Tianjin maternity allowance reimbursement process

I. Tianjin Maternity Insurance Reimbursement Process

1. Pregnancy Registration

The employee goes to the Tianjin Maternity Insurance designated medical institution within 10 weeks of pregnancy to get a pregnancy diagnosis and issue a pregnancy certificate, and registers at the Maternity Insurance Management Center on the 10th day.

2. Submission of materials

The employee submits the medical insurance card, pregnancy diagnosis certificate, pregnancy test certificate and maternity certificate to the Maternity Insurance Management Center.

3. Hospitalization registration

An employee is required to apply for hospitalization registration on the day of giving birth, and during the hospitalization period, the applicant is required to submit the relevant materials to the Maternity Insurance Management Center for the birth or termination of pregnancy, abortion, or induced abortion hospitalization.

4, receive reimbursement

Materials submitted to the Maternity Insurance Management Center, materials can be reviewed and approved for maternity insurance reimbursement.

Two, maternity insurance bills and documents paste method:

1, a group of bills paste:

(1) to each outpatient receipt as a unit, the corresponding valid bills as a group;

(2) outpatient receipts on the top, the machine-printed details in the bottom, vertical to the left to align prevail in the paste into a group of bills.

(3) copies of reports or prescriptions bottom coupon folded to the length and width of the outpatient receipt;

2, each visit to the registration fee receipts to right-aligned, top-aligned pasted in the first group of bills of the day.

3, in accordance with the chronological order from right to left (interval 0.5-1cm), first inside and then outside, fish scale type will be each group of bills pasted on the "Tianjin Maternity Insurance Medical Fee Declaration Bill Paste Sheet" (hereinafter referred to as the "Paste Sheet") bills on the paste line.

4. Number all the registration fee receipts and outpatient receipts in the order of 1, 2, 3-n and mark them on the lower right corner of the receipts.

5. Surgical or diagnostic certificates and copies of medical records and discharge summaries are pasted on the left side of the ticket paste line or after the last set of tickets and folded within the Paste List.

6, the list of costs need to be folded in the scope of the Paste Sheet;

7, after verification of the contents of the Paste Sheet.

Tianjin maternity insurance pregnancy registration procedures

1. Tianjin urban and rural insured persons, as long as the pregnancy within 12 weeks, first to the current place of residence or the household registration office of the birth control office to obtain maternity service certificate (also known as "birth certificate").

2. Bring the birth certificate, ID cards of both husband and wife, and social security cards to the networked maternity insurance designated hospitals (usually the grassroots community health centers) in your current place of residence or household registration, to carry out pregnancy diagnosis, and establish the Tianjin Maternity Health Handbook.

3. Verify the birth service certificate online and complete the networked pregnancy registration.

4. After the pregnancy registration, the insured person will bring the social security card to the hospital for prenatal checkups, and the expenses incurred can be settled directly through the network.

Tianjin maternity insurance hospitalization registration procedures

Participants should first choose the maternity insurance designated hospitals that have been networked, and apply for hospitalization registration in the hospital network on the day of hospitalization or within five days. When going through the procedure, bring along the social security card, hospitalization certificate, maternity service certificate, pregnancy registration form or Tianjin Maternal Health Handbook. When discharged from the hospital, the insured person only pays the expenses that the individual should bear, and the other hospitalization expenses are settled between the Municipal Social Security Center and the designated hospital.

Tianjin Maternity Insurance Replacement Procedure

1. If the insured person has not registered for maternity before declaring the advance of medical expenses, he should make up for the registration procedures at the same time of declaring the medical expenses;

2. The labor service center of the townships (streets) or the district and county students' medical insurance service centers are responsible for accepting the replacement materials, and then send them to the medical insurance agency, which will make up for the registration procedures within a specified period of time. The medical insurance agency will make up the registration formalities within the specified time.

Expanded Information

Tianjin Municipal Maternity Insurance Regulations for Urban Workers, Jin Zheng Fa [2005] No. 069, was formulated in accordance with the Labor Law of the People's Republic of China and relevant laws and regulations, and in the light of the actual situation in the city to ensure that female workers receive the necessary economic compensation and medical protection during childbirth.

Tianjin Municipal Maternity Insurance Provisions for Urban Workers

Article 1 These provisions are formulated in accordance with the Labor Law of the People's Republic of China*** and the State of China and the relevant laws and regulations, taking into account the actual situation in the city, in order to guarantee that female workers receive the necessary financial compensation and medical protection during the period of maternity.

Article 2 These provisions shall apply to all kinds of enterprises and their employees in the cities and towns within the administrative area of the city. State organs, institutions, social organizations, private non-enterprise units and other urban social organizations and their employees in accordance with these provisions.

Article 3 The municipal labor security administrative department shall be in charge of the maternity insurance work in the city. District and county labor security administrative departments are responsible for the organization and implementation of maternity insurance work in their own administrative areas. The social insurance agency under the municipal labor security administrative department is responsible for the specific work of maternity insurance. Finance, health, population and family planning, audit, price, drug supervision and other departments shall, in accordance with their respective responsibilities to assist the administrative department of labor security to carry out maternity insurance work.

Article 4 The city establishes a maternity insurance fund. The Maternity Insurance Fund shall be integrated throughout the city in accordance with the principle of "expenditure against income" and "basic balance of income and expenditure".

Article 5 The Maternity Insurance Fund consists of the following:

(1) Maternity insurance premiums paid by the employer;

(2) Interest on the Maternity Insurance Fund;

(3) Late payment fees;

(4) Other funds.

Article 6: The maternity insurance fund shall be managed in a special account for social insurance and shall be used exclusively for that purpose, and shall not be misappropriated or misappropriated by any unit or individual. The Maternity Insurance Fund is not subject to taxation.

Article 7 The budget and final accounts of the income and expenditure of the Maternity Insurance Fund shall be prepared by the social insurance agencies and submitted to the municipal people's government for approval after being approved by the municipal administrative department of labor security and examined by the municipal financial department.

Article 8 The municipal labor security and finance departments shall supervise and manage the maternity insurance fund. The municipal audit department shall, in accordance with law, audit the income and expenditure and management of the maternity insurance fund of the social insurance agency.

Article 9: The Maternity Insurance Fund Supervisory Organization shall be established with the participation of representatives of the relevant municipal administrative departments, the Municipal General Confederation of Trade Unions, employers, medical institutions and relevant experts to carry out social supervision of the Maternity Insurance Fund.

Article 10: Maternity insurance premiums shall be collected and paid by the municipal social insurance agency in accordance with the provisions of the Interim Regulations on the Collection and Payment of Social Insurance Premiums (State Council Decree No. 259).

Article 11 The employer shall pay monthly maternity insurance premiums at the rate of 0.8% of the sum of the average monthly wages of the individual employee in the preceding year. Individual employees shall not pay maternity insurance premiums.

If the average monthly salary of an individual employee in the previous year is less than 60% of the average monthly salary of an employee in the city in the previous year, it shall be calculated according to 60% of the average monthly salary of an employee in the city in the previous year; if the average monthly salary of an individual employee in the previous year is more than 300% of the average monthly salary of an employee in the city in the previous year, it shall be calculated according to 300% of the average monthly salary of an employee in the city in the previous year.

If the average monthly salary of an individual employee for the previous year cannot be determined, it shall be calculated in accordance with the average monthly salary of an employee in the city for the previous year.

The maternity insurance premiums paid by the employer are expensed before tax.

Article 12 When the contribution rate for maternity insurance needs to be adjusted, the municipal labor security administrative department, together with the municipal finance department or other departments, shall put forward their opinions and submit them to the Municipal People's Government for approval.

Article 13 The registration system for maternity insurance shall be implemented. An employer shall register for maternity insurance within 30 days of the implementation of these provisions.

The social insurance agency shall complete the examination within 10 working days from the date of accepting the registration. Registration shall be granted if the provisions are met, and the employer shall be notified if the provisions are not met.

If the employer's maternity insurance registration changes, the employer shall, within 30 days from the date of the change, apply for the change at the social insurance agency.

Article 14 If an employer is revoked, dissolved or bankrupt by law, or is declared to be terminated for other reasons, the employer shall reserve maternity insurance premiums for pregnant female workers in accordance with the level of per capita maternity insurance benefits paid by the Maternity Insurance Fund of the city in the previous year when the employer's assets are liquidated.

Article 15 Employees entitled to maternity insurance benefits shall have the following conditions:

(1) the employer participates in maternity insurance in accordance with the regulations and pays the maternity insurance premiums in full on a monthly basis;

(2) the birth of a child or the performance of a family planning operation is in accordance with the provisions on family planning of the State and of the City.

Article 16 The following expenses shall be paid by the Maternity Insurance Fund:

(1) prenatal examination fees;

(2) maternity medical fees;

(3) maternity allowances;

(4) family planning surgery fees.

Article 17: Female workers who give birth to a child or terminate a pregnancy shall be entitled to maternity allowance on a daily basis, except for those who give birth to a child in accordance with the family planning policy and then become pregnant again and terminate the pregnancy. The daily rate of the maternity allowance is calculated by dividing the average monthly amount of the person's wages for maternity insurance premiums in the preceding year by 30.4.

(i) 15 days of maternity allowance if the pregnancy is terminated at less than 12 weeks of gestation;

(ii) 30 days of maternity allowance if the pregnancy is terminated at 12 weeks of gestation up to less than 16 weeks of gestation;

(iii) 42 days of maternity allowance if the pregnancy is terminated at 16 weeks of gestation up to less than 28 weeks of gestation;

(iv) 42 days of maternity allowance if the pregnancy is terminated after a normal childbirth or at 28 weeks of gestation or more;

(d) 42 days of maternity allowance if the pregnancy is terminated after a normal childbirth or at 28 weeks of gestation or more;

(e) 42 days of maternity allowance if the pregnancy is terminated at 28 weeks or more of gestation. (d) Normal childbirth or termination of pregnancy at the end of 28 weeks or more shall be entitled to 90 days of maternity allowance.

Article 18: The maternity allowance shall be increased in the following cases:

(1) in the event of a difficult birth, the maternity allowance shall be increased by 15 days;

(2) in the event of a multiple birth, the maternity allowance shall be increased by 15 days for each additional child;

(3) in the event of a tubal ligation during childbirth, the maternity allowance shall be increased by 14 days;

(4) the normal birth or termination of a pregnancy of 28 weeks or more shall be entitled to 90 days' maternity allowance.

(iv) If a female worker gives birth late (gives birth to her first child at the age of 24 or older) and receives a One-Child Certificate, the maternity allowance is increased by 30 days.

Article 19 If a female worker suffers complications during childbirth (except during the period of labor and delivery), her medical expenses shall be paid by the medical insurance fund in accordance with the provisions of the city's basic medical insurance for urban workers.

Article 20: Medical expenses incurred for the treatment of complications arising from family planning surgeries shall be paid by the Maternity Insurance Fund as determined by the family planning complication appraisal organization.

Article 21 The Maternity Insurance Fund shall not pay for medical expenses in any of the following cases:

(1) medical expenses incurred in violation of the state or municipal regulations on family planning;

(2) medical expenses incurred in connection with medical accidents;

(3) medical expenses incurred in non-scheduled medical institutions;

(4) medical expenses that should be borne by the employee individually as stipulated in the regulations;

(5) medical expenses incurred by the employee individually as stipulated in the regulations;

(6) medical expenses incurred by the employee individually as stipulated in the regulations. (d) Medical expenses that should be borne by the individual employee.

Article 22 The scope of medicines, diagnostic items and standards of medical service facilities for maternity insurance shall be implemented in accordance with the relevant provisions of the basic medical insurance for urban workers in the city, except for the provisions on incremental payment.

Article 23 The payment standards and settlement methods for prenatal examination fees, childbirth medical fees and medical fees for family planning surgery shall be separately formulated by the municipal labor security administrative department.

Article 24: Maternity insurance implements a designated medical management system. Employees who give birth to a child or undergo family planning surgery shall give birth or seek medical treatment at a designated medical institution for basic medical insurance that is qualified to provide midwifery and family planning technical services.

Social insurance agencies shall sign agreements with basic medical insurance designated medical institutions that are qualified to provide midwifery and family planning technical services, and make them known to the public.

Article 25 If an employer fails to participate in maternity insurance and pay maternity insurance premiums in accordance with these provisions, or fails to pay or pays less maternity insurance premiums, the administrative department of labor security shall deal with the matter in accordance with the relevant provisions of the state and the city on social insurance collection.

Article 26: The administrative departments of labor security, health, drug supervision and price shall supervise designated medical institutions in accordance with the law. Designated medical institutions in violation of medical, pharmaceutical, price and other regulatory provisions, the administrative department of labor security respectively, health, drug supervision, price management department to deal with the law; the circumstances are serious, by the administrative department of labor security to cancel its designated qualifications; constitutes a crime, shall be investigated for criminal responsibility.

Article 27 Any employer or individual who fraudulently obtains maternity insurance benefits by means of misrepresentation or fraudulent claims shall be dealt with by the administrative department of labor security in accordance with the provisions of the second paragraph of Article 27 of the Regulations on Labor Security Supervision (Decree of the State Council No. 423), and if a crime is constituted, the person responsible shall be held criminally liable in accordance with the law.

Reference:

Tianjin Municipal Municipal Workers' Maternity Insurance Regulations - Baidu Encyclopedia? Maternity insurance reimbursement process - Baidu Encyclopedia