Dongguan maternity insurance policy in 2022-2023: All insured persons can enjoy maternity allowance.

The new policy of maternity insurance in Dongguan will be implemented this year. On August 25th, the Dongguan Municipal Government Information Office and the Municipal Social Security Bureau held a press conference, revealing that after the implementation of the new regulations, maternity insurance benefits in Dongguan included maternity medical expenses and maternity allowance. The original maternity medical expenses and maternity allowance are paid in one lump sum instead of the actual medical expenses, and the maternity allowance is paid in combination with the average monthly salary and holiday days. The scope of maternity allowance will be extended from those who participate in supplementary medical insurance to all those who participate in maternity insurance. At the same time, new medical expenses such as prenatal examination and family planning surgery will be reimbursed.

In addition, a major change in the New Deal is that employers pay maternity insurance for employees, and the contribution rate of maternity insurance is set at 1%, which is temporarily levied at 0.46%.

Change 1: the maternity expenses of designated medical institutions are reimbursed and settled on the spot.

According to the current policy, at present, the maternity medical expenses of the insured in Dongguan are paid by the medical insurance fund in a lump sum. The insured person of Dongguan basic medical insurance can enjoy reproductive medical treatment according to the following standards: 3,500 yuan for cesarean section and 2,000 yuan for delivery through birth canal. In addition, the insured who has participated in supplementary medical insurance can also enjoy maternity allowance.

After the implementation of the new regulations, Dongguan maternity insurance benefits include maternity medical expenses and maternity allowance. After the adjustment, the maternity insurance benefits will be quite different from the current maternity benefits, and the level of maternity insurance benefits for the insured will be greatly improved. From the original maternity medical expenses and maternity allowance to one-time fixed payment, maternity medical expenses are paid according to the actual medical expenses, and maternity allowance is paid according to the average monthly salary and holiday days. Secondly, new medical expenses such as prenatal examination and family planning operation will be reimbursed.

Compared with the current situation that the insured person pays the maternity medical expenses first and then goes to the social security agency with the medical invoice, the new regulations will be more convenient and faster. After the implementation of the new regulations, if the insured who has participated in maternity insurance 1 year has gone through the medical confirmation procedures and given birth in a designated medical institution confirmed by medical treatment, the medical expenses for their birth can be directly settled in the designated medical institution on the spot without going to the social security agency. In order to facilitate the insured to handle this procedure, Dongguan will implement information and network management for maternity insurance handling. If the insured person who participated in maternity insurance 1 year has given birth, he can directly apply for medical confirmation in the selected medical institution with relevant information, without going to the social security agency.

Because the current payment is fixed, there is no hard and fast regulation on the choice of the insured person's production hospital, but according to the new regulations, the insured person needs to give birth in the confirmed designated medical institution. How to determine this designated medical institution? In this regard, Zhang Yalin, deputy director of Dongguan Social Security Bureau, explained that the insured in the designated social security medical institutions in Dongguan can choose according to their actual situation. The implementation of the New Deal is accountable. Will this cause the top three hospitals to burst and the low-level hospitals have no choice? Zhang Yalin said that relevant guidelines will be issued to adjust and limit this.

Change 2: The maternity insurance rate is set at 1%, which is temporarily levied at 0.46%.

After the implementation of the new regulations, the employer will pay maternity insurance for employees.

It is reported that 1998 According to the "Trial Measures for Maternity Insurance for Enterprise Employees" issued by the Ministry of Labor, Dongguan implements maternity insurance for employees of enterprises owned by the whole people, municipal collective enterprises, institutions, social organizations and other units, and the units pay 0.5% of the total average monthly salary of all employees in the previous year. With the rapid development of economy, the composition of enterprises and workers in Dongguan has changed significantly, and migrant workers have gradually become the main body of workers in Dongguan. In 2000, Dongguan expanded the scope of maternity insurance to Guancheng and Shilong towns, and carried out maternity insurance for migrant workers on a pilot basis. The maternity insurance premium was paid by the employer. In June 2009, in order to further expand the coverage of maternity insurance, Dongguan City integrated the social medical insurance and maternity insurance systems and implemented unified management. Maternity insurance is no longer paid separately. The insured can enjoy the corresponding maternity medical expenses when participating in medical insurance, and can also enjoy the corresponding maternity allowance when participating in supplementary medical insurance.

According to the Regulations on Maternity Insurance for Employees in Guangdong Province and the Notice on Implementing Relevant Matters issued by Dongguan Municipal Government, the obligation of the employer to participate in maternity insurance for employees is clarified, and it is stipulated that the employer and all its employees within the administrative area of this Municipality should participate in maternity insurance, and the maternity insurance premium shall be paid by the employer on a monthly basis; Urban and rural residents with school-age household registration in this city shall be provided with maternity insurance by the village community, and the maternity insurance premium shall be borne by the finance. Employees or individual urban and rural residents do not need to pay fees. According to the requirements of the Notice, the contribution rate of maternity insurance in Dongguan is set at 1%. However, considering the economic operation, in the early stage of the implementation of the Maternity Insurance Regulations, Dongguan temporarily lowered the contribution rate of maternity insurance by 0.54 percentage points, and actually levied maternity insurance premiums at 0.46%. Judging from the current implementation of provincial regulations in cities in the province, this payment ratio is at the lowest level in the province.

Change 3: Maternity allowance is paid to all the insured on a daily basis.

In addition, the reporter learned from the press conference that after the implementation of the new regulations, the scope of maternity allowance will be extended from those who participated in supplementary medical insurance to all those who participated in maternity insurance. The maternity allowance that employees should enjoy shall be calculated by dividing the average monthly salary of employees in the previous year by 30 and multiplying it by the prescribed number of vacation days. In addition, under the authorization of the Maternity Insurance Regulations, Dongguan has formulated supporting regulations and standards, mainly including the proportion of maternity insurance contributions and the reimbursement standards for maternity medical expenses in different situations.

The just-released White Paper on Social Security of Enterprises in China says that nearly 62% of enterprises in China have not been approved according to the actual wages of their employees, and 24% of them have paid according to the minimum base. In fact, this situation is also very common in Dongguan. What should I do if the payment base declared by the unit is lower than the actual salary of the employees, which will directly affect the maternity allowance of the insured? The relevant person in charge of Dongguan Social Security Bureau explained that the payment base of maternity insurance needs the signature of employees, and the social security department will allocate and calculate according to the payment base declared by enterprises.

How to pay maternity allowance? Dongguan Social Security Bureau explained that the social security department will pay the employer, and then the employer will pay the individual. "If the maternity allowance is higher than the original wage standard of the employees, the employer shall pay the balance of the maternity allowance to the employees; If the maternity allowance is lower than the employee's original salary standard, the difference will be made up by the employer. " At the same time, the reporter learned at the press conference that after the maternity allowance is issued, the employer will no longer need to pay the salary during maternity leave to the maternity insured.

In addition, the Regulations on Maternity Insurance stipulates that if an employer fails to register maternity insurance for employees or fails to pay maternity insurance premiums in full and on time, resulting in employees or unemployed spouses of employees not being able to enjoy maternity insurance benefits, the employer shall pay relevant fees to employees in accordance with the regulations and the maternity insurance benefits standards stipulated in the overall planning area. If the employer fails to fully declare the total wages of employees, resulting in the loss of maternity allowance, the employer shall be responsible for compensation. If the employer fails to pay maternity allowance to the employees in full, fails to make corrections within the time limit, conceals the real situation, issues perjury or participates in maternity insurance by other improper means, the social insurance administrative department shall order it to make corrections and impose a fine of more than 2,000 yuan and less than 20,000 yuan; If the relevant personnel have enjoyed the maternity insurance benefits, the social insurance agency shall order them to return the paid maternity insurance benefits and impose a fine of more than 2 times and less than 5 times the corresponding amount. Suspected of a crime, transferred to judicial organs for handling according to law.

Small reminder:

1, enjoy maternity insurance benefits must comply with the family planning policy. The insured person of maternity insurance can only apply for maternity insurance related benefits after reporting the registered population and family planning information in time and receiving family planning technical management services.

2. Those who do not meet the payment time requirements for the time being can be postponed to enjoy it after payment 1 year. If the maternity insurance is less than 1 year or the family planning operation is implemented, after the insured person has participated in the maternity insurance for 12 months, the maternity medical expenses will be paid by the maternity insurance fund within 50% of the annual settlement standard of the designated medical institutions at the same level in this city, and the excess will not be paid.

Under any of the following circumstances, the insured person shall pay the maternity medical expenses that meet the requirements in advance, and apply for a one-time maternity insurance medical expenses subsidy to the social insurance agency with the required information within the specified time after the birth or family planning operation, and the treatment standard shall be implemented in accordance with the following provisions:

1 has participated in maternity insurance 1 year and has gone through the medical confirmation procedures. If an emergency or rescue occurs in a non-designated medical institution in the city or a medical institution outside the city, the maternity medical expenses will be paid by the maternity insurance fund within the annual settlement standard of the designated medical institution at the same level in the city, and the excess will not be paid;

2. Those who have participated in maternity insurance 1 year but have not gone through the medical confirmation procedures and given birth in the designated medical institutions in this Municipality shall be paid by the maternity insurance fund within 70% of the annual settlement standard of the designated medical institutions at the same level in this Municipality, and the excess shall not be paid;

3. For those who have participated in maternity insurance 1 year and gone through the medical confirmation procedures, the maternity medical expenses shall be paid by the maternity insurance fund within 60% of the annual settlement standard of the designated medical institutions at the same level in the city due to emergency or rescue, and the excess shall not be paid; ?

4. If you participate in maternity insurance 1 year but fail to go through the medical confirmation procedures and give birth in a non-designated medical institution in the city or a medical institution outside the city, the maternity insurance fund will pay within 50% of the annual settlement standard of the designated medical institution at the same level in the city, and the excess will not be paid;

5. Participate in maternity insurance for 1 year, and carry out family planning operation in non-designated medical institutions in the city or medical institutions outside the city. If there is no emergency or rescue, the maternity medical expenses will be paid by the maternity insurance fund within 50% of the annual settlement standard of designated medical institutions at the same level in the city, and the excess will not be paid;

Participate in maternity insurance for less than 1 year or implement family planning surgery. After the insured person participates in maternity insurance for over 12 months, the maternity medical expenses will be paid by the maternity insurance fund within 50% of the annual settlement standard of the designated medical institutions at the same level in this city, and the excess will not be paid.

Maternity medical expenses enjoyed by unemployed spouses of employees shall be subsidized by one-time maternity insurance medical expenses with reference to the provisions of this article. The annual settlement standard of designated medical institutions at the municipal level shall be announced to the public regularly by the municipal social insurance administrative department.