The scope and standard of maternity insurance reimbursement in Wuhan

What are the reimbursement conditions for maternity insurance in Wuhan? What are the procedures for reimbursement of maternity insurance in Wuhan? Wu Hanyou maternity insurance designated hospital? We will answer the questions about maternity insurance one by one. Maternity insurance reimbursement conditions and procedures are as follows. The scope of reimbursement includes: family planning operation fees (outpatient and hospitalization), prenatal examination fees and maternity medical expenses (excluding baby fees and bed fees exceeding the payment standard). The premise of reimbursement of the above expenses is that it does not exceed the list of drugs and medical items stipulated by medical insurance. After the insured person has incurred the above expenses in the designated medical insurance hospital of his own choice, the insured individual shall pay in cash first, and properly keep the details, prescriptions, original receipts and related vouchers of maternity insurance medical expenses. According to the regulations, it should be paid by the maternity insurance fund, which shall be summarized by my unit and reported to the county social security agency for settlement. Maternity insurance premiums incurred by the insured in other places are also reimbursed in this way. 1. Employees who meet the following conditions shall enjoy maternity insurance benefits: (1) Those who have given birth or have family planning operations in line with the national family planning policy; (two) the unit in accordance with the provisions for employees to participate in maternity insurance and full payment for more than one year. 2. Reimbursement of maternity expenses includes examination expenses, delivery expenses, operation expenses, hospitalization expenses, medicine expenses and treatment expenses incurred by female employees due to pregnancy and childbirth. Medical expenses incurred by employees in placing (taking out) IUD, abortion, induced labor, sterilization and recanalization. 3. Apply for maternity insurance benefits at the local social insurance agency with the following materials: (1) my ID card, marriage certificate and original proof of medical expenses; (two) normal birth, submit the "family planning service manual" or "birth certificate", birth medical certificate or death medical certificate; (three) the implementation of family planning surgery, submit relevant medical certificates; (4) If the spouse of a male employee participating in maternity insurance has no work unit, the certificate of the village (neighborhood) committee where the spouse's household registration is located shall be submitted. 4. The maternity allowance for female employees is the average monthly payment salary of the previous year divided by 30 days multiplied by the number of maternity leave days. The maternity leave for normal childbirth of female employees is 90 days, including prenatal leave 15 days; Increased dystocia 15 days; For multiple births, each additional baby will be increased by 15 days; Late childbearing increased by 60 days; If the female employee miscarries within 2 months of pregnancy, the maternity leave is 15 days; Pregnant for more than 2 months but less than 3 months, maternity leave is 20 days; Maternity leave is 30 days for those who are pregnant for more than 3 months but less than 4 months; Pregnant for more than 4 months, maternity leave is 42 days.

Legal objectivity:

Maternityinsurance is a social insurance system that the state and society provide medical services, maternity allowance and maternity leave when pregnant and childbirth female workers temporarily stop working, and the state or society provides necessary economic compensation and medical care for maternity workers. Maternity insurance benefits in China mainly include two items. One is maternity allowance, and the other is maternity medical care. The Measures for Maternity Insurance in Ministry of Human Resources and Social Security (Draft for Comment) has been open to the public for comments since 2012165438+10. The opinion draft makes it clear that maternity insurance benefits will no longer be limited to household registration, and units that do not pay maternity insurance must pay maternity fees. According to the relevant laws and regulations, the benefits that maternity insurance can enjoy mainly include: maternity allowance (salary during maternity leave, payment base of one month before delivery ÷30× maternity leave days); The fixed payment of maternity medical expenses shall be subject to local regulations. The following is about the scope of reimbursement of maternity insurance in Wuhan, and it also involves the characteristics and treatment of maternity insurance. 1. When will the maternity insurance measures for employees in Wuhan be implemented? A: The Measures of Wuhan Municipality on Maternity Insurance for Employees (hereinafter referred to as the Measures) came into effect on June 5438+February 10, 2006. All units that have participated in maternity insurance according to the regulations and paid for more than 6 months continuously, whose employees' maternity or family planning operations meet the family planning regulations, can enjoy maternity insurance benefits according to the Measures. 2. What are the main features of maternity insurance? Answer: (1) Maternity insurance covers both male and female employees, but mainly female employees; (two) the conditions for enjoying the treatment are closely related to the family planning policy; (three) regardless of the pregnancy results of female employees, they can get compensation according to the regulations; (4) The medical service during delivery mainly focuses on health care, consultation and examination, which is different from the medical service based on treatment provided by medical insurance; (5) Maternity leave has fixed requirements; (six) maternity insurance benefits have certain welfare. 3. What are the main benefits of maternity insurance? A: (1) Maternity leave, that is, the rest time given to employees during childbirth as stipulated by national, provincial and municipal laws and regulations; (two) maternity allowance, that is, the living expenses given to female employees during the period of leaving their jobs due to childbirth as stipulated by national, provincial and municipal laws and regulations. When employees do not participate in maternity insurance, maternity leave wages are paid by the employer; After participating in maternity insurance, it is a maternity allowance, which is paid by the maternity insurance fund. They don't enjoy each other repeatedly. (three) medical services, that is, a series of services such as diagnosis, treatment and rehabilitation provided by medical institutions when workers give birth or perform family planning operations. (four) nursing leave allowance, that is, according to the provisions of the Hubei Provincial Population and Family Planning Regulations, the living expenses for male employees during the period of leaving their jobs to take care of their spouses and babies. 4. Who should participate in maternity insurance in our city? A: All kinds of enterprises, organs, institutions, social organizations, private non-enterprise units and their employees who have participated in the basic medical insurance in this Municipality should participate in the maternity insurance for employees in this Municipality. 5. How to pay maternity insurance premium? Answer: The maternity insurance premium is paid by the employer, and the individual employees do not pay the maternity insurance premium. The employer shall pay the maternity insurance premium at 0.7% of the total average monthly salary of employees in the previous year. Maternity insurance and basic medical insurance in our city shall be uniformly collected, and the annual maternity insurance payment base and the basic medical insurance payment base shall be approved together.