How to reimburse the medical insurance

①The process of reimbursing the costs of purchasing resident medical care for the birth of a child is relatively simple, and is usually reimbursed directly at the hospital. Usually, the hospital will leave the social security card, maternity service card when the mother for hospitalization, after that will automatically in the checkout of the reimbursement of part of the cost.

②Purchase of employee medical reimbursement is relatively more cumbersome, you need to take the approval form and diagnostic certificates and other materials to go to the Social Security Administration, fill out the form, submit materials.

Taking the reimbursement of child birth expenses by the residents' medical insurance as an example, the basic flat rate subsidy of 300 yuan will be given for a normal delivery in a designated hospital at the township level. If you give birth at a county-level or above designated hospital, you will be given a fixed subsidy of 450 yuan. However, in the case of cesarean section, medical expenses are generally reimbursed only if they exceed 2,000 yuan, 45 percent of those between 2,000 and 7,000 yuan, and 65 percent of those exceeding 7,000 yuan.

The conditions for reimbursement of medical insurance for children:

1) comply with national, provincial and municipal family planning policies;

2) at the time of delivery or family planning surgery, the employer has participated in the maternity insurance for the full 12 consecutive months of payment. The health insurance for the birth of a child is paid by the employer on behalf of the employee, and the individual does not need to pay any insurance premiums.

3) When applying for reimbursement of medical insurance for the birth of a child, it is also necessary to be declared by the employer or the labor security service personnel on behalf of the employee.

④When an insured female worker becomes pregnant, has a miscarriage or before planning to have a family, she is required to report the situation to the relevant department of the employing unit or the labor security service department of the place where she lives, who will then bring the worker's declaration materials to the window of the local social insurance center's health insurance window to make a declaration for the birth of a child.

Medical insurance reimbursement process for children

1: Declaration acceptance

Medical insurance for children is paid by the employer on behalf of the employee, and the individual does not need to pay any insurance premiums. Accordingly, when applying for reimbursement of medical insurance for the birth of a child, it is necessary for the employer or the labor security service personnel to make a declaration on behalf of the employee. Specifically, when a female employee is pregnant, has a miscarriage, or is planning to have a family, she must report the situation to the relevant department of her employer or the local labor security service, who will then bring the employee's declaration materials to the local social insurance center's birth medical insurance window to make a declaration. The declaration materials include the employee's social insurance registration form, maternity insurance declaration summary form and so on.

Two: Eligibility Audit

The maternity department of the local social insurance center, upon receiving the declaration acceptance materials submitted by the employee's employer or labor security staff, needs to carry out a foreground eligibility and information audit as soon as possible. If the audit passes, the acceptance receipt will be issued and a medical certificate will be issued; if it does not pass, an inadmissibility receipt will be issued.

Three: Treatment Approval and Settlement

If the acceptance receipt is received, within one month after the start of the maternity leave of the female worker, the employer or the staff of the local labor security department will bring the relevant reimbursement materials to the local social insurance center of the birth of a child medical insurance window to go to the birth of a child insurance reimbursement. The reimbursement materials include a family planning certificate, a birth certificate, the employee's own ID card, a maternity medical certificate, a maternity medical claim form, a medical fee application form, a surgical fee application form, a maternity insurance treatment approval settlement form, and original materials such as the woman's and employee's medical fee bills, fee lists, and medical records. The relevant staff at the Social Insurance Center will re-examine the declarations for treatment and account for the final reimbursement data.

Four: Treatment allocation

After passing the audit of the reimbursement materials, the staff at the maternity insurance window of the local social insurance center will calculate the medical insurance benefits to be paid to the employee. If there is no objection, the social insurance center will transfer the maternity medical fee and maternity allowance to the account of the insured female employee. After receiving the notice from the social insurance center, the insured female worker can make inquiries about the medical insurance benefits for the birth of a child.

Legal basis

Article 54 of the Social Insurance Law of the People's Republic of China

Where an employer has paid maternity insurance premiums, its employees are entitled to maternity insurance benefits; the employee's un-employed spouse is entitled to maternity medical expenses in accordance with state regulations. The necessary funds are paid from the Maternity Insurance Fund. Maternity insurance benefits include maternity medical expenses and maternity allowances.

Article 55 of the Social Insurance Law of the People's Republic of China

Medical expenses for maternity include the following:

(1) medical expenses for giving birth;

(2) medical expenses for family planning;

(3) expenses for other items stipulated by laws and regulations

Article 30 of the Social Insurance Law of the People's Republic of China

The People's Republic of China

Medical expenses for maternity include the following Social Insurance Law, Article 30

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health;

(4) those that are sought outside of China. If the medical expenses should be borne by a third person according to law, and the third person does not pay or the third person cannot be identified, the basic medical insurance fund will pay first. The basic medical insurance fund shall have the right to recover the costs from the third party after making the payment first.

Article 54 of the Social Insurance Law of the People's Republic of China

Where an employer has paid maternity insurance premiums, its employees are entitled to maternity insurance benefits; the employee's unemployed spouse is entitled to maternity medical expenses in accordance with State regulations. The required funds are paid from the Maternity Insurance Fund.

Maternity insurance benefits include maternity medical expenses and maternity allowance.