How to make reimbursement for maternity insurance

Abstract: Maternity insurance is a social insurance system in which the State adopts legislation to provide medical services, maternity allowances and maternity leave by the State and society in the event of temporary interruption of the labor of a woman worker who is pregnant and has given birth, and in which the State or society provides the necessary financial compensation and medical care to the worker who has given birth. Its purpose is to help working women recover their labor capacity and return to work by providing them with maternity benefits, medical services and maternity leave. Please follow me to see the following knowledge about the conditions of maternity insurance reimbursement and the process of maternity insurance reimbursement. Introduction to Maternity InsuranceMaternity insurance is a social insurance system that provides, through national legislation, for timely material assistance from the state and society when the labor force is temporarily interrupted due to the birth of a child by a worker. Maternity insurance treatment in China mainly includes two items. The first is the maternity allowance, and the second is the maternity medical treatment. Its purpose is to help working women regain their labor capacity and return to work by providing them with maternity allowances, medical services and maternity leave.

Maternity Insurance ParticipationParticipantsAll workers, including male workers, who have established a labor relationship with an employer should participate in maternity insurance.

The employer pays maternity insurance premiums in accordance with state regulations, and the employee does not pay maternity insurance premiums.

Beijing's maternity insurance contribution rate is 0.80% of the employee's contribution base;

Guangzhou's maternity insurance contribution rate is 0.85% of the employee's contribution base.

Reimbursement

Conditions for Maternity Insurance Reimbursement

Employees who are entitled to maternity insurance benefits should meet the following conditions:

1. The employer has made contributions for the employee for more than one year in total and continues to make contributions for him/her;

2. It is in line with the regulations of the state and province on population and family planning.

Maternity Insurance Reimbursement ScopeMaternity Medical FeesThe examination fees, delivery fees, operation fees, hospitalization fees and medication fees for a female worker giving birth are paid by the Maternity Insurance Fund. Medical operation fees and medication fees (including those for self-financed drugs and nutritional drugs) in excess of the stipulated limits shall be borne by the individual employee.

After a female worker is discharged from the hospital after giving birth, the medical fees for diseases caused by childbirth shall be paid by the Maternity Insurance Fund; medical fees for other diseases shall be handled in accordance with the provisions of the medical insurance treatment. If a female worker needs rest and treatment due to illness after the expiration of her maternity leave, it shall be handled in accordance with the provisions on sick leave treatment and medical insurance treatment.

Maternity allowances for female workers during their maternity leave in accordance with the law are calculated on the basis of the average monthly wages of the workers of the enterprise in the preceding year, and are paid by the Maternity Insurance Fund.

Maternity leave is calculated on the basis of 98 days of basic maternity leave, of which 15 days may be taken before the birth;

in the event of a difficult birth (e.g., cesarean section, or perineal rupture of the Ⅲ degree), the maternity leave may be increased by 30 days;

in the event of a miscarriage of a pregnancy of less than four months, the maternity leave shall be granted for a period of between 15 days and 30 days, according to the opinion of the medical department;

in the event of a miscarriage of a pregnancy of four months or more (inclusive), the maternity leave shall be granted for a period of 42 days ) miscarriage, 42 days of maternity leave shall be granted;

if a one-child child is born voluntarily, an additional 35 days shall be granted;

if a child is born late, an additional 15 days shall be granted;

One-time nutritional subsidy for childbirth. A certain percentage of the average monthly salary of on-the-job workers in the preceding year in the coordinating area to which it belongs. The specific proportion shall be determined by the people's government of the coordinating area.

Family planning surgical expenses include medical expenses incurred by employees for the placement or removal of intrauterine devices, abortions, induced abortions, sterilizations, and restorative surgeries for family planning purposes.

Leave allowances for male employees The leave allowances for male employees who are insured and are entitled to caretaker's leave as stipulated are based on the average monthly salary of on-the-job employees in the previous year in the coordinating area to which they belong and are payable in accordance with the stipulated period of leave.

Leave allowance for caregiver = the average paid salary of the unit in the current month ÷ 30 (days) x the number of days of leave

The Maternity Insurance Fund shall not pay for the following expenses:

1. Expenses that do not comply with the national and provincial urban workers' basic medical insurance and maternity insurance's drug list, diagnostic and treatment items, medical service facility items and relevant regulations on the management of medical treatment;

2, Expenses incurred as a result of medical accidents;

3. Expenses incurred for the treatment of maternity complications outside the period of labor and delivery.

Maternity insurance reimbursement systemThe current situation of China's maternity insurance is the implementation of two systems coexisting:

The first one is that the female worker's unit bears the maternity leave wages and maternity medical expenses of the female worker who gives birth. According to the State Council's Provisions on the Labor Protection of Female Workers and Employees and the Ministry of Labor's Circular on Several Issues Concerning the Maternity Treatment of Female Workers and Employees, the examination, delivery, operation, hospitalization, and medication fees of a female worker during her pregnancy shall be borne by the unit in which she is employed. Wages are paid during maternity leave.

The second type is maternity social insurance. According to the Ministry of Labor's Trial Measures for Maternity Insurance for Enterprise Employees, employers participating in maternity social insurance shall pay maternity insurance premiums to the local social insurance agency; the proportion of maternity insurance premiums to be paid shall be determined by the local people's government in accordance with the maternity allowances for female workers who plan to give birth and the expenditure on maternity medical care, etc., and shall not exceed a maximum of 1 percent of the total wages, with no contribution by the individual employee. After a female employee of a participating enterprise gives birth or has a miscarriage, her maternity allowance and maternity medical expenses are paid by the Maternity Insurance Fund. The maternity allowance is paid in accordance with the average monthly salary of the employees of the enterprise in the previous year; the maternity medical expenses include the examination fee, delivery fee, operation fee, hospitalization fee and medication fee of the female employee who gives birth to a child or suffers a miscarriage (the fee for medical services and medication exceeding the stipulated amount shall be borne by the employee personally), as well as the medical expenses for the illnesses caused by the birth of a child after the female employee has been discharged from the hospital.

Maternity insurance declaration and handling of declaration and payment 1, declaration materials medical and maternity insurance legal manual

(1) "Social Insurance Registration Form";

(2) "Participation in the basic old-age pension, work-related injuries and maternity insurance personnel increase or decrease table";

(3) "enterprise employees basic old-age pension, work-related injuries and maternity insurance declaration summary table";

2 Procedures (1) The employer goes to the business hall of the Social Labor Insurance Office with the declaration materials;

(2) The staff accepts the declaration materials, approves them and returns one copy of the summary form and one copy of the increase/decrease form with a stamp;

(3) The employer goes to the local local tax department to make the payment in the following month;

Insurance benefits 1. Conditions for declaration (1) The unit in which the employee was employed at the time of giving birth to a child or performing a family planning operation is required to participate in the insurance program in accordance with the regulations;

The insurance benefits 1. The unit where the operation is performed participates in and fulfills the obligation to pay contributions in accordance with the regulations, and pays maternity insurance premiums for the enterprise employee for a total of three months.

(2) Employees who have given birth or performed family planning surgery in accordance with the national family planning policy.

2. Declaration materials (1) Family planning certificate issued by the family planning department (original and copy)

Settlement method of maternity insurance expensesSettlement method of maternity insurance expenses refers to the way in which the social insurance agency pays for the expenses incurred for medical services within the scope of maternity insurance. At present, the settlement methods adopted internationally include: payment by disease, payment by item, and payment by headcount. Qingdao city has worked out a settlement method suitable for our country's maternity insurance medical expenses in practice.

The flow chart of applying for maternity insurance benefits refers to the way the social insurance agency pays for the expenses incurred for medical services within the scope of maternity insurance. At present, the settlement methods adopted internationally include: payment by disease, payment by item, and payment by headcount. Qingdao City has worked out in practice a settlement method suitable for China's maternity insurance medical expenses. The method adopted is that female workers go to designated hospitals to give birth, and the social insurance agency and the designated hospitals implement fixed-rate settlement. The main steps of this settlement method are:

Maternity insurance reimbursement processParticipating employees can enjoy maternity insurance treatment according to the regulations when they have the following conditions:

1. 12 months.

3. For prenatal checkups and delivery expenses, the person concerned will bring his/her marriage certificate, social security card (citizen card) and the birth control certificate issued by the street to the designated hospital for maternity insurance and settle the bill directly by credit card.

4. To declare the maternity allowance and one-time nutritional allowance, the person concerned should fill in the Maternity Insurance Benefit Declaration Form and affix the official seal of the unit, provide the marriage certificate, one-child certificate (for the child), and the hospital discharge summary, etc., and go to the maternity section of the Municipal Health Insurance Center on the working days between the 1st and 10th of each month to go through the declaration formalities. (Relevant procedures should be handled within one year after the delivery)

Maternity Insurance FAQ 1: Can maternity insurance be transferred?

Maternity insurance is not transferable. Unemployment insurance and work injury insurance are also not transferable. However, pension insurance can be transferred across provinces, medical insurance can be transferred, and housing provident fund can transfer the entire balance of the account at one time.

2, maternity insurance can be replaced?

According to the Wuhan Municipal Employees' Maternity Insurance Measures, if an employee is diagnosed as pregnant and the employer has paid contributions for her for more than six consecutive months, she should declare her maternity medical registration to the social security agency in the precinct where the unit is located at least before she gives birth and seek medical treatment at designated medical institutions in Wuhan, so as to be eligible for reimbursement of the fixed medical fees for maternity and childbirth.

3. Is nutritional expense available to every female employee?

Yes, as long as the national policy in line with the legal birth of compatriots should enjoy the birth of the nutrition fee subsidies: 945 yuan for a normal birth. Cesarean section 1890 yuan.

4. How should flexibly employed people enjoy the benefits of maternity insurance?

First of all, flexible employment is only bought: pension, medical and critical illness insurance, and we enjoy the premise of maternity insurance: social security (maternity) insurance in the designated hospital or delivery must be cumulative purchase of one year, and must be in the state of insurance.

If you are insured as a flexible employee, there is no maternity insurance at all, so you will not be able to enjoy the benefits of maternity insurance.

If you want to enjoy the maternity insurance, you must first stop the flexible employment of this kind of insurance, to find a company to buy the basic health care (Guangzhou outside the account can buy foreign mobile social security), if you have never bought social security (maternity) insurance, you have to in the first four months before the pregnancy to find a unit for the social insurance for a good increase in the number of people, if you have bought this kind of insurance, you wait for the pregnancy, and then you can buy the insurance, and you can buy the maternity insurance. After the BB ready: a copy of the ID card, the original birth certificate, a small one-inch photo two, and perinatal card or diagnostic certificate to find a good unit to determine the social security increase.