During the epidemic, the various social security benefits affected?

Today, I'm going to come with you to understand the treatment of maternity, medical, pension, unemployment and industrial injury during the epidemic.

Part I: Maternity insurance treatment

1, affected by the epidemic, the employer late payment of maternity insurance premiums, maternity medical treatment how to protect?

According to the "Guangzhou Municipal Bureau of Medical Security on doing a good job in the management of medical security services to promote the prevention and control of new coronavirus-infected pneumonia epidemic notice" point 5: "affected by the epidemic can not be timely and monthly payment of social health insurance, maternity insurance costs, allowed to make up for the end of the epidemic three months after the replacement of the replacement payment, without charging a late fee, during the epidemic does not affect the During the epidemic period, it will not affect the participants' enjoyment of medical treatment...", the relevant treatment principles are as follows:

(1) Participants who have selected local medical institutions for maternity checkups and deliveries

If a participant has selected a local medical institution for maternity checkups and deliveries, and due to the impact of the epidemic, the employer is late in making the payment, the participant's relevant medical expenses (including maternity checkups, deliveries, or family planning insurance fees) will be reimbursed to the employer. Including maternity, childbirth or family planning, the same below) can first pay the deposit, without settlement, to be paid by the employer in accordance with the requirements of the deposit vouchers to the medical institution for supplementary accounting.

If the participant has already settled the medical expenses, he/she can wait for the employer to make up the payment as required, and then go to the medical institution with the invoice to handle the refund and make up the account.

(2) Participants who have selected a foreign medical institution for maternity examination and delivery

Participants who have selected a foreign medical institution for maternity examination and delivery, and the employer is late in making payment due to the impact of the epidemic, the relevant medical expenses of the participant can be reimbursed at the medical insurance sub-centers within one year of the end of the epidemic after the employer has made up for the payment according to the requirements.

(3) Participants who have not yet selected a medical institution for maternity examination and delivery

If a participant has not yet selected a medical institution for maternity examination and delivery, and if the employer is late in making payment due to the impact of the epidemic, the participant can apply for the medical voucher after making normal payment, and if the employer has already completed the required retroactive payment, the participant can contact the corresponding sub-centers of the medical insurance and adjust the starting time of the voucher for treatment of related medical expenses according to the first and the second points. The medical expenses will be handled according to the first and second points.

(4) How to enjoy maternity medical treatment for employees who have paid contributions for less than one year and whose units have not yet made contributions during the epidemic period

Female employees who have paid contributions for less than one year and who need to enjoy maternity medical treatment (including maternity checkups, deliveries and family planning surgeries) cannot enjoy maternity medical treatment during the period when their units are in arrears with their maternity insurance contributions, and their units' retroactive payment of the contributions according to the regulations will be regarded as normal contributions, and if their pregnancy has not yet been terminated, the retroactive payment of the contributions after the retroactive payment of the contributions will be considered as normal contributions. If the unit has not yet terminated the pregnancy, and the contributions have been paid for one year after the retroactive payment (including the retroactive part), the unit can first process the voucher, and then adjust the time of enjoyment of the benefits to the Guangzhou Municipal Health Insurance Center sub-centers, and then carry out the retroactive accounting process according to the regulations; if the pregnancy has been terminated, the unit can carry the information to the Guangzhou Municipal Health Insurance Center sub-centers.

For example:

Mrs. Li registered for the insurance in April 2019 and made normal contributions, and her pregnancy was confirmed in January 2020, with an expected date of delivery in September 2020, but the unit was affected by the epidemic and did not pay the contributions, so Ms. Li can't apply for the confirmation of maternity medical treatment and enjoy maternity medical treatment for the time being; if the unit makes up for the payment of relevant expenses in May 2020, Ms. Li can apply for the confirmation of maternity medical treatment after the unit makes up for the payment in May and go to the hospital's branch center for the treatment. If the unit pays the relevant fees in May 2020, Ms. Li can apply for the confirmation of medical treatment in May after the unit pays the fees and adjust the date of enjoying the treatment at the medical insurance sub-center of the hospital. If the unit in October 2020 to make up the relevant costs, and Ms. Li has already given birth, you can bring the required information to the health insurance sub-centers to deal with (the specific processing, to the acceptance of the sub-centers of the health insurance shall prevail).

Note

Participants who are affected by the epidemic and are unable to make sporadic reimbursements for maternity insurance in time: the time limit for reimbursement of maternity insurance medical expenses incurred by participants that meet the requirements for sporadic reimbursement has been adjusted from one year from the date of incurring the expenses to one year after the end of the epidemic. Participants are requested to try their best to handle the zero-reimbursement business after the end of the epidemic.

2. Will the maternity allowance still be paid if the unit defaults on payment during the epidemic?

According to the "Guangzhou Municipal Bureau of Medical Security on doing a good job in the management of medical security services to promote the prevention and control of new coronavirus-infected pneumonia epidemic notice" point 5: "affected by the epidemic can not be timely and monthly payment of social health insurance, maternity insurance costs, allowed to make up for the end of the epidemic three months after the replacement of the payment, without charging a late fee, during the epidemic does not affect the Participants enjoy medical treatment during the epidemic ..." requirements, the employer owes maternity insurance premiums during the maternity allowance will not be allocated, the employer in accordance with the provisions of the retroactive payment, as normal payment, Guangzhou Municipal Medical Insurance Center will be allocated in accordance with the provisions of the payment.

Part II: medical insurance treatment

1, during the epidemic, how to implement the policy of reducing the levy of employee medical insurance?

From February to June 2020, the unit contribution rate of Guangzhou's employee medical insurance is levied at 50% of the rate before the fee reduction, i.e., during the period of implementing the policy of reducing the levy by half, the unit contribution rate of the employee's social medical insurance is 3.5%, and that of maternity insurance is 0.85%, with the total unit contribution rate of 4.35%, and the measure is estimated to reduce the burden of the enterprises by about This initiative is expected to reduce the burden on enterprises by about 8.325 billion yuan in five months, effectively supporting the resumption of work and production and promoting stable employment.

2, affected by the epidemic, the employer failed to pay the fee in time, how to protect the treatment?

Aiming at the epidemic period on some of the insured units, insured persons may cause the impact of medical treatment, the Municipal Health Insurance Bureau has optimized the treatment enjoyment policy and handling process. Due to the impact of the epidemic can not be timely monthly payment of social health insurance, maternity insurance costs, allowing the end of the epidemic within three months to make up for the retroactive payment, do not charge a late fee, during the epidemic does not affect the participants to enjoy the medical treatment. During the epidemic, the health insurance system batch opening of the participant's employee health insurance and maternity insurance medical treatment, health insurance treatment of the participant with social security card in the designated medical institutions after medical treatment in accordance with the provisions of the settlement of medical expenses (without the need to additionally apply for the zero report procedures); such as all kinds of reasons for not being able to directly settle the payment, you can make up for the retroactive payment of the epidemic within three months after the end of the retroactive payment, and by the way of retroactive treatment of hospitals to make up for the account or zero report. For the health insurance reimbursement strategy, I just happened to organize the relevant content, I hope to help you: 2020 national social security health insurance application reimbursement process!

3, the epidemic period health insurance delayed payment, affecting the qualification review of the application of small and medium-sized bus indicators?

On the issue of medium and small bus indicators, due to the epidemic part of the city's delayed payment of social security (medical insurance) situation, the traffic department has been introduced on April 9, 2020 appropriate adjustments to non-city residents apply for incremental indicators of the conditions of the relevant measures, from April onwards, the applicant is not audited for the last month of the city's employees social health insurance payment records. For the latest news on the policy adjustment, please pay attention to the official website of the Indicator Regulation (/).

4. What are the changes in medication during the epidemic?

During the epidemic period, long prescriptions will be implemented for outpatient medical insurance visits. Patients who have applied for one type of outpatient specific diseases and are within the validity period of their insurance (including municipal health insurance participants) can relax the prescription dosage up to three months after assessment by the doctors of the designated medical institutions. Employee medical insurance, urban and rural residents medical insurance a class of outpatient specific disease maximum payment limit standard from the monthly limit adjusted to the quarterly limit, the quarterly limit standard for the original monthly limit of three times the standard.

For example:

Employee (resident) health insurance participant applied for a valid diabetes class I outpatient specific diseases, the original participant can be prescribed in February to the health insurance designated medical institutions in the month of the amount of medication, the health insurance fund maximum payment of 200 (50) yuan; now the participant can be prescribed in February to the health insurance designated medical institutions, the diagnosis and treatment of the designated medical institutions, doctors assessed by the prescribed medical institutions, prescribe the 2- April*** 3 months' worth of medication, with a maximum payment of 600 (150) yuan from the health insurance fund. (Parentheses for the content of the city residents health insurance participants)

Policy documents provide:

During the epidemic, health insurance designated medical institutions will be based on the actual situation of patients, a reasonable increase in the amount of medication in a single prescription, reduce the number of patients to the designated medical institutions to dispense medication; on the city's social health insurance participants hypertension, diabetes, and other chronic diseases, after the diagnosis and treatment of the hospital doctor's assessment, can be prescribing The amount of medication is relaxed to three months, health insurance monthly payment limit adjusted to the quarterly limit, the quarterly limit standard is three times the original monthly limit standard.

5. How to deal with the medical expenses of the new cases of pneumonia imported by people returning from abroad?

According to the "Notice of the Guangdong Province Crown Pneumonia Prevention and Control Command Office Epidemic Prevention and Control Team on the Relevant Expenses of Personnel Returning from Overseas to Guangdong" and other relevant regulations, those who participate in the basic medical insurance among the imported cases of personnel returning from overseas to Guangdong will be subsidized by the financial sector for the part of their personal burdens after paying the medical expenses according to regulations of the basic medical insurance, the major disease insurance, and the medical aid. For those who are not covered by basic medical insurance among the imported cases of people who have returned to Guangdong from overseas, the medical expenses will be borne by the patients in principle. For those who have participated in commercial health insurance, the commercial insurance company will pay according to the contract. For those who are not covered by basic medical insurance and are in genuine difficulties among the imported cases of people who have returned to Guangdong from overseas, medical assistance can be provided in accordance with laws and regulations if they are recognized as eligible. In other words, the insured only need to show their medical insurance card or social security card, and their related expenses will be settled by the medical institutions in accordance with the medical insurance policy; the medical expenses of the non-insured are in principle borne by the patients individually, and the specifics of the case can be consulted with the medical institutions or the administrative departments of health care.

6. How to deal with the screening cost of new coronary pneumonia?

According to the "Guangzhou City, the new coronavirus pneumonia prevention and control command office medical prevention and control group forwarded to the Guangdong Province, the new coronavirus pneumonia epidemic prevention and control command office on the sub-district and graded to carry out key populations of nucleic acid test screening work of the notice", at present, Guangdong Province, health insurance participants belong to the provincial prevention and control requirements of the key screening objects, in the fixed-point health care institutions incurred the cost of nucleic acid testing, according to the provisions of the health insurance payment Scope; the provincial prevention and control command clear screening outside the scope of the relevant units (enterprises) and individuals request their own nucleic acid test costs, at their own expense. That is to say, the insured person only need to show the health insurance card or social security card, the relevant costs will be settled by the medical institutions in accordance with the health insurance policy; non-insured person's detection costs or the insured person belongs to the provincial prevention and control command of the scope of the costs of the clear detection, the specific circumstances can be consulted with the medical institutions or health care administrative departments.

Part III: Pension Insurance Treatment

1, what is the impact on the urban and rural residents' pension insurance processing during the epidemic?

During the epidemic period, urban and rural residents who failed to register for insurance contributions, declare their contributions, and claim their benefits on time are allowed to make up for it after the end of the epidemic, and the pension insurance treatment during the extended period will be enjoyed normally without affecting the record of individual rights and interests of the participants, and the making up for it should be completed within three months after the lifting of the epidemic.

2, during the epidemic late application for urban and rural residents pension insurance treatment, will affect the pension?

For the urban and rural residents pension insurance treatment application, meet the treatment application conditions, according to the provisions of the relevant treatment. For the deferred payment of social security premiums, retroactive payment is re-approved and the relevant treatment is reissued. Qualification certification for urban and rural residents' insurance benefits can be done through the Guangdong Social Security APP and the WeChat Guangdong Provincial Affairs mini-program, and the payment of benefits will not be suspended if the certification is not done on schedule.

3. Can I wait until the end of the epidemic to apply for my pension if I meet the conditions during the epidemic? Will the delay affect my pension?

If you did not apply for your pension on time during the epidemic, you are allowed to do it within three months after the epidemic is lifted, and it will not affect the amount of your pension.

4. During the epidemic, there was a special policy to reduce or delay the payment of social security premiums. If the social security premiums are reduced or delayed, will it affect my pension claim?

The policy of social security fee reduction and exemption is only for the part of the unit's contribution, which will not affect the application for pension or the amount of pension.

If the individual contribution portion of the social security fee is deferred, the social insurance agency will temporarily issue the pension insurance benefits according to the contributions before the deferral, and then re-approve the pension insurance benefits and make up for the difference in the benefits after the deferred contributions are actually paid into the account as if they were normal contributions.

The policy encourages employers to prioritize contributions for workers who have reached retirement age.

5, the epidemic period can not go to the social security front desk for pension eligibility certification procedures? Is there any other convenient way?

Used during the epidemic