How much can the inspection fee in Beijing be reimbursed?

Maternity insurance is the state's welfare compensation for women's childbirth, which can help to reimburse maternity expenses. Its welfare benefits mainly include two parts:

Maternity medical expenses: reimbursement from pregnancy to delivery, including outpatient examination fees, medical service fees (formerly known as registration fees) and hospital delivery fees;

Maternity allowance: Maternity allowance refers to the living expenses paid to professional women during their absence due to childbirth.

Generally speaking, if you don't use drugs outside the scope of reimbursement, after the reimbursement of maternity medical expenses, the cost of prenatal examination and delivery is not much.

From May 1 day, 2020, Beijing adjusted the payment standard of maternity insurance medical expenses, and the check-up expenses were from

1400 yuan

Suddenly mention

Three thousand yuan.

, improved.

1 14%

! The payment standard for hospital delivery is determined by the following factors

Three thousand yuan.

Raise to

5,000 yuan

; Other types of hospital delivery expenses and family planning expenses have also increased to varying degrees.

First, enjoy the conditions for reimbursement of maternity medical expenses

1 conforms to the national family planning regulations.

2 in the designated medical insurance unit birth or abortion.

As long as the social security participation status is normal on the day of birth check-up, the current birth check-up fee, registration fee or hospital delivery fee can be reimbursed, but it cannot be reimbursed if the payment is suspended on the same day. The reimbursement of maternity medical expenses is not restricted by the continuous payment of maternity insurance. Maternity allowance needs to be paid continuously.

The reimbursement of maternity medical insurance in Beijing is mainly divided into three parts: outpatient examination fee, medical service fee (formerly known as registration fee) and hospital delivery fee. Among them, the hospital delivery fee is directly settled by social security card, and the outpatient examination fee and medical service fee must be reimbursed by the unit to the social security center. Let's talk about it in detail.

1. Outpatient examination fee: 3000 yuan at most.

Reimbursement standard after May 2020 1:

From the confirmation of pregnancy to the termination of pregnancy, at present, the cost of prenatal check-up in Beijing clinics has increased from the original 1.400 yuan to the maximum reimbursement of 3,000 yuan. No matter how much we spend on prenatal examination, the reimbursement is less than 3,000 yuan, and the maximum reimbursement is 3,000 yuan above 3,000 yuan.

Reimbursement time, materials and processing flow:

Reminder: The earliest declaration date is the second month after production (for example, production in September, 165438+ 10). Please sort out all your reimbursement documents and submit them to the unit personnel for reimbursement. There is no deadline for the time being, so it is recommended to declare as soon as possible.

2. Medical service fee is commonly known as registration fee: there is no maximum limit.

From April 8, 20 17, the medical service fee of maternity insurance is no longer restricted by the highest reportable 400 yuan. Instead, report as much as possible.

Reimbursement ratio:

Medical service fees cannot be reimbursed in real time. You need to keep the registered receipt and invoice of each birth check-up, and reimburse it together with the outpatient birth check-up fee in the second month after delivery.

3. Hospital delivery fee: up to 5,800 yuan.

Insured in Beijing to give birth in Beijing, holding social security card and birth service registration form: real-time settlement (if the unit pays commercial insurance, employees can be reimbursed for the second time);

No social security card or maternity service registration form: return to the unit for manual reimbursement;

Insured in Beijing to give birth in different places: return to the unit for manual reimbursement;

Reimbursement ratio:

Medical expenses for natural delivery: 5,000 yuan for tertiary hospitals, 4,800 yuan for secondary hospitals and 4,750 yuan for primary hospitals (the fixed payment standard for vaginal trial delivery and intraspinal labor analgesia after cesarean section is increased by 1 1,000 yuan on the basis of the fixed standard for "natural delivery" in hospitals at all levels);

Medical expenses for artificial intervention in childbirth: 5,200 yuan for tertiary hospitals, 5,000 yuan for secondary hospitals and 4,950 yuan for primary hospitals;

Medical expenses for cesarean section: 5,800 yuan for tertiary hospitals, 5,600 yuan for secondary hospitals and 5,550 yuan for primary hospitals;

The methods of artificial intervention in delivery include: cervical sealing, oxytocin intravenous drip for induced labor, manual placental abruption, curettage, cervical laceration, incision of vaginal wall hematoma, lateral incision of perineum and complicated laceration, forceps for single fetus, breech traction of single fetus, fetal head attraction, varus and eversion, abortion operation delivery, and drug induced labor in the third trimester of pregnancy.

Materials required when online real-time settlement is not possible:

Hospital bills;

Detailed list of hospitalization expenses;

Discharge diagnosis certificate (copy);

Emergency certificate (provided by emergency patients without a card, it is necessary to make clear that the hospitalization route is emergency admission);

Copy of marriage certificate;

Copy of the medical certificate of the baby's birth (Chinese version);

Grade certificate of designated medical institutions (medical personnel in different places are required to provide this certificate);

Copy of Beijing Birth Registration Service Sheet or Beijing Floating Population Birth Registration Service Sheet or Beijing Re-birth Confirmation Service Sheet or Beijing Floating Population Re-birth Confirmation Service Sheet.

Two, Beijing medical insurance can not choose designated hospitals for reimbursement.

First, specialized hospitals. (such as Chaoyang women and children, Haidian women and children, etc.). )

B, Chinese medicine hospital. (such as Beijing Hospital of Traditional Chinese Medicine)

C, 19 Class A designated hospitals

1, Peking Union Medical College Hospital, China Academy of Medical Sciences

2. Beijing Tongren Hospital affiliated to Capital Medical University

3. xuanwu hospital, Capital Medical University.

4. Beijing Friendship Hospital affiliated to Capital Medical University

5. Peking University First Hospital

6. Peking University People's Hospital

7. Peking University Third Hospital

8. beijing jishuitan hospital

9. Guang 'anmen Hospital, Chinese Academy of Traditional Chinese Medicine

10, Beijing Chaoyang Hospital affiliated to Capital Medical University

1 1, China-Japan Friendship Hospital

12, Peking University Shougang hospital

13, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University

14, Beijing Tiantan Hospital affiliated to Capital Medical University

15, Beijing Millennium Monument Hospital (Beijing Railway General Hospital)

16, Beijing Gong Jian Hospital

Beijing Fangshan Liangxiang Hospital 17

18, Beijing Daxing District People's Hospital

19, Beijing Shijingshan Hospital

Three. Answer frequently asked questions

1. Is there a designated medical institution for maternity insurance? Can maternity insurance be reimbursed for childbirth in non-designated hospitals?

A: Yes. Insured persons can go to designated medical insurance hospitals, all designated Chinese medicine hospitals, specialized hospitals and first-class and first-class designated medical institutions for medical treatment. In non-designated hospitals, maternity medical expenses cannot be reimbursed, and maternity allowance can be received.

2. The woman has no insurance and the man has maternity insurance. Can it be reimbursed?

Answer: The man's maternity insurance can't be used if the spouse doesn't participate in social security. At the same time, the woman has no maternity allowance.

3. What is the use of maternity insurance for male employees?

A: According to Beijing policy, male workers who participate in Beijing maternity insurance can reimburse medical expenses for family planning operations such as vasectomy and vasectomy.

4. Are the abortion expenses of female employees paid by maternity insurance fund?

A: Female employees who have miscarried need to issue necessary certificates before they can receive maternity insurance and be reimbursed.

5. Can a child be reimbursed if he is cut off in the middle of reimbursement?

A: The reimbursement of birth inspection fee, registration fee and maternity fee is not restricted by continuous payment. As long as the social security participation status is normal on the day of the birth inspection, the current birth inspection fee and registration fee can be reimbursed, but it cannot be reimbursed if it is suspended.

Similarly, the reimbursement of maternity expenses is also a direct online settlement of social security cards. If the social security participation status is normal on the day of payment, it can be directly reimbursed online.

6. Can I pay social security in Beijing and go to a different place for a checkup?

A: It can be reimbursed, provided that the designated medical insurance institutions at or above the county level can have an inspection and delivery. The similarities between Beijing and other places are reimbursed according to Beijing's quota standard. The difference is that delivery in Beijing can be settled in real time by medical insurance card, and delivery in different places needs to be reimbursed manually by HR after delivery.

7. Is the reimbursement of registration fee within the reimbursement limit of 3,000 yuan for production inspection fee?

A: The registration fee is not included in the 3000 yuan limit.

8. Will changing work units during pregnancy affect the reimbursement of maternity medical expenses?

A: The normal payment of medical insurance does not affect the amount and standard of reimbursement for maternity medical expenses.

9. Is employee spontaneous abortion a maternity reimbursement or a manual medical reimbursement?

Answer: The diagnosis certificate of spontaneous abortion should indicate how many weeks of intrauterine pregnancy or ectopic pregnancy. Intrauterine pregnancy with gestational age shall be reimbursed according to abortion leave, and ectopic pregnancy shall be reimbursed according to manual medical treatment.

10. How long is the maternity insurance processing cycle?

Answer: reimbursement of outpatient examination fees: materials are submitted in the current month, and reimbursement can generally be received in the middle of the next month.

Application for maternity allowance: submit the materials in the current month, and generally you will get the money in the middle and late of the next month.

1 1. When will the new maternity insurance payment policy be implemented?

A: As long as the submitted maternity check-up fee includes the check-up fee after May 1, even if it is only once, according to the new regulations, the payment limit can be 3,000 yuan. Please note that bills reviewed 42 days after delivery are not included.

12. Can hospitalization reimbursement be settled in real time through maternity insurance?

A:

1) did not take the social security card, and was hospitalized directly in the emergency department.

2) During the period when employers default, such as during the epidemic, many companies default on social security fees. During the company's default, we can't settle our hospitalization in real time. You need to wait for the company to make up the arrears before you can make offline reimbursement.

3) When you go back to your hometown to give birth to a child, you need to go through the formalities of medical treatment in different places, and then all the hospitalization expenses of delivery in designated hospitals in different places need to be reimbursed manually in Beijing. (In addition to keeping all hospital documents, you also need a copy of hospital medical records, otherwise you will not be reimbursed. If you don't want a copy of your medical record when you leave the hospital, you will have to pay extra for it later. )

13. Is it necessary to apply for the "Beijing Floating Population Birth Registration Service Form" in order to be reimbursed?

Answer: For the insured persons with foreign registered permanent residence who have not lived in this city for a long time, if they can't apply for the Beijing Floating Population Birth Registration Service Form in this city, they need to provide: (1) the marriage and birth certificate issued by both husband and wife units, and affix the official seal (this certificate is valid for 1 year). The contents of the certificate include: 1 the specific reasons why the "Beijing Floating Population Birth Registration Service Form" cannot be processed. 2. Marital status of husband and wife. 3. The situation of children born by both husband and wife. (2) a copy of the birth certificate issued by the family planning administrative department at or above the street (township) where the household registration is located.

14. Can the special prenatal examination be reimbursed up to 3000 yuan?

A: In principle, you can't apply for maternity reimbursement for special inspection, and the scope of maternity reimbursement is the same as that of medical insurance reimbursement. You can also consult the hospital in advance whether it belongs to the scope of medical insurance reimbursement.

15. Can maternity allowance and maternity insurance only be handled by employees of the unit? Can I submit my own materials?

A: Maternity allowance and maternity insurance can only be handled by the unit, not by the individual.

16. During the epidemic, the company applied for extension of social security. Do you pay first and then pay continuously? Can I get maternity allowance?

A: After the company applies for deferred payment, the state's default welfare enjoyment will not be affected. As long as the company makes up after the extension expires, maternity reimbursement and maternity allowance will not be affected.

17. Payment of medical reimbursement expenses for maternity insurance (medical documents have been submitted long ago, but the money has never been received. Where did the money go?

A: After June 65438+1 October1in 2020, the medical reimbursement fee for maternity insurance will be paid to the personal bank account bound by the insured's medical insurance card. If there is no problem with the personal account and the unit has not changed the payment method, the amount of reimbursement will be credited to the insured's personal bank account. You can call the social security center of the insured place for telephone consultation, and finally attach the telephone numbers of all districts in Beijing, which is limited to working days.

Four, Beijing medical insurance handling telephone

Beijing Social Security Center Hotline: 12333

Service time: 24-hour manual service is provided from Monday to Sunday.

Manual service: citizens dial "12333" and select "0", and the consultant will directly answer the citizens' inquiries. If you encounter a problem, refer it to an expert. (If you cannot dial "12333", please dial 633 16602, 89 1528 13 for policy consultation. )