Tianjin maternity insurance policy in 2023

Article 1 These Provisions are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC), the Decision of the State Council on Further Optimizing the Birth Policy and Promoting the Long-term Balanced Development of the Population, and other laws and regulations in order to safeguard the legitimate rights and interests of employees and ensure that female employees can obtain basic medical care and living security during childbirth and family planning operations. Special Provisions on Labor Protection of Female Workers and other relevant laws, regulations and documents, combined with the actual situation of this Municipality.

Article 2 These Provisions shall apply to the insurance payment, treatment payment, fund management, handling service and supervision of maternity insurance for employees within the administrative area of this Municipality.

Article 3 The maternity insurance for employees in this Municipality shall be coordinated by the whole city, and the working principles of adapting the level of protection to the level of economic and social development, equality of rights and obligations, and combination of fairness and efficiency shall be followed to promote the high-quality and sustainable development of maternity insurance for employees.

Fourth municipal and district medical security departments are responsible for the management of maternity insurance for employees within their respective administrative areas.

Finance, health, human society, taxation and other departments are responsible for maternity insurance for employees within their respective responsibilities.

Medical insurance agencies are responsible for providing maternity insurance services for employees.

The municipal medical security department may entrust the municipal medical security administrative law enforcement agency to implement the supervision and inspection of maternity insurance for employees and other administrative law enforcement work.

Article 5 This Municipality shall strengthen cooperation with other provinces and cities in maternity insurance for employees, and do a good job in regional coordination of maternity insurance. In accordance with the unified provisions of the state, do a good job in the cross-regional treatment of maternity insurance for employees and the direct settlement of medical treatment in different places.

Chapter II Insurance Payment

Sixth state organs, enterprises, institutions, social organizations, private non-enterprise units, individual industrial and commercial households with employees and other employers and their employees shall participate in maternity insurance for employees. Flexible employees who participate in the basic medical insurance for employees participate in maternity insurance for employees at the same time and are included in the scope of maternity insurance for employees.

Article 7 An employing unit shall register maternity insurance for its employees according to law. Flexible employees who participate in maternity insurance shall apply for maternity insurance registration for their employees.

Article 8 The employing unit shall pay the maternity insurance premium for the employees on a monthly basis according to 0.5% of the total average monthly salary of the employees in the previous year, and the individual employees shall not pay the premium. Flexible employees pay maternity insurance premiums for employees on a monthly basis at 0.5% of the basic medical insurance payment base.

Article 9 The combined collection of employee basic medical insurance and employee maternity insurance shall determine the new employee basic medical insurance premium rate according to the sum of the contributions of employee maternity insurance and employee basic medical insurance.

Tenth people who receive unemployment insurance benefits to participate in maternity insurance for employees, and their expenses are paid from the unemployment insurance fund. Individuals do not pay fees and enjoy treatment according to regulations.

Article 11 The employing unit shall declare itself in accordance with the law, pay the maternity insurance premium of employees in full and on time, and collect the late payment fee according to the regulations. The collection agency of maternity insurance premiums for employees shall collect maternity insurance premiums for employees on time and in full according to law.

Article 12 The payment rate of maternity insurance for employees in this Municipality shall be determined according to the economic and social development level of this Municipality and the operation of the fund, and adjusted accordingly. The municipal medical security department shall, jointly with the municipal finance and other relevant departments, put forward the adjustment plan in a timely manner and implement it after being approved by the Municipal People's Government.

Chapter III Welfare Payment

Article 13 Maternity medical expenses incurred by employees of the employing unit participating in maternity insurance for employees shall be included in the reimbursement scope of maternity insurance for employees from the month of normal payment, the month of continuous normal payment for flexible employees for six months, and the month of receiving unemployment insurance benefits. The conditions for determining the treatment of maternity medical expenses after the insured person of maternity insurance interrupts payment shall be implemented with reference to the basic medical insurance for employees.

Article 14 The maternity allowance paid by maternity insurance shall be determined according to the relevant policies of the state. Persons receiving unemployment insurance benefits are eligible to apply for maternity allowance after paying maternity insurance premiums for employees normally in the month of childbirth or termination of pregnancy; Other insured persons who have given birth or terminated pregnancy in the current month have normally enjoyed the reimbursement treatment of maternity medical expenses according to the regulations, and the current continuous payment (including overdue payment) has been more than 6 months, and they have the conditions to apply for maternity allowance. In the month when the insured receives the maternity allowance, he should normally enjoy the reimbursement of maternity medical expenses according to the regulations.

Fifteenth maternity insurance benefits include maternity medical expenses and maternity allowance.

(a) maternity medical expenses include the following contents:

1. Medical expenses for delivery;

2. Family planning medical expenses;

3. Other project expenses stipulated by laws and regulations.

(two) employees in any of the following circumstances, can enjoy maternity allowance in accordance with state regulations:

1. Female employees enjoy maternity leave;

2. Enjoy family planning operation leave;

3. Other circumstances stipulated by laws and regulations.

Sixteenth female workers who give birth or terminate pregnancy shall enjoy maternity allowance on a daily basis. The daily standard of maternity allowance for employees of the employing unit is calculated by dividing the average monthly salary of employees in the previous year by 30.4 when they give birth or terminate pregnancy. The daily standard of maternity allowance for flexible employees is calculated by dividing the monthly average payment base of maternity insurance for flexible employees in this city by 30.4 in the previous year.

(1) If the pregnancy is less than 4 months, she shall enjoy the maternity allowance of 15 days;

(two) abortion after 4 months of pregnancy, enjoy 42 days of maternity allowance;

(three) the birth of a baby, enjoy 128 days maternity allowance; In case of dystocia, increase the maternity allowance 15 days; In case of multiple births, the maternity allowance will be increased by 1 5 days for each additional child. Unless otherwise stipulated by the state, such provisions shall prevail.

Seventeenth insured maternity allowance classification application and payment. Among them, the state organs and institutions are applied by the unit and issued on behalf of it; The enterprise is applied by the unit and distributed to the insured female employees by the medical insurance agency; Flexible employment personnel shall apply by themselves, and shall be sent to me by the medical insurance agency.

If the wage standard of female employees during maternity leave is higher than the maternity allowance standard approved by the medical insurance agency, the employer shall pay the difference to the female employees themselves.

Article 18 If a female worker has complications or complications during her childbirth, she shall be paid according to the project. Among them, the medical expenses for complications shall be paid by the employee's basic medical insurance in accordance with the regulations, and the medical expenses for complications shall be paid in full by the employee's basic medical insurance in accordance with the regulations.

Nineteenth any of the following circumstances, the insured maternity medical expenses are not included in the scope of maternity insurance payment:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Going abroad for medical treatment;

(five) other circumstances stipulated by the state and the city not to pay.

Twentieth retirees who participate in the basic medical insurance for employees in this Municipality can enjoy the reimbursement of maternity medical expenses during the period of enjoying the basic medical insurance benefits for employees, and the maternity insurance fund for employees shall reimburse them in accordance with these regulations.

Twenty-first maternity insurance reimbursement scope conforms to the basic medical insurance and maternity insurance drug list, diagnosis and treatment project list, medical service facilities standards. Considering the affordability of the basic medical insurance (including maternity insurance) fund and related technical specifications, appropriate labor analgesia and assisted reproductive technology projects will be gradually included in the fund payment scope according to procedures.

Twenty-second maternity medical expenses and family planning medical expenses and other payment standards and payment methods shall be formulated by the municipal medical security department in conjunction with the municipal finance and health departments according to the economic and social development level of this Municipality and the operation of the fund.

Chapter IV Fund Management

Twenty-third maternity insurance fund management should adhere to the principle of supporting fixed income and basic balance of income and expenditure, and implement overall planning in the city to ensure the stable and sustainable operation of the fund.

Twenty-fourth maternity insurance fund consists of the following items:

Maternity insurance premiums paid by employers or flexible employees;

(two) the interest of the employee maternity insurance fund;

(3) late fees;

(4) Other funds.

Article 25 After the maternity insurance fund for employees is incorporated into the basic medical insurance fund for employees, it will be incorporated into the management of social insurance financial accounts, which will be used for special purposes, and no unit or individual may occupy or misappropriate it.

Twenty-sixth after the merger of maternity insurance and basic medical insurance for employees, the income of maternity insurance fund for employees is no longer listed separately, and the maternity treatment expenditure item is set up in the treatment expenditure of basic medical insurance fund for employees.

Article 27 The budget and final accounts of the maternity insurance fund for employees and the basic medical insurance fund for employees shall be uniformly compiled by the municipal medical insurance agency, in which the income budget and final accounts of the municipal medical insurance agency shall be jointly compiled by the municipal tax department, and submitted to the Municipal People's Government for examination and approval after being audited by the municipal medical insurance department and the municipal finance department.

Chapter V Loading and Unloading Services

Article 28 The insured gives birth, performs family planning operation, etc. , should go to the designated medical institutions with midwifery technology, family planning technical service qualification for production or medical treatment. Medical security institutions shall sign agreements with designated medical institutions with midwifery skills and family planning technical service qualifications, and announce them to the public.

Twenty-ninth insured off-site birth and family planning medical expenses paid by individuals, and then reported to the medical security agencies. Medical insurance agencies should timely review and pay.

Thirtieth city insured in accordance with the provisions for maternity insurance pregnancy registration, began to enjoy maternity insurance benefits for employees.

Thirty-first medical insurance agencies should strengthen the management of the agreement, and give corresponding treatment to the designated medical institutions that violate the maternity insurance service agreement. After examination and verification, designated medical institutions shall not pay the fees for reporting violations. Designated medical institutions shall not transfer the cost of refusal to pay to the insured.

Thirty-second designated medical institutions to provide the insured with medical items other than the prescribed items and maternity insurance for employees, and charge corresponding fees, must obtain the consent of the insured.

Thirty-third to promote the reform of payment methods of maternity insurance for employees, and generally adopt the payment methods of hospital delivery medical expenses by disease type and prenatal examination by head, guide designated medical institutions to make rational diagnosis and treatment, and further control maternity expenses.

Thirty-fourth do a good job in the examination and approval and payment of maternity insurance for employees, and promote the "cross-provincial universality" in the examination and approval and payment of maternity insurance for employees. We will promote the joint work of "one thing at birth" such as birth medical certificate, child vaccination, household registration and basic medical insurance for urban and rural residents.

Chapter VI Supervision and Supervision

Article 35 If an employer fails to participate in or pay maternity insurance premiums for employees in accordance with these provisions, or fails to pay or underpays maternity insurance premiums for employees, resulting in losses in maternity insurance benefits for employees, the employer shall pay them in accordance with the relevant provisions of laws and regulations.

Thirty-sixth municipal medical insurance and financial departments shall supervise and manage the maternity insurance fund for employees.

Article 37 If people's governments at all levels, medical security departments and other relevant departments of this Municipality abuse their powers, neglect their duties or engage in malpractices for selfish ends in the management and supervision of maternity insurance for employees, the directly responsible person in charge and other directly responsible personnel shall be dealt with according to law.

Thirty-eighth to encourage and support units and individuals to report violations of laws and regulations related to maternity insurance for employees. If it is verified, it will be rewarded in accordance with relevant regulations. The department that accepts the report shall keep the relevant information of the informant confidential.

Thirty-ninth other illegal acts of designated medical institutions and their staff and insured persons, which belong to the maternity insurance service agreement, shall be handled in accordance with the agreement; If it falls within the scope of administrative punishment prescribed by laws, regulations and relevant provisions, it shall be given administrative punishment according to law.

Chapter VII Supplementary Provisions

Fortieth municipal medical security department shall, jointly with the municipal finance, health, taxation, human society and other relevant departments, formulate detailed implementation rules separately.

Article 41 These Provisions shall come into force on June 65438+1 October1day, 2023, with a validity period of 5 years.