Suzhou Maternity Insurance Reimbursement Process and Proportion

Suzhou Maternity Insurance Reimbursement Process and Proportion

Maternity insurance has been paid for more than 1 year and continues to be paid, which is in line with the national fertility policy. Then, maternity insurance can be reimbursed. Below, I have carefully arranged the reimbursement process and proportion of Suzhou maternity insurance for everyone. I hope you like it!

Suzhou maternity insurance insurance insurance time

Maternity insurance is a social policy that the state provides economic and material assistance to maternity workers through social insurance legislation. Its purpose is to provide maternity allowance, maternity leave and medical services for female workers, to ensure their basic economic income and medical care when they temporarily lose their working ability due to childbirth, and to help female workers recover their working ability and return to work, thus reflecting the support and care given to women by the state and society in this special period.

Maternity insurance should be purchased continuously for 12 months, reimbursed within 18 months after the baby is born, and insured at the same time. Maternity insurance is a typical local policy, which varies from 10 months to 6 months or even lower. Therefore, the local social security center should prevail.

Suzhou Social Security Center reminds that female workers should go to the community or village (neighborhood) committee of their domicile or place of residence for examination and confirmation with the certificate issued by the employer, their ID card and marriage certificate (the floating population must also issue the marriage and childbearing certificate of the floating population and the ID cards of both husband and wife). In line with the provisions of the family planning policy, the community or village (neighborhood) Committee will issue a contact list of maternity insurance or birth control surgery services; Then, the female employee gives birth or family planning in the designated medical institution of maternity insurance that she chooses independently with her social security card, contact list of maternity insurance or contact list of birth control surgery service, and the medical expenses that meet the settlement conditions of maternity insurance are directly settled by the social security agency and the designated medical institution of maternity insurance.

Suzhou maternity insurance reimbursement process

After being pregnant, female workers in Suzhou shall go through the relevant formalities according to the following procedures and enjoy the relevant treatment of maternity insurance:

(1) Publish the contact list. Female workers hold their resident ID card, marriage certificate and the certificate of marriage and childbearing issued by the employer (the floating population must also provide the certificate of marriage and childbearing of the floating population and the spouse's resident ID card issued by the family planning department where the household registration is located), and go through the birth registration formalities at the street or community family planning department. Family planning departments to confirm compliance with the family planning policy, the issuance of "maternity insurance contact list", the entry of family planning information system.

? Street or community? Refers to the insured workers whose household registration is in Canglang District, Pingjiang District, Jinchang District, High-tech Zone, Wuzhong District and xiangcheng district, and is the street or community where their household registration is located; The insured workers whose household registration is outside the above-mentioned scope, but who live within the above-mentioned scope, are the streets or communities where they live; Insured employees whose household registration and residence are not within the above range are the streets or communities where the unit is located. Among them, Canglang District, Pingjiang District and Jinchang District are in their communities, and High-tech Zone, Wuzhong District and Xiangcheng District are in their streets (towns).

(2) Perinatal health examination. Female employees hold their own medical insurance cards, medical insurance medical records of employees and social insurance cards (hereinafter referred to as medical cards) for perinatal health care examination in designated medical institutions of maternity insurance, and establish perinatal health care cards in the first-visit hospitals. Perinatal health examination fees shall be paid directly by credit card according to the relevant provisions of medical insurance.

(3) Delivery or abortion due to pathological reasons.

Giving birth in a designated medical institution of maternity insurance or having an abortion due to pathological reasons. Female workers hold their medical cards and "Maternity Insurance Contact Sheet" to the designated medical institutions for maternity insurance. After examination by the hospital, and through the medical insurance system and the insured payment data and the registration data of the family planning department, it is confirmed that the female employees who meet the conditions for enjoying maternity insurance benefits are paid in the following ways:

Maternity medical treatment: the attending doctor fills in the Notice of the Expenses of Maternity and Family Planning Surgery for Insured Employees, and the notice is signed by the female employee herself. When a female worker gives birth or miscarries due to pathological reasons, the designated medical institution will print a detailed list of her birth expenses. Female workers only need to pay out-of-pocket expenses in cash at designated medical institutions, and the rest of maternity medical expenses and medical expenses for maternity complications that meet the requirements shall be settled by the municipal social security center and designated medical institutions after the next month's settlement. The hospitalization expenses incurred by the insured workers due to diseases, ectopic pregnancy and hydatidiform mole termination of pregnancy shall be paid in designated medical institutions according to the provisions of medical insurance.

Maternity Nutrition Subsidy and Perinatal Health Care Subsidy: Female employees who meet the conditions of enjoying maternity nutrition subsidy and perinatal health care subsidy should apply for maternity nutrition subsidy and perinatal health care subsidy at the maternity insurance department of the municipal or district social security agency (hereinafter referred to as the municipal or district social security agency) where the unit social security relationship is located with their medical card, resident ID card, discharge summary and medical certificate of newborn birth within 6 months after the payment of postpartum expenses. After the social security agency reviews, print the Statement of Maternity Nutrition Subsidy and Perinatal Health Care Subsidy, and the female employees will receive the subsidy amount after signing for confirmation.

Maternity allowance: in the month following the settlement of maternity medical expenses between the Municipal Social Security Center and the designated medical institution for maternity insurance, the maternity allowance will be charged in the social insurance premium settlement table of the employer, and will be directly allocated to the employer after being examined and confirmed by the industrial injury maternity insurance department of the Municipal Social Security Center.

Giving birth in a designated medical institution other than maternity insurance or having an abortion due to pathological reasons. The medical expenses incurred by female workers in giving birth in other places or in designated medical institutions other than maternity insurance due to emergency or pathological reasons shall be paid by female workers in cash first, and then the medical treatment card, resident ID card, discharge summary, maternity insurance contact form, medical certificate of newborn birth, detailed list of expenses and original invoice shall be used to go through the examination and settlement procedures of maternity insurance benefits at the municipal and district social security agencies.

Maternity medical care, maternity nutrition subsidy and perinatal health care subsidy: after the social security agency examines, it prints the statement of maternity medical expenses, maternity nutrition subsidy and perinatal health care subsidy for female employees, and the female employees receive relevant maternity insurance benefits after signing and confirming. Among them: if the maternity medical expenses are higher than the quota standard of similar hospitals in this city, they will be paid according to the quota standard, and if they are lower than the quota standard, they will be paid according to the facts; Medical expenses for reproductive complications that meet the requirements can be paid in accordance with the regulations; Eligible female employees can apply for maternity nutrition subsidies and perinatal health care subsidies at the same time.

Suzhou maternity insurance reimbursement ratio

Maternity insurance funds are raised and used in accordance with the principle of fixed income and expenditure and balance of payments. When the maternity insurance fund is insufficient to pay, the local people's governments at or above the county level shall give subsidies. The maternity insurance fund consists of the following items:

(1) Maternity insurance premium paid by the employer

(2) Value-added income such as interest of maternity insurance fund.

(3) collect late fees according to regulations.

(4) government subsidy funds

(five) other funds that should be included in the maternity insurance fund according to law.

Maternity medical expenses paid by maternity insurance fund refer to the medical expenses of insured workers during pregnancy and childbirth, such as abortion and induced labor caused by prenatal examination, hospital delivery or childbirth, which meet the requirements of maternity insurance. Among them, the medical expenses for prenatal examination shall be given to individual employees in a lump sum according to the quota standard, and the subsidy standard for one-time prenatal examination shall be separately formulated by the administrative department of human resources and social security and announced to the public. The medical expenses of abortion and induced labor caused by hospitalization or childbirth shall be paid by the social security agency to the designated medical institutions according to the quota standard.

The insured workers are complicated with amniotic fluid embolism, intractable postpartum hemorrhage, acute fatty liver during pregnancy, disseminated intravascular coagulation (DIC), severe pregnancy-induced hypertension syndrome, severe pregnancy complicated with intrahepatic cholestasis, pregnancy complicated with heart failure, pregnancy complicated with cerebrovascular accident, pregnancy complicated with severe thrombocytopenia, severe obstetric infection, obstetric multiple organ failure and other diseases. The medical expenses incurred due to the treatment complications shall be paid by the maternity insurance fund according to the provisions of maternity insurance.

Medical expenses arising from the termination of pregnancy due to illness, ectopic pregnancy and hydatidiform mole shall be paid by the employee basic medical insurance fund in accordance with the provisions of the employee basic medical insurance.

Family planning medical expenses paid by maternity insurance fund refer to the medical expenses incurred by employees who meet the requirements of maternity insurance due to placing or taking out intrauterine devices, skin burial, induced abortion, induced labor, tubal ligation or vasectomy, and recanalization. The medical expenses incurred by the insured workers in implementing the above-mentioned family planning operation shall be paid by the social security agency to the designated medical institutions according to the quota standard.

If an employee has complications due to the implementation of the family planning operation specified in the preceding paragraph, the medical expenses exceeding the quota during the operation and hospitalization shall be paid by the maternity insurance fund in accordance with the provisions of maternity insurance.

The above expenses incurred after the operation or discharge shall be paid by the employee basic medical insurance fund according to the provisions of the employee basic medical insurance.

Suzhou maternity insurance reimbursement scope

Maternity complications included in the scope of maternity insurance fund payment include:

Amniotic fluid embolism, intractable postpartum hemorrhage, acute fatty liver during pregnancy, disseminated intravascular coagulation (DIC), severe pregnancy-induced hypertension syndrome, severe pregnancy complicated with intrahepatic cholestasis, pregnancy complicated with heart failure, pregnancy complicated with cerebrovascular accident, pregnancy complicated with severe thrombocytopenia, severe obstetric infection and obstetric multiple organ failure.

The following expenses are not included in the scope of maternity insurance fund payment:

(1) Violating the national and provincial laws and regulations on population and family planning, such as maternity medical expenses, maternity allowance and one-time nutrition subsidy for maternity or family planning operation;

(two) does not meet the maternity insurance drug list, diagnosis and treatment items, medical service facilities and payment standards;

(three) the expenses that should be paid by the basic medical insurance fund;

(4) Expenses that should be borne by public health or other public service projects and free family planning technical service projects according to regulations;

(5) Expenses that should be borne by a third party due to medical malpractice;

(6) Maternity medical expenses incurred abroad and in Hong Kong, Macao and Taiwan;

(7) Newborn disease screening, nursing and medical expenses;

(8) Maternity medical expenses for medical treatment in non-designated medical institutions without approval (except emergency and rescue);

(nine) other expenses that are not paid by the maternity insurance fund stipulated by the state and the province.

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