What is the scope and standard of maternity insurance reimbursement in Guangzhou?

The reimbursement scope of maternity insurance mainly includes family planning operation expenses and maternity medical expenses. Details are as follows:

1. Family planning operation expenses: the operation expenses incurred by the insured workers in the designated medical institutions of maternity insurance or basic medical insurance in this city and approved to carry out family planning operations in different places in China.

Two, maternity medical expenses:

First, the insured workers for emergency (including childbirth, obstetric diseases, abortion) in non-selected hospitals belonging to the scope of maternity insurance payment of medical expenses;

B, approved in the territory of different birth or termination of pregnancy medical expenses;

C medical expenses incurred due to obstetric complications during maternity leave;

D other medical expenses that meet the requirements of maternity insurance.

Description of reimbursement for 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 Bureau of Labor and Social Security and the hospital (the part exceeding 1 10,000 yuan shall be settled according to the approved amount).

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, the medical expenses of off-site delivery, lower than the quota standard according to the actual reimbursement; Above the quota standard, according to the quota standard reimbursement.

Guangzhou maternity insurance reimbursement process

I. reimbursement process

1. Maternity medical expenses, which fall within the scope of reimbursement for sporadic medical expenses of maternity insurance, shall be paid by the insured person in advance, 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.

Second, the scope of reimbursement and the serial number, reimbursement category, carrying materials, special materials and basic information of the carrying materials.

If you fail to apply for the Medical Confirmation Certificate of Maternity Insurance for Enterprise Employees in Guangzhou (hereinafter referred to as the Medical Confirmation Certificate) and have an emergency abortion or delivery without a birth certificate or a family planning service certificate, you need a certificate from the family planning department of the street where both husband and wife are located.

1, original and copy of hospital medical records;

2. The original and photocopy of the hospital diagnosis certificate;

3. Special receipts or invoices for medical expenses printed by financial and tax departments;

4. Detailed list of medical expenses consistent with the receipt (invoice) amount (or manual record list with hospital seal);

5. The original and photocopy of the birth certificate or the original and photocopy of the family planning service certificate.

Off-site delivery (the application for off-site delivery has been filed in the municipal medical insurance center) "Application Form for Off-site Delivery of Maternity Insurance for Enterprise Employees in Guangzhou" or "Application Form for Selection of Designated Hospitals for Maternity Insurance"

Have done a "diagnosis", emergency abortion or delivery in a non-designated hospital.

Original and photocopy of medical certificate;

A written report issued by the insured or his family. 4 Postpartum complications. 5 Maternity insurance medical expenses are determined by the municipal medical insurance center under various special circumstances.

A written report issued by the insured or his family;

The municipal medical insurance center requires the insured to provide information according to various situations.