EsSalud in Peru: Affiliation, Contributions, and What to Do If Your Employer Doesn't Register You

What EsSalud is and who must be affiliated

EsSalud (Social Health Insurance) is Peru’s public social security health system, created under Ley N° 26790, the Law on the Modernization of Social Security in Health. Every worker who provides services as a dependent employee on payroll — under any type of contract, whether fixed-term, indefinite, or part-time — must be affiliated by their employer as a “regular insured member.”

This affiliation is not optional and is not left to the company’s discretion: the law itself states that “it is the obligation of Employer Entities… to enroll the regular affiliates who depend on them” (Article 5). If you work on payroll, your employer has a legal duty to register you, and that duty begins on your very first day of work.

How registration happens: T-Registro

In practice, the employer fulfills this duty through T-Registro, the Labor Information Registry administered by SUNAT as part of the Electronic Payroll system. Each worker is entered there with their personal data, start date, and type of insurance coverage. According to SUNAT itself, registration must be completed on the same day the worker begins providing services, regardless of the type of contract. Specialized secondary sources agree that, in practice, this means the worker must be registered on or before their first day of work, never after.

Two related but distinct procedures are worth telling apart:

• T-Registro (registering the employment relationship and the type of insured worker).
• PLAME (the Electronic Payroll return), through which the company declares and pays monthly contributions, including the EsSalud contribution.

The 9% contribution: the company pays it, not you

One of the most common points of confusion is who pays the EsSalud contribution. The law is clear: the contribution for active workers “equals 9% of pay” and “is borne by the employer entity, which must declare and pay it” (Article 6, subsection a of Ley N° 26790). SUNAT’s guidance on gob.pe is consistent with this: your employer must register, declare and pay the contributions every month, and the declaration and payment are made through PLAME.

This is different from your pension contributions (to ONP or an AFP), which are indeed deducted from your gross pay. If you see a “9% EsSalud” deduction on your pay stub, that does not match the rule currently in force for dependent workers on payroll, and it’s worth raising with your employer.

What happens if your employer never registered you

If your employer fails to register you or fails to pay the corresponding contributions, you have two layers of protection:

1. Health coverage is still guaranteed. Article 10 of Ley N° 26790 states that if the employer fails to pay the contribution and a covered event occurs (a genuine need for health care), EsSalud or the relevant health provider “must cover it” and then has the right to demand reimbursement of the cost of the care provided from the company. In other words, your employer’s failure to pay should not leave you without medical care — the financial risk of that failure falls on the company, not on you.

2. Labor inspection by SUNAFIL. Failing to register a worker in T-Registro and failing to pay EsSalud contributions are violations that SUNAFIL can inspect as part of its authority over social security and payroll compliance. The process for filing a complaint follows the same general logic as any other labor complaint to SUNAFIL; see how to file a complaint with SUNAFIL for the step-by-step process, and if you’re worried your employer might find out you filed it, check whether a SUNAFIL complaint is anonymous.

What to do if you suspect you’re not registered

• Ask your employer for your T-Registro enrollment confirmation (they are required to give you one).
• Check EsSalud’s own portal to see if you appear as an insured member.
• If you’re not registered, demand in writing that it be fixed.
• If your employer doesn’t respond, consider filing a complaint with SUNAFIL, and keep all your pay stubs and communications as evidence.

This situation can also overlap with other ways an employer tries to avoid labor obligations, such as paying through a disguised independent-contractor arrangement when a real employment relationship exists — which often comes paired with a failure to register the worker with EsSalud. Keep in mind, too, that missing or irregular contributions can also affect how other benefits are calculated, such as your bonuses, CTS, and vacation pay.