Proportion of medical insurance reimbursement for caesarean section

The reimbursement rate for caesarean section is generally around 60%, which is determined according to local medical insurance.

The reimbursement rate of caesarean section varies according to different regions, and also according to the different medical insurance you enter. The reimbursement rate of medical insurance for employees is slightly higher than that of urban residents. The specific amount is recommended to consult the local medical insurance center. You can only be reimbursed if you entered the medical insurance in that year. For general caesarean section, such as bed fee or anesthetic injection fee, it is not within the scope of reimbursement, but also depends on the level of the hospital. Caesarean section is different from natural delivery, and it takes a long time to recover after operation, and there are relatively many matters needing attention after operation. Although the reimbursement rate of caesarean section is higher than that of natural delivery, the cost of caesarean section is also higher. In addition, caesarean section can only be selected if there are indications for caesarean section.

1. How much is the medical insurance reimbursement for caesarean section?

There are three kinds of reimbursement for maternity expenses of female employees:

First, the maternity expenses and inspection expenses of female employees in government institutions and fully funded institutions are reimbursed by the medical insurance fund. Individuals need to pay in cash in the hospital first, and then submit an invoice and medical insurance card to the municipal medical insurance settlement center for reimbursement. Reimbursement benefits refer to medical insurance reimbursement benefits for common diseases.

Two, maternity insurance for female employees in enterprises in the city social labor insurance fund management center.

Third, the maternity expenses of female employees in self-supporting institutions are solved according to the original channels or relevant documents of the Family Planning Commission.

Fourth, if commercial maternity insurance is insured, it can be reimbursed. Please consult the insured insurance company for details.

Second, the materials required for reimbursement of caesarean section:

One original and one copy of the marriage certificate;

One original and one copy of the Maternity Service Certificate;

One original and one copy of the baby's birth certificate;

One original and one copy of the medical diagnosis certificate;

"Registration Form for Persons Applying for Maternity Allowance" in duplicate.

Three, caesarean section reimbursement processing flow:

The unit manager shall submit the above materials to the social security center and pay the maternity allowance within 30 working days after accepting the approval.

If both husband and wife have participated in maternity insurance, the woman's unit shall fill in the "Registration Form for Personnel Applying for Maternity Allowance"; The woman did not participate in maternity insurance, the man has participated in maternity insurance, and the man enjoys maternity allowance. The unit where the man works shall fill in the Registration Form for Personnel Applying for Maternity Allowance (in duplicate) and make a declaration.

legal ground

Social insurance law

Fifty-fourth employers have paid maternity insurance premiums, and their employees enjoy maternity insurance benefits; Unemployed spouses of employees enjoy 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 allowance.

Fifty-fifth maternity medical expenses include the following:

(1) Maternity medical expenses;

(two) family planning medical expenses;

(3) Other project expenses stipulated by laws and regulations.

Fifty-sixth employees in any of the following circumstances, can enjoy maternity allowance in accordance with state regulations:

(1) Female employees enjoy maternity leave;

(2) Enjoy family planning operation leave;

(3) Other circumstances stipulated by laws and regulations.

Maternity allowance is calculated and paid according to the average monthly salary of employees in the previous year of the employer.