Guangzhou Maternity Insurance Reimbursement Standard 2023

The employing unit shall pay maternity insurance premiums according to a certain proportion of the total wages of its employees. The proportion of maternity insurance payment shall be determined by the people's government of the overall planning area according to the maternity insurance treatment items and expenses, and adjusted according to the expenses. 1. Guangzhou maternity insurance reimbursement standard 1. Maternity medical expenses: including maternity medical expenses and family planning operation medical expenses. (1) Maternity medical expenses: medical expenses incurred by female employees during pregnancy and childbirth, including prenatal examination expenses, termination of pregnancy expenses, delivery expenses, operation expenses, hospitalization expenses, medicine expenses, and pregnancy complications and complications diagnosis and treatment expenses. Prenatal check-up items shall be implemented in accordance with the Notice of guangdong provincial department of human resources and social security on the Prenatal Check-up Items of Maternity Insurance for Employees (Guangdong Social Regulation [2014] No.6). Prenatal check-up items are divided into routine items and reference items, and designated medical institutions can determine the check-up items and check-up times according to obstetric industry norms and the actual needs of the insured during pregnancy. (2) Medical expenses for family planning operation: including medical expenses incurred by workers in placing or taking out intrauterine devices, tubal ligation or recanalization, induced abortion, induced labor, etc. 2. Maternity insurance also requires maternity allowance (that is, wages during maternity leave). The calculation and publicity are: the average monthly salary of employees in the previous year ÷30× the specified number of vacation days. Second, Guangzhou maternity insurance reimbursement conditions 1, emergency treatment of insured persons in non-selected medical institutions, approved medical treatment in different places and other maternity medical expenses that meet the requirements; 2, the insured person to participate in the city's maternity insurance cumulative payment over 1 year, did not go through the medical confirmation procedures or not according to the provisions of medical treatment, in childbirth, abortion, family planning surgery 1 year to apply for a one-time maternity medical expenses subsidies; 3. If the insured person is pregnant or performs family planning operation during the maternity insurance period in this city, but the accumulated payment is less than 1 year, he shall apply for reimbursement within 1 year after the accumulated payment is over 12 months. Three. Guangzhou maternity insurance reimbursement process 1. Medical expenses within the scope of reimbursement for sporadic medical expenses of maternity insurance shall be paid by the insured first, and the insured shall submit relevant information to the insured unit after delivery or termination of pregnancy 1 year (after accumulated payment is insufficient 1 year); 2, by the unit manager (agent) to carry relevant information, to Guangzhou medical insurance agencies for sporadic reimbursement procedures; 3, Guangzhou medical insurance agencies to accept, review and settle the insured sporadic medical expenses reimbursement; 4. The medical expenses payable shall be allocated by the Social Security Fund Center. Insured female workers who are pregnant and give birth in different places can go through medical treatment procedures in different places in the social insurance agencies in the overall planning area. If the maternity medical expenses incurred in medical treatment in different places are within the payment standard stipulated in the overall planning area, they shall be paid by the maternity insurance fund according to the actual amount; The excess will not be paid.

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. First, employees who meet the requirements to participate in maternity insurance for a total of one year, and Guangzhou household registration employees who are still insured at the time of childbirth (abortion), enjoy maternity insurance benefits according to relevant regulations. Second, the payment standard Note: Maternity insurance allowance: it will be processed within five months after giving birth to a child, and the units where female employees and male spouses work apply for maternity insurance benefits respectively. (a), female workers 1, maternity allowance in the month of childbirth (abortion) as the base of the average salary of the unit according to the provisions of the holiday plan. Maternity allowance = average paid salary of the unit in the current month ÷30 (days) × holiday days: (1) normal maternity leave is 90 days (including prenatal check-up 15 days); (2) The one-child leave is increased by 35 days; (3) Maternity leave for late childbirth is increased by 15 days; (4) dystocia maternity leave and third degree perineal rupture cesarean section increased by 30 days; Suction delivery, forceps delivery and breech delivery increased 15 days. (5) The maternity leave is increased by 65,438+05 days for each additional baby born in multiple births. (6) Abortion false pregnancy is less than 2 months 15 days; Less than 4 months and 30 days pregnant; Pregnant for more than 4 months (including 4 months) to less than 7 months for 42 days; Pregnant for more than 7 months, surviving less than 75 days in case of stillbirth, stillbirth or premature delivery; 2. Maternity medical expenses (1) The medical expenses for medical treatment after the status of maternity medical treatment is confirmed by the medical insurance center shall be settled by the Guangzhou Municipal Labor and Social Security Bureau and the hospital (the part exceeding 1 10,000 yuan shall be settled according to the approved number). (2) Sudden abortion before pregnancy 16 weeks, and obstetric complications during emergency and maternity leave in non-designated hospitals, shall be reimbursed according to the approved number. (3) If the medical expenses for delivery in different places are lower than the quota standard, they shall be reimbursed according to the facts; Above the quota standard, according to the quota standard reimbursement. 3. One-time delivery nutrition subsidy (1) Normal delivery and abortion for more than 7 months; Last year, the average monthly salary of employees in the city was × 25%; (2) Dystocia and multiple births: the average monthly salary of employees in the previous year was ×50%. 4, a one-time subsidy in one or two hospitals delivery, each additional one-time subsidy 300 yuan. (2) The male spouse who receives the One-Child Preferential Card for male employees enjoys 10 day holiday, and the holiday is calculated according to the unified salary paid by the unit in the month when the child is born. Male spouse's holiday salary = unified salary paid by the unit in the current month ÷30 (days) × 10 (days). Three. Reimbursement scope and carrying materials. Reporting method 1. Maternity medical expenses within the scope of reimbursement for sporadic medical expenses of maternity insurance shall be paid by the insured person first, and shall be reported to the subordinate unit within 5 months from the date of discharge (or settlement of medical expenses). 2, by the unit manager to carry relevant information, to the city medical insurance center on the fourth floor of the medical insurance business comprehensive service hall designated window for reimbursement procedures. V. List of Settlement Standards for Sporadic Reimbursement of Maternity Insurance Amount Unit: Yuan