What is sporadic reimbursement of maternity insurance?

Maternity allowance, also known as cash allowance, refers to a maternity insurance treatment in which professional women pay cash regularly in accordance with maternity insurance laws and regulations when they leave their jobs due to childbirth or abortion and interrupt their income.

Maternity allowance has become an important measure to care for working women internationally. Its purpose is to provide basic economic security for the parturient, so that she and her baby can maintain a healthy life according to a certain standard of living during maternity leave. It is a basic right of working women to enjoy maternity allowance.

The Municipal Bureau of Human Resources and Social Security issued the Notice on Improving the Methods for Applying for and Issuing Maternity Allowance for Female Workers (hereinafter referred to as the Notice), which will take effect on 20 17 1. At that time, if a late-childbearing female worker applies for increasing the maternity allowance, it is not necessary to provide the certificate of the only-child honor award, and the social insurance agency will no longer review the certificate.

Effective from 20 17 1+0.

apply for

The employing unit shall, within 12 months from the month following the birth or termination of pregnancy of female employees, apply for maternity allowance for female employees online in time.

ask about

Employers and female employees can check the declaration process, allowance standard and payment progress of maternity allowance online.

cheque

The social insurance agency shall complete the maternity allowance audit within 10 working days after accepting the declaration.

distribute

After the examination and approval, the maternity allowance shall be allocated according to the regulations before the 5th of the following month.

If a female worker of childbearing age applies for increasing maternity allowance, it is not necessary to provide a certificate of honor award for the only child, and the social insurance agency will no longer review the certificate. The employing unit shall, in accordance with the relevant provisions of the state and this Municipality, determine the wages of female employees during maternity leave. If the salary during maternity leave is higher than the maternity allowance standard approved by the social insurance agency, the difference shall be paid to the female employee in full according to the agreed date of salary payment.

Scope and conditions of application

It is clear in the notice that the maternity allowance enjoyed by female employees belonging to enterprises, social organizations, private non-enterprise units, individual industrial and commercial households with employees and other organizations (hereinafter referred to as "employers") will be transferred to the employer's account in one lump sum and paid to my social security card account on a monthly basis. The maternity allowance for female employees in government agencies and institutions shall be transferred to the account of the employer by the social insurance agency on a monthly basis, and the employer shall pay it to me in time.

The employer has continuously paid maternity insurance premiums for female employees who have given birth or terminated pregnancy for more than 6 months (including overdue payment) and has the conditions to apply for maternity allowance; If the continuous payment is less than 6 months, you can apply for maternity allowance after 6 months of payment.

20 17 Guangzhou maternity insurance reimbursement conditions

First, enjoy the conditions.

Workers who have participated in maternity insurance for a total of one year and are still insured at the time of childbirth (abortion) shall enjoy maternity insurance benefits according to relevant regulations.

Second, the distribution standard

Note: Maternity insurance allowance: it shall be handled within five months after giving birth to a child, and the unit where the female employee and the male spouse work shall apply for maternity insurance benefits respectively.

(1) Female employees

1, maternity allowance

In the month of birth (abortion), the unified salary of the issuing unit shall be calculated according to the prescribed holidays.

Maternity allowance = the average payment salary of this unit in the current month ÷30 (days) × holiday days.

Holidays:

(1) Normal maternity leave is 90 days (including prenatal examination 15 days);

(2) The one-child leave is increased by 35 days;

(3) Late childbirth maternity leave increased by 15 days;

(4) Difficult maternity leave

Caesarean section and third degree rupture of perineum increased by 30 days;

Suction delivery, forceps delivery and breech delivery increased 15 days.

(5) The maternity leave is increased by 65,438+05 days for each additional baby born in multiple births.

(6) Abortion leave

Pregnancy less than 2 months 15 days;

Less than 4 months and 30 days pregnant;

Pregnant for more than 4 months (including 4 months) to less than 7 months for 42 days;

Pregnant for more than 7 months, surviving less than 75 days in case of stillbirth, stillbirth or premature delivery;

2. Maternity medical expenses

(1) The medical expenses for medical treatment after the maternity medical treatment status is confirmed by the medical insurance center shall be settled by the Guangzhou Municipal Bureau of Labor and Social Security and the hospital (the part exceeding 10000 yuan shall be settled according to the approved amount).

(2) Sudden abortion before pregnancy 16 weeks, and obstetric complications during emergency and maternity leave in non-designated hospitals, shall be reimbursed according to the approved number.

(3) If the medical expenses for delivery in different places are lower than the quota standard, they shall be reimbursed according to the facts; Above the quota standard, according to the quota standard reimbursement.

3. One-time childbirth nutrition subsidy

(1) Normal delivery, abortion over 7 months; Last year, the average monthly salary of employees in the city was × 25%;

(2) Dystocia and multiple births: the average monthly salary of employees in the previous year was ×50%.

4. One-time subsidy

In primary and secondary hospitals, each person will receive a one-time increase in 300 yuan subsidy.

(2) Male employees

Male spouses who receive the "One-Child Preferential Card" enjoy 10 days holiday, and are paid according to the unified salary of the unit in the month when the child is born.

Male spouse's holiday salary = unified salary paid by the unit in the current month ÷30 (days) × 10 (days).

Three. Reimbursement scope and carrying materials

Serial number reimbursement category carries information.

Special data basic data

1 If the Medical Confirmation Certificate of Maternity Insurance for Enterprise Employees in Guangzhou (hereinafter referred to as "Medical Certificate") has not been processed, or if there is no birth certificate or family planning service certificate, the family planning department of the street where the husband and wife are located needs to issue a certificate. 1, original and copy of hospital medical records;

2. The original and photocopy of the hospital diagnosis certificate;

3. Special receipts or invoices for medical expenses printed by financial and tax departments;

4. Detailed list of medical expenses consistent with the receipt (invoice) amount (or manual record list with hospital seal);

5. The original and photocopy of the birth certificate or the original and photocopy of the family planning service certificate.

2. Off-site delivery (the application for off-site delivery has been filed in the Municipal Medical Insurance Center) "Application Form for Off-site Delivery of Maternity Insurance for Enterprise Employees in Guangzhou" or "Application Form for Selection of Designated Hospitals for Maternity Insurance"

3. The original and photocopy of the medical certificate that has been issued and used for emergency abortion or delivery in non-designated hospitals;

(2) A written report issued by the insured or his family.

4 Postpartum complications

5. The medical expenses of maternity insurance under various special circumstances identified by the municipal medical insurance center ① a written report issued by the insured or his family;

② Information provided by the municipal medical insurance center according to various situations.

Fourth, the declaration method

1. Maternity medical expenses, which fall within the scope of reimbursement for sporadic medical expenses of maternity insurance, shall be paid by the insured person in advance, and shall be reported to the subordinate unit within 5 months from the date of discharge (or settlement of medical expenses).

2, by the unit manager to carry relevant information, to the city medical insurance center on the fourth floor of the medical insurance business comprehensive service hall designated window for reimbursement procedures.

List of settlement standards for sporadic reimbursement of maternity insurance

Zhengzhou maternity insurance handling process guide

Basic processing flow

Female workers apply for maternity insurance registration cards at the municipal medical insurance center within five months of pregnancy-submit relevant materials to the medical insurance center for review within four months after delivery-reimburse maternity medical expenses and receive maternity allowance.

Time to apply for maternity insurance registration card and materials to be provided. Female workers hold the original birth certificate (community certificate, Zheng after graduation from the family planning school in their district) and its copy, the original and copy of my ID card, one-inch photo and medical insurance card, and go to the municipal medical insurance center for processing from the 20th to 30th (working days) every month. The second child needs the unit to provide proof of compliance with the family planning policy (explain the detailed reasons). If it is not handled within the time limit, the unit shall issue a certificate (explaining the reasons for not handling it in time). Under special circumstances, a pension plan is required.

Materials to be provided for expense reimbursement

1. Maternity reimbursement (including induced labor for more than 7 months): copy of inpatient medical records (first page of medical records, doctor's advice, operation records, discharge summary), detailed list of expenses, discharge certificate, original and copy of baby's birth (death) diagnosis certificate, original and copy of my ID card, birth registration card, effective bill for perinatal care and medical insurance card. The highest payment standard of perinatal health care fund is 500 yuan; The maximum payment standard of natural childbirth fund is 1500 yuan, and the maximum payment standard of cesarean section fund is 3,000 yuan. Those who exceed the standard shall be paid at their own expense, and those who are below the standard shall be paid according to the actual expenses.

2. Abortion and induced labor: the certificate of termination of pregnancy issued by the designated medical institution or the certificate of family planning operation issued by the designated family planning service institution (in triplicate), Zheng Ming from the family planning office of the unit (explaining the cause of abortion and whether it conforms to the family planning policy), the original and photocopy of my ID card, the fee limit form, the medical insurance card and the original marriage certificate.

3. Sheung Wan and ring removal: family planning operation certificate (in triplicate) issued by designated medical institutions or designated family planning technical service institutions, 2 original and photocopies of my ID card, fee limit sheet and medical insurance card.

4. In case of delivery or abortion/induced labor in non-designated medical institutions due to emergency, emergency diagnosis certificate shall be provided before reimbursement. The payment standard is 90% of the reimbursement standard of designated medical institutions.

If the maternity insurance benefits meet the relevant provisions of population and family planning for female workers to give birth or terminate pregnancy, during the following statutory maternity leave, they will be changed from receiving wages to enjoying maternity allowance:

1. Those who have given birth or induced labor for more than 28 weeks are entitled to 90 days of maternity allowance; Maternity allowance for dystocia increased 15 days; In the case of multiple births, the maternity allowance will be increased by 1 5 days for each additional birth1baby; Late childbirth will increase the maternity allowance by 90 days.

2. If the pregnancy is more than 12 weeks but less than 28 weeks, the pregnant woman will be entitled to maternity allowance for 42 days.

3. Those who are pregnant for 8 weeks but have miscarried less than 12 weeks are entitled to maternity allowance for 30 days; Those who are less than 8 weeks pregnant are entitled to 15 days maternity allowance.

The daily standard of maternity allowance is calculated by dividing the average monthly salary of employees in the previous year by 30 in the employer where the female employees work, and paid from the maternity insurance fund. If the maternity allowance is lower than the salary level of female workers before childbirth or family planning operation, the difference shall be made up by the employer.

Female workers who receive maternity allowance shall go to the medical insurance center to receive maternity allowance within four months after giving birth, and at the same time receive maternity allowance according to relevant regulations.

The reimbursement time is 1. From 25th to 30th of each month (working day), the relevant information will be reported to the Maternity Insurance Department of the Municipal Medical Insurance Center for review.

2. In the first month of each quarter, from June 5438 to August 22 (working day), bring the personal medical insurance card to the finance department on the second floor of the municipal medical insurance center to handle the change.

First of all, maternity insurance has four payment ranges:

(1) Prenatal check-up fee;

(2) Maternity medical expenses;

(3) maternity allowance;

(four) the cost of family planning operation

Now let me talk about the first three items. This is what every pregnant woman needs.

Prenatal examination fee

First of all, if you find yourself pregnant, congratulations. Then you have to register for pregnancy. Now many hospitals can register online without going to social security.

Materials required:

(1) pregnancy diagnosis certificate (original): indicate the start time and expected date of pregnancy, and affix the special seals for maternity insurance and medical insurance; (In general hospitals, B-ultrasound is now used to see the embryo buds of fetal heart, so don't worry. )

(2) The original and photocopy of the birth service certificate (i.e. birth permit);

(3) The original and photocopy of the medical guarantee and ID card;

(4) test sheet (urine pregnancy test);

(5) The agent needs a copy of the agent's ID card.

After registration, if the hospital is networked (generally), the prenatal examination fee can be settled by credit card. Note that you use maternity insurance, and the maximum payment is 1 100 yuan. If it is paid in full, it will eventually be reimbursed by the unit.

Prenatal examination fees are paid by quota, which means that your medical insurance card will have a corresponding quota every week of pregnancy:

/kloc-400 yuan for termination of pregnancy within 0/2 weeks.

/kloc-less than 0/2 weeks 16 weeks to terminate pregnancy 600 yuan.

Termination of pregnancy 16 weeks to less than 28 weeks 800 yuan

Termination of pregnancy or delivery for 28 weeks is 1 100 yuan.

Maternity medical expenses

Generally, this is also the window registration for maternity insurance in the hospital, and then you can directly declare the operation fee when you check out. If the same amount is paid in advance, the company will still be reimbursed.

The cost of surgery is also different.

First, the natural childbirth is 3,000 yuan;

B, labor intervention is 3 100 yuan;

C, simple caesarean section 3600 yuan;

D, cesarean section myomectomy, cesarean section ovarian cyst removal, cesarean section hysterectomy, cesarean section appendectomy 3800 yuan.

maternity benefits

Maternity allowance refers to the living expenses paid by social security institutions to maternity workers in accordance with relevant regulations. Anyone who meets the national family planning policy and holds a "birth service certificate" can enjoy maternity allowance according to regulations, regardless of the number of pregnancies.

Maternity allowance = standard of maternity allowance × days of enjoyment.

The daily standard of maternity allowance = calculated according to my insured base (the year when the child was born) is 30.4.

Enjoy the days of pregnancy

< 12 weeks 15 days

12- 16 weeks and 30 days

16-28 weeks and 42 days

≥28 weeks and 98 days

Days of output increase

Dystocia 15 days

Delivery with forceps 15 days

Fetal head aspiration 15 days

Multiple births 15 days/every extra baby.

Tubal ligation 14 days

Give birth 30 days later. ※

Late-born one-child refers to: women who have reached the age of 23 get married late, married women who have reached the age of 24 or given birth to their first child after late marriage get pregnant late, and their children get the one-child certificate. ※.

★ At the same time, if there is more than one situation, the number of days to enjoy maternity allowance shall be calculated cumulatively.

Materials required to declare maternity allowance:

1. Original and photocopy of the medical certificate of birth of the baby.

2. Discharge record (abstract) (chapter on maternity insurance and chapter on medical record room)

3, operation records (cesarean section, maternity insurance chapter and special seal for medical record room)

4. Diagnostic certificate. (Special seal for diagnosis certificate and maternity insurance seal)

5, late childbirth (24 years old registered marriage) only child, provide the "one-child certificate" (baby) and a copy of the original.

6. Copy of ID card (second-generation double-sided copy)

7, social security card (double copy, no social security card for medical insurance)

Among them, the operation record (cesarean section) and discharge summary should be obtained from the hospital medical record room (only copies are given) and stamped with the seal of the medical record room. Doctors won't remind you, so sisters should do their homework in advance and get all the materials at once when they leave the hospital.

The above materials are based on Hongqiao District and Nankai District, and other districts may increase or decrease on this basis. ※.

Maternity allowance is to wait until your maternity leave is the date approved in the above table, and then give it to our unit. If you pay it early, you have to hold it back. Because social insurance can't be collected before it expires, people sometimes feel that maternity allowance is reported slowly.

Payment of maternity allowance:

If the enterprise does not pay wages during maternity leave, all maternity allowances will be given to individuals; If the enterprise normally pays wages on a monthly basis, if the maternity allowance is higher than the salary, the company will make up the difference for the employees; If the maternity allowance is lower than the salary, then the maternity allowance enterprise will deduct it all. Now the general situation is that enterprises don't pay wages, so this money is for individuals.

This money is paid into the company account after the social security report is completed, and then the individual goes to the enterprise to withdraw money, instead of paying into the personal medical insurance account.

Provisions of Guangdong Province on Maternity Insurance for Employees

Chapter I General Provisions

Article 1 These Provisions are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC), the Special Provisions on Labor Protection for Female Employees and other laws and regulations, combined with the actual situation of this province, in order to enable employees to obtain basic medical care and living security during childbirth, balance the burden of maternity expenses of employers and promote fair employment.

Article 2 Within the administrative area of this province, state organs, enterprises, institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations and individual industrial and commercial households with employees (hereinafter referred to as employers) and all their employees and employees (hereinafter referred to as employees) shall participate in maternity insurance, and these Provisions shall apply.

Article 3 The employing unit and its employees shall participate in maternity insurance in the place where the employing unit is registered in accordance with the principle of territorial management. If the employing unit is a state organ or a people's organization, it shall participate in maternity insurance at the place where the unit is located.

Central units stationed in Guangdong, provincial units and their employees, employers with non-military employees, armed police forces and their non-military employees participate in maternity insurance where their units participate in basic medical insurance for employees.

Article 4 The social insurance administrative department of the people's government at or above the county level shall be responsible for the management of maternity insurance within their respective administrative areas, and other relevant departments shall be responsible for the relevant maternity insurance work within their respective functions and duties.

Social insurance agencies specifically undertake maternity insurance affairs such as maternity insurance registration, maternity insurance premium verification, personal rights record, maternity insurance benefits payment, and are responsible for providing maternity insurance business consulting and inquiry services.

Article 5 Maternity insurance premiums shall be collected by social insurance premium collection agencies.

Sixth maternity insurance funds, fund income and maternity insurance benefits shall be exempted from taxes and fees in accordance with state regulations.

Article 7 The maternity insurance fund shall be co-ordinated at the local level and at the provincial level in accordance with the provisions of the state.

Chapter II Maternity Insurance Fund

Article 8 Maternity insurance funds shall be raised and used in accordance with the principle of fixed income and fixed expenditure and balance of payments.

People's governments at or above the county level shall make up for the insufficient payment of maternity insurance funds.

Article 9 The maternity insurance fund consists of the following funds:

(1) Maternity insurance premium;

(two) the interest of maternity insurance fund;

(3) late fees;

(4) financial subsidies;

(five) other funds incorporated into the maternity insurance fund according to law.

Tenth maternity insurance premiums paid by the employer on a monthly basis. Self-employed workers do not pay maternity insurance premiums.

The employer shall pay the maternity insurance premium at a rate not exceeding the total wages of the employees of the unit last month 1%. The specific payment ratio is proposed by the administrative department of social insurance in the overall planning area according to the local actual situation, implemented after the approval of the people's government in the overall planning area, and reported to the provincial social insurance administrative department for the record.

If the total wages of employees of the employing unit last month exceeded the product of three times the average monthly wages of employees in the last year of listing multiplied by the number of employees in the unit, it shall be calculated according to the product of three times the average monthly wages of employees in the last year of listing multiplied by the number of employees in the local unit.

If the employer has no monthly salary, it shall be calculated based on the total wages of employees this month.

Eleventh maternity insurance fund shall be deposited in the financial special account of social security fund, and budget management shall be implemented, and separate accounts shall be established to account for price subsidies.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.