trở đi nhưng đã thôi việc tại đơn vị mà có nguyện vọng nộp hồ sơ hưởng chế độ tại cơ quan BHXH), thì hồ sơ như sau:
+) Hồ sơ theo quy định tại điểm a, c nêu trên.
– Trường hợp nghỉ thai sản khi sinh con theo quy định tại khoản 3 Điều 31 Luật BHXH mà các hồ sơ quy định tại nội dung “Trường hợp khi mang thai phải nghỉ việc để dưỡng thai” mà không thể hiện việc nghỉ dưỡng thai thì có thêm Giấy chứng nhận nghỉ dưỡng thai.
+) Trường hợp thanh toán phí GĐYK thì có thêm hóa đơn, chứng từ thu phí giám định; bảng kê các nội dung giám định của cơ sở thực hiện GĐYK.
——————————————————————————-
2. Các bước thực hiện:
Bước 1:
– Người lao động nộp hồ sơ cho DN.
Bước 2:
– Doanh nghiệp nộp 1 bộ hồ sơ trực tiếp tại bộ phận một cửa BHXH.
Thời hạn giải quyết của DN:
– DN giải quyết và chi trả chế độ cho người lao động trong thời hạn 03 ngày làm việc kể từ ngày nhận đủ hồ sơ.
Thời hạn giải quyết và chi trả của Cơ quan BHXH:
– Trường hợp Doanh nghiệp đề nghị: Tối đa 06 ngày làm việc kể từ khi nhận đủ hồ sơ theo quy định.
– Trường hợp người lao động, thân nhân người lao động nộp hồ sơ trực tiếp cho cơ quan BHXH: Tối đa 03 ngày làm việc kể từ ngày nhận đủ hồ sơ theo quy định.
(Theo khoản 4 điều 5 Quyết định 166/QĐ-BHXH)
————————————————————————————————————
3. Thời hạn nộp hồ sơ hưởng chế độ thai sản:
Theo Công văn 1075/BHXH-CSXH ngày 29/03/2016 của BHXH Việt Nam quy định về thời hạn nộp hồ sơ hưởng chế độ thai sản:
“Người lao động có trách nhiệm nộp hồ sơ theo quy định cho người sử dụng lao động nhưng không quá 45 ngày kể từ ngày trở lại làm việc”.
-> Như vậy, khi đã chuẩn bị hồ sơ đầy đủ theo quy định của pháp luật, người lao động có thể nộp ngay hồ sơ cho người sử dụng lao động mà không phải đợi đến hết thời gian nghỉ việc hưởng chế độ thai sản.
-> Sau khi nhận đủ hồ sơ từ người lao động, người sử dụng lao động có thể nộp ngay cho cơ quan BHXH để giải quyết sớm quyền lợi cho người lao động.”
————————————————————————–
Lưu ý:
– DN phải tiếp nhận hồ sơ để: Giải quyết và chi trả chế độ cho người lao động;
– Hàng tháng hoặc quý, DN phải lập:
+ Danh sách thanh toán chế độ thai sản Mẫu 01B-HSB nộp cho BHXH quận, huyện.
+ Kèm theo hồ sơ của người lao động cùng toàn bộ phần mềm đã giải quyết trong tháng hoặc quý để quyết toán.
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