Proportion of reimbursement for hospitalization expenses of social security maternity insurance

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The new rural cooperative medical system only reimburses the birth expenses in proportion. Social security can not only reimburse maternity expenses, but also provide maternity subsidies of about 10000- 15000.

Maternity insurance is a social insurance system in which the state and society provide medical services, maternity allowance and maternity leave when pregnant and pregnant female workers temporarily stop working, and the state or society provides necessary economic compensation and medical care for maternity workers. "New rural cooperative medical system", the full name of the new rural cooperative medical system, refers to the farmers' medical mutual aid and mutual aid system organized, guided and supported by the government, in which farmers voluntarily participate and individuals, collectives and the government jointly raise funds.

Both types of insurance are social insurance. If you can only reimburse one person who participates in the new rural cooperative medical system and the unit maternity insurance at the same time, you can return the social insurance of the new rural cooperative medical system and you can't enjoy the treatment at the same time. If the unit has maternity insurance and the spouse is unemployed, the maternity medical expenses incurred can be reimbursed according to 50% of the standard stipulated by the local maternity insurance policy of the man. If the woman is reimbursed by the new rural cooperative medical system, only maternity allowance will be given.

First, the reimbursement method of maternity insurance:

Maternity insurance covers four items:

① Maternity allowance;

② Maternity medical expenses;

③ Medical expenses of family planning operation;

(four) other expenses stipulated by the state and this Municipality.

Medical expenses shall be paid by the employer according to state regulations, and employees shall not pay maternity insurance premiums.

Two, maternity insurance reimbursement conditions:

1, workers enjoy maternity insurance benefits, should also meet the following conditions:

(1) The employer has paid more than 1 year for employees and continues to pay;

(2) in line with national and provincial population and family planning laws and regulations.

Three, maternity insurance reimbursement scope:

① Maternity medical expenses.

The examination fee, delivery fee, operation fee, hospitalization fee and medicine fee for the birth of female employees shall be paid by the maternity insurance fund. Medical business expenses and drug expenses (including self-funded drugs and nutritional drugs) exceeding the prescribed amount shall be borne by the employees themselves.

After the female workers are discharged from the hospital, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; The medical expenses of other diseases shall be handled in accordance with the provisions of medical insurance benefits. After the expiration of maternity leave, if a female employee needs rest and treatment due to illness, it shall be handled in accordance with the relevant provisions on sick leave and medical insurance benefits.

② Maternity allowance.

Female employees shall enjoy maternity allowance according to law during maternity leave, which shall be calculated and paid by maternity insurance fund according to the average monthly salary of employees in the previous year.

Four, the "new rural cooperative medical system", the full name of the new rural cooperative medical system, refers to the organization, guidance and support by the government, farmers voluntarily participate, individuals, collectives and the government to jointly raise funds, with serious illness as the main content of the farmers' medical mutual aid system.

The new rural cooperative medical system is a medical security system created by farmers themselves in China, which has played an important role in ensuring farmers' access to basic health services and alleviating poverty caused by illness and returning to poverty due to illness. The reimbursement scope of the new rural cooperative medical system includes outpatient compensation, hospitalization compensation and serious illness compensation.

1, reimbursement scope of new rural cooperative medical system:

The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses).

The new rural cooperative medical fund payment set up Qifubiaozhun and maximum payment limit. The hospitalization expenses below the annual deductible line of the hospital shall be paid by the individual. If the Qifubiaozhun is reached in the same overall period, the hospitalization expenses incurred by two or more hospitalizations can be reimbursed cumulatively. The hospitalization expenses exceeding Qifubiaozhun shall be calculated in sections and reimbursed cumulatively, and there is a maximum amount of accumulative reimbursement per person per year.

2, the new rural cooperative medical reimbursement standard guarantee level:

In order to avoid catastrophic family medical expenses for urban and rural residents and reasonably determine the compensation policy for serious illness insurance, the actual payment ratio is not less than 50%; The proportion of payment is determined according to the level of medical expenses. In principle, the higher the medical expenses, the higher the payment ratio. With the continuous improvement of financing, management and security, the proportion of reimbursement for serious illness will be gradually increased, and the burden of personal medical expenses will be reduced to the greatest extent.

Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

3. Both kinds of insurance are social insurance. At the same time, those who participate in the new rural cooperative medical system and the unit maternity insurance can only reimburse one, and can return the social insurance of the new rural cooperative medical system, and are not allowed to enjoy the treatment at the same time.

Surrender of new rural cooperative medical system;

According to Ministry of Human Resources and Social Security 19 1 document "Notice of Ministry of Human Resources and Social Security, Ministry of Health and Ministry of Finance on Printing and Distributing the Interim Measures for the Transfer and Continuation of the Basic Medical Security Relationship for Migrant Workers", Article 4 stipulates: "After the participants of the new rural cooperative medical insurance participate in the urban basic medical insurance, the social (medical) insurance agency in the place of employment will notify the new rural cooperative medical insurance agency in the place of residence to handle the transfer procedures and withdraw from the new rural cooperative medical insurance according to local regulations.

Information required for surrender of the new rural cooperative medical system:

With the letter of introduction from the employment unit and the certificate from the social (medical) insurance agency in the place of employment, I applied for voluntarily giving up participating in the new rural cooperative medical system (with the consent and seal of the village and township), and my ID card applied to the new rural cooperative medical system management center for surrender.