How to reimburse maternity insurance for less than one year?

If the insured person is pregnant or performs family planning operation during maternity insurance, 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. In addition, the following circumstances can also be used as sporadic expenses to participate in maternity insurance reimbursement:

1. The insured meets the requirements of maternity medical expenses such as emergency treatment in non-selected medical institutions and medical examination and approval in different places;

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;

Materials required for reimbursement

(1) basic materials

1. Employee maternity insurance medical application form;

2 special receipts for medical expenses printed by the finance and taxation department or invoices printed by the tax department;

3. Detailed summary of medical expenses;

4. Proof materials that meet the family planning regulations (subject to the latest family planning regulations of the health and family planning administrative department, and a copy shall be kept after the original verification).

(2) Special materials for different types of medical services.

1. Outpatient: Outpatient medical records (original verification, keep a copy).

2. Hospitalization business: the first page of the hospitalization medical record or discharge summary, and the diagnosis certificate (stamped with the official seal or business seal of the medical institution, and the original copy shall be kept after verification).

(3) Special materials for other business types.

1. If medical treatment in different places is approved, the original Application Form for Confirmation of Maternity Insurance for Employees shall be provided, and the hospital giving birth in different places or carrying out family planning operation shall fill in the hospital level and affix the official seal or business seal of the hospital.

2. If the insured applies for reimbursement of maternity medical expenses after paying maternity insurance premium 12 months, he must also supplement the labor contract or the employer's recruitment certificate (in the case of labor dispatch, he must also provide a labor dispatch agreement); Wage payment vouchers of employees during their employment; Business license or registration certificate or organization code certificate of the employing unit (the original shall be verified and a copy shall be kept, and the copy shall be stamped with the official seal of the employing unit).

3. If the unemployed spouse of the insured male worker fails to go through the birth confirmation procedures, it is required to provide:

(1) Marriage certificate (copy shall be kept after the original is verified);

(2) Proof that the unemployed spouse of the male worker did not enjoy the basic medical insurance for urban and rural residents (including the basic medical insurance for urban residents or the new rural cooperative medical system) (verified copy of the original).

Note: It refers to the certificate of not participating in the basic medical insurance for urban and rural residents (including the basic medical insurance for urban residents or the new rural cooperative medical system) issued by the social insurance agency at or above the county level or the health department at the place where the household registration is located (the original is verified, and a copy is kept) and the valid unemployment registration certificate of this city (it is necessary to have unemployment registration information during pregnancy, which can be inquired through information sharing without personal provision).

4. If the insured couple are foreigners, it is not necessary to provide proof of compliance with family planning regulations, but should provide:

(1) Employment certification materials (a copy shall be kept after the original is verified);

(2) valid passports or Hong Kong, Macao and Taiwan passes of both husband and wife (copies shall be kept after verification of the original).

5. If you apply for transferring to a personal account, you must also provide the first page of the passbook or a copy of the bank card of the payee's account opened in this city.

6. Due to personal reasons of the insured, if the medical expenses of family planning that should be accounted for in medical institutions are not accounted for, it is also necessary to provide proof of the reasons for not being accounted for issued by medical institutions.

7. Entrusted processing:

(1) Entrusting others: the power of attorney, a copy of the client's ID card, a copy of the social medical insurance card and the original and copy of the client's ID card are required.

(2) Handling by the unit manager: If a letter of introduction from the unit and a copy of the ID card of the manager are provided in advance for filing in the corresponding medical insurance agency, only the original ID card of the manager is required when handling the personal business of the insured person of the unit.

Treatment process

1. The unit manager (agent) carries relevant information to the secondary medical insurance agency for handling;

2 in line with the provisions of the two medical insurance agencies to accept the application of the unit manager (agent), input system;

3 secondary medical insurance agencies to apply for examination and settlement of medical expenses;

4 secondary medical insurance agencies will transfer the settlement of medical expenses to the municipal social security fund center after examination and signature, and the municipal social security fund center will allocate medical expenses.

If the maternity insurance has not been paid for one year, it will take 25 days to be reimbursed (the expenses allocated by the fund center are not within this period).

legal ground

People's Republic of China (PRC) social insurance law

Article 24 The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.