Is maternity insurance just reimbursement like medical insurance?

The two are different. Maternity insurance and medical insurance cannot be reimbursed at the same time, only one can be reimbursed. Because both reimbursement needs to provide materials such as original medical bills, if the original medical bills are used for maternity reimbursement, medical expenses reimbursement cannot be used for reimbursement. If you want to reimburse maternity medical expenses, if maternity insurance meets the reimbursement conditions, it is best to use maternity reimbursement, which can be used to reimburse prenatal examination, delivery surgery expenses, family planning surgery expenses, etc. And you can also receive maternity allowance.

Private hospitals can enjoy reimbursement if they are covered by local medical insurance. Medical insurance and maternity insurance can only be reimbursed for one item, not both. If there is a job, the birth check-up and production expenses will be reimbursed by maternity insurance. If there is no job and the man has no maternity insurance reimbursement, he can use the woman's medical insurance to reimburse the related expenses. According to the provisions of the general outpatient service and hospitalization, the reimbursement is calculated separately.

Paragraph 1: What are maternity insurance and medical insurance?

Maternity insurance, the full name of maternity insurance, refers to a kind of social insurance paid by employers for female employees. This insurance is mainly used to provide financial security for employees during pregnancy or childbirth. The full name of medical insurance is basic medical insurance, which refers to the medical insurance system that is jointly participated by the state and individuals and aims to provide basic medical security services for the insured.

Paragraph 2: Can maternity insurance and medical insurance be insured at the same time?

The answer is yes. According to the regulations of the state, while paying the basic medical insurance, female workers should also participate in maternity insurance, which is a statutory social insurance. Therefore, female employees can participate in maternity insurance and medical insurance at the same time, and the two insurances are not in conflict. When a female worker is pregnant, gives birth or miscarries, maternity insurance will provide corresponding welfare protection, while medical insurance will provide basic medical services and expense reimbursement.

Paragraph 3: Is there a difference between the reimbursement scope of maternity insurance and medical insurance?

There are some differences between the reimbursement scope of maternity insurance and medical insurance. Maternity insurance is mainly used to reimburse female employees for medical expenses such as pregnancy check-up, delivery, cesarean section and abortion during pregnancy, childbirth and abortion. Medical insurance is to reimburse the insured for the expenses incurred in the medical process, but it is limited to the medical insurance entity expenses, drug expenses, medical treatment project expenses, etc. Within the scope of basic medical care and included in bilateral accounting. Therefore, while participating in maternity insurance and medical insurance, female employees need to choose appropriate reimbursement methods according to different situations in order to make full use of the benefits and services provided by the social security system.

I hope the above content can help you. If in doubt, please consult a professional lawyer.

Legal basis:

Article 28 of the Regulations of People's Republic of China (PRC) Municipality on the Basic Medical Insurance for Urban Employees.

Personal accounts are used to pay medical expenses beyond the scope of the overall fund payment; If the personal account is insufficient to pay, it shall be borne by me.

Article 29

The hospitalization expenses for major diseases are paid in the following ways:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses. The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.

Article 23 of the Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 53 of the Social Insurance Law

Employees shall participate in maternity insurance, and the employer shall pay maternity insurance premiums in accordance with state regulations, and employees shall not pay maternity insurance premiums.