Maternity off-site medical insurance reimbursement process

Maternity off-site medical insurance reimbursement process:

(1) The female employee will bring the information to submit an application for reimbursement.

(2) The medical and maternity treatment audit department (usually the social security center) to review.

(3) After the audit is approved, the auditing department issues a voucher to the female worker.

(4) The female worker goes to the bank with the processing voucher to receive the money.

Some of the costs of maternity checkups can be reimbursed with maternity insurance, but many people have questions about whether maternity insurance can be reimbursed off-site. Generally speaking, the process of reimbursing maternity insurance in a different place is not much different from the local one, only the required materials are different.

I. Materials required for reimbursement of maternity insurance in other places

If the insured female employee gives birth to her first child (the first miscarriage after marriage is also counted), she is required to provide the following documents (which may contain photocopies depending on the region):

(1) family planning card

(2) birth certificate

(3) ID card of the person himself

(4) One-child certificate

(5) Invoice for medical expenses

(6) Discharge summary

(7) Provisions on Maternity Leave for Enterprise Employees

(8) Application Form for Maternity Insurance Benefits for Enterprise Employees

(9) For cesarean section, the invoice amount is more than 5,000 yuan; for a normal birth, the invoice amount is more than 3,000 yuan; and for a miscarriage, the amount more than 300 yuan, all three cases need to provide a copy of the hospital's stamped medical order form and a list of summarized medical expenses.

(10) In case of abortion, you need to bring perinatal outpatient medical record, medical advice sheet, list of medical fees and family planning certificate issued by the family planning department.

(11)If both parents are only children and the couple does not have an only child certificate, you need to provide both parents' only child certificates.

II. Scope of reimbursement for maternity insurance in other places

1. Maternity living allowance. Maternity living allowance should be claimed by the maternity worker herself or her delegate with the prescribed documents at the maternity insurance agency within 90 days after the birth and termination of pregnancy.

2. Prenatal examination fees. It is fully paid by the employee, and is claimed by the employee or his/her written delegate within 90 days after the birth or termination of pregnancy at the maternity insurance office with the required documents.

3. Medical expenses incurred in outpatient (emergency) clinics, off-site and in non-maternity insurance service organizations. For outpatient (emergency) medical expenses incurred by insured workers for childbirth, termination of pregnancy and treatment of complications, and family planning surgeries, or medical expenses incurred at off-site and non-birth insurance agreement service organizations, the individual shall first pay the full amount in advance and keep the relevant vouchers appropriately. Within 90 days after the completion of the operation or treatment, the maternity worker himself/herself or his/her written delegate shall make a one-time claim at the maternity insurance reimbursement agency of the off-site location with the prescribed materials.

4. Hospitalization medical expenses for childbirth, termination of pregnancy and treatment of complications. The part of hospitalization medical expenses incurred by insured employees for childbirth, termination of pregnancy and treatment of complications at their stipulated maternity insurance agreement service institutions shall be settled directly between the individual employees and the hospitals, and the part to be paid by the fund shall be settled between the maternity insurance operator and the agreement service institutions.

Legal basis

Article 54 of the Social Insurance Law stipulates that if an employer has paid maternity insurance premiums, its employees shall be entitled to maternity insurance benefits; and the unemployed spouse of an employee shall be entitled to maternity medical expenses in accordance with state regulations. The required funds are paid from the Maternity Insurance Fund. Maternity insurance benefits include maternity medical expenses and maternity allowances.