How to reimburse Shijiazhuang maternity insurance? Proportion of hospitalization reimbursement for medical insurance in Shijiazhuang

Insurance Bian Xiao helps you answer, and more questions can be answered online.

Are you talking about employee medical insurance or urban residents' medical insurance? According to the implementation plan of the basic medical insurance for urban residents in Shijiazhuang, the urban deductible standards for residents' medical insurance are: 400 yuan, a first-level medical institution (including community health service center), 600 yuan, a second-level medical institution, and 900 yuan, a third-level medical institution. The expenses below the deductible are paid by the individual, and the expenses above the deductible are reimbursed according to different levels of medical institutions. The reimbursement rate of hospitalization medical expenses in urban areas is 70% for primary medical institutions (including community health service centers), 60% for secondary medical institutions and 50% for tertiary medical institutions. For urban residents who have paid for five consecutive years, the reimbursement rate will increase by 0.5% for each additional year, with a maximum increase of 10 percentage point. For urban insured residents, the maximum medical expenses paid by the residents' basic medical insurance fund within one year is 25,000 yuan. The expenses exceeding the maximum payment limit of the medical insurance fund shall be paid by large medical insurance for 60%, with a maximum payment of 75,000 yuan within one year. The deductible period of employees' medical insurance at all levels is slightly higher than that of residents' medical insurance, and the reimbursement ratio is up to 85%, which is higher than that of residents' medical insurance.

I. Procedures

1. The employer shall report to the business hall of the social labor insurance department with the application materials;

2, the staff accepted the application materials, after examination and approval, stamped and returned to the summary table, increase or decrease table;

3, the employer in the next month to the local tax authorities to apply for payment.

Second, the application materials

1, social insurance registration form;

2, "to participate in the basic pension, work injury and maternity insurance personnel increase or decrease table";

3, "enterprise employees basic pension, work injury and maternity insurance declaration summary".

Third, the reimbursement process, the insured workers meet the following conditions, can enjoy maternity insurance benefits in accordance with the provisions:

1, in line with national, provincial and municipal family planning policies;

2. When giving birth or carrying out family planning operation, the employer has participated in maternity insurance and paid the maternity insurance premium in full 12 months.

3, prenatal examination fees and production costs, the parties bring a marriage certificate, social security card (citizen card) and family planning certificate issued by the street to the maternity insurance designated hospital direct credit card settlement.

4. To declare maternity allowance and one-time nutrition allowance, you need to fill in the maternity insurance benefits declaration form and affix the official seal of the unit, provide marriage certificate, one-child certificate (for children), discharge summary and other materials, and go through the declaration formalities at the obstetrics department of the municipal medical insurance center on the working day between 1- 10 every month. (Go through relevant formalities within one year after delivery)

Extended data

1. Insurance benefits, maternity allowance, maternity medical expenses, family planning operation expenses and other expenses stipulated by the state and this Municipality;

(1) Maternity allowance:

1. Maternity allowance is the salary of female employees during maternity leave. If the maternity allowance is lower than my salary standard, the difference will be made up by the enterprise. Maternity allowance is calculated according to the payment base of the month when female employees give birth divided by 30 and multiplied by the number of days of maternity leave.

2 employees who have participated in maternity insurance for a total of one year, who are still insured during maternity (abortion), enjoy maternity insurance benefits according to relevant regulations.

3, maternity insurance benefits, maternity allowance payment standards, based on the employer's average monthly salary of employees in the previous year, according to the provisions of the holiday plan:

(2) 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 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. Multiple birth leave, every additional baby 15 days;

6. Abortion leave: less than 2 months of pregnancy 15 days; Less than 4 months and 30 days pregnant; 4 months or more (including 4 months) to 7 months is 42 days; In case of stillbirth, stillbirth or premature delivery for more than 7 months, the survival time is less than 75 days;

(3) Nutrition subsidy

1, normal delivery, abortion for more than 7 months; Last year, the average monthly salary of employees in the city was × 25%;

2, dystocia, multiple births: the average monthly salary of employees in the previous year × 50%.

(four) maternity medical expenses include the following contents:

1, maternity medical expenses;

2. Family planning medical expenses;

3. Other project expenses stipulated by laws and regulations.

The medical expenses for medical treatment after the maternity medical treatment is confirmed shall be settled by the Municipal Labor and Social Security Bureau and the hospital (the part exceeding 6,543,800 yuan shall be settled according to the approved number).

(5) Maternity insurance money

Maternity insurance = maternity allowance+Medicaid allowance: based on the average monthly salary of employees of the employer.

1, 3 months (90 days) for normal birth.

2. Late childbearing is 3.5 months (105 days).

3. Those who have given birth and have received the One-Child Certificate are counted as 4. 17 months (125 days).

4. Those who have given birth late and have received the One-Child Certificate are counted as 4.67 months (140 days).

(6) Medicaid: based on the average monthly salary of enterprise employees in the last year of the Special Zone.

1, normal birth is 2 months.

2, caesarean section or multiple births

Baidu encyclopedia-maternity insurance

First, the reimbursement ratio of residents' medical insurance cards.

1. For hospitalization expenses that meet the above-mentioned provisions of Qifubiaozhun, the proportion paid by medical insurance fund is: 60% for hospitalization in community health service centers and first-class medical institutions; The proportion of hospitalization payment in secondary medical institutions is 50%; The proportion of hospitalization payment in tertiary medical institutions is 40%.

2, Qifubiaozhun: refers to the medical insurance fund before payment, according to the provisions of the individual should bear a certain amount of medical expenses. Medical expenses above Qifubiaozhun can only be paid by the medical insurance fund according to the prescribed proportion.

3. The hospitalization Qifubiaozhun is: 200 yuan, a community health service center and a first-class medical institution; 400 yuan, a second-class medical institution; 800 yuan, a third-class medical institution. The minimum living standard of Huimin Hospital is 100 yuan. Residents who have no ability to work, no fixed income, and can't decide their dependents or dependents are hospitalized in Huimin Hospital without Qifubiaozhun.

Second, the proportion of employee medical insurance card reimbursement

1, outpatient and emergency medical expenses: the medical expenses that met the requirements of the basic medical insurance in that year (1 10/February/31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. Residents' insurance outpatient service —— In an insurance year, if the general outpatient expenses incurred by insured residents in designated outpatient medical institutions are within 100 yuan (inclusive), the residents' medical insurance fund will pay 30%, and individuals will pay 70%; Personal consumption exceeds 100 yuan.

Extended data

Interpretation of the basic medical insurance policy in Shijiazhuang;

1, Q: How much is the overall reimbursement for the general outpatient service of employee medical insurance?

Answer: The general outpatient policy is: the minimum threshold is 700 yuan, the first-class and below medical institutions, the second-class medical institutions 1.000 yuan, and the third-class medical institutions 1.500 yuan; The reimbursement rate is 80% for first-class and below medical institutions, 70% for second-class medical institutions and 60% for third-class medical institutions; The annual reimbursement limit is 2,500 yuan for employees 1500 yuan and retirees. Counties (cities) can refer to the implementation.

2. Q: What is the threshold and reimbursement rate for employees with chronic diseases?

A: Chronic diseases and common diseases are managed separately, which increases the treatment of chronic diseases. The deductible line is within 200 yuan, regardless of the level of medical institutions. The reimbursement rate is 90% for first-class and below medical institutions, 85% for second-class medical institutions and 80% for third-class medical institutions.

3. Q: What are the chronic diseases and annual reimbursement limits of employee medical insurance?

A: The number of chronic diseases has increased from 15 to 30, which are divided into two categories. One is the annual reimbursement limit of 2000 yuan, and the specific diseases are: 1 hypertension (high-risk stage III and above); ② Rheumatic heart disease; 3 cor pulmonale; 4 chronic obstructive pulmonary disease; ⑤ angina pectoris; 6 myocardial infarction; 7 chronic atrial fibrillation; 8. Various chronic heart failure; 9 sequelae of cerebrovascular disease (with severe dysfunction); 10 chronic hepatitis; 1 1 chronic nephritis; 12 nephrotic syndrome; 13 rheumatoid arthritis (with severe limb dysfunction or serious organ damage); 14 epilepsy; 15 active pulmonary tuberculosis; 16 femoral head necrosis; 17 primary aldosteronism; 18 leukopenia and granulocytopenia.

The other kind of annual reimbursement limit is 3000 yuan, and the specific disease is: 1 diabetes (with serious complications); ② Chronic renal failure (failure to reach dialysis level); 3 mental disorder; ④ Systemic lupus erythematosus; 5 cirrhosis; 6 Parkinson's disease; 7 myasthenia gravis; 8 myelodysplastic syndrome; 9 systemic sclerosis; 10 thrombocytopenic purpura; 1 1 chronic osteomyelitis; 12 motor neuron disease.

Suffering from two or more chronic diseases, the deductible is not accumulated, and the annual payment limit is accumulated. The annual maximum payment limit is 5000 yuan.

4. Q: After the large medical insurance is adjusted to critical illness insurance, how can employees' medical insurance be reimbursed?

Answer: (1) Qifubiaozhun. The deductible standard of 20 17 is 20,000 yuan for the medical expenses paid by the insured employees. (2) Reimbursement ratio. The deductible line 1 10,000 yuan (excluding the deductible line) is reimbursed by 50%, the deductible line 1 10,000 yuan to 20,000 yuan is reimbursed by 60%, and the deductible line110,000 yuan to 30,000 yuan is reimbursed by 70%; 80% reimbursement for 30,000-40,000 yuan; The part exceeding the maximum payment limit of 40,000 yuan will be reimbursed by 90%. (3) reimbursement limit. In a settlement year, the maximum annual reimbursement limit of employee's serious illness insurance is 400,000 yuan, and the annual reimbursement limit of basic medical insurance fund is 250,000 yuan, that is, 650,000 yuan.

Social Security Network: 20 18 Shijiazhuang medical insurance reimbursement ratio.

Official Website of Shijiazhuang Municipal People's Government: Interpretation of Shijiazhuang's Basic Medical Insurance Policy

What is the reimbursement ratio of maternity insurance in Shijiazhuang?-:The reimbursement standard of maternity insurance for female employees in Shijiazhuang is 1, maternity allowance = the average payment salary of the unit in the current month ÷30 (days) * holiday days: (1) Normal maternity leave is 90 days (including prenatal examination 15 days); (2) The one-child leave is increased by 35 days; (3) ...

Shijiazhuang maternity insurance how much to report for a child-:Hello, maternity insurance, natural delivery: 2000 dystocia: 2500 caesarean section: 3500 units pay maternity insurance for one year, then report more, about 10000.

How much can Shijiazhuang maternity insurance be reimbursed? -:Almost impossible. If there are welfare benefits, they will be given privately by the unit. The normal birth fund is 2200 yuan, and the early maternal and child health examination fee is 3000 yuan.

In Shijiazhuang, I want to enter maternity insurance. How to enter, how much to pay, and how much to reimburse after giving birth? If you are satisfied with the answer, you will get extra points-:maternity insurance does not need to be entered separately, and it is a compulsory additional insurance for medical insurance. When I was born, I had a natural delivery of 3000 yuan and a total production of 5000 yuan. Just go directly to the relevant departments for reimbursement after discharge.

Shijiazhuang maternity insurance reimbursement scope: three months' salary plus fixed reimbursement expenses (natural delivery is different from caesarean section)

How to reimburse the hospitalized children of Shijiazhuang urban residents for medical insurance -:0. 1%

How much can Shijiazhuang maternity insurance be reimbursed-:As long as it is a hospital that can be reimbursed, it should be reimbursed. The maternity leave lasts for three months, and the maternity leave salary is 60% of the salary. You'd better find your personnel to calculate your salary and ask if you can come back for reimbursement when you have children in your hometown. The specific rules are different.

How much can Shijiazhuang reimburse for having children? I heard that 1w or above can be reimbursed? If you are an enterprise employee, maternity insurance is indeed more than 10 thousand. But if you are a government official, it should be more than 4 thousand.

What is the reimbursement standard of maternity insurance in Shijiazhuang? : According to Article 26 of Shi Zhengban Fa [20 1 1] 15, the medical expenses of employees' spouses for childbirth, termination of pregnancy and family planning operations are reimbursed according to the quota, and the standard is 50% of the standard stipulated in Articles 24 and 25 of these Measures. ...

How much is the reimbursement standard for female workers in Shijiazhuang maternity insurance? : 1, maternity allowance = average paid salary of the unit in the current month ÷30 (days) * holiday days: (1) normal maternity leave is 90 days (including prenatal check-up 15 days); (2) The one-child leave is increased by 35 days; (3) Late childbirth maternity leave increased by 15 days; 2. Maternity medical expenses (1) The medical expenses after the confirmation of maternity medical treatment shall be settled by the Municipal Labor and Social Security Bureau and the hospital (the part exceeding 10000 yuan shall be settled according to the approved number). (3) The medical expenses for delivery in different places shall be reimbursed according to the facts; Above the quota standard, according to the quota standard reimbursement. 3. One-time delivery nutrition subsidy is normal delivery and abortion for more than 7 months; Last year, the average monthly salary of employees in the city was * 25%; 4, a one-time subsidy in the first and second class hospital delivery, each one-time increase in 300 yuan subsidies.