Sichuan maternity insurance reimbursement conditions and standards

Mainly based on the Sichuan Maternity Insurance Measures, employees need to meet the conditions of participation, medical expenses in line with the scope of reimbursement, and in accordance with the prescribed process and standards for the preparation of relevant materials for reimbursement.

I. Conditions for reimbursement

1. Insured employees: Employees who have participated in maternity insurance in Sichuan Province and have given birth during the period of insurance can enjoy the reimbursement treatment of maternity insurance.

2. Medical expenses: the scope of reimbursement mainly includes medical expenses for prenatal checkups, labor and delivery, abortion (including medication abortion and induced abortion), and family planning surgery.

3. Payment of insurance fees on time: the employee's unit or individual is required to pay maternity insurance fees in full and on time.

2. Reimbursement Standards

1. Prenatal examination fees: reimbursement will be made at a certain rate according to the specific examination items and hospital grade.

2. Delivery expenses: including normal delivery and cesarean section, with different reimbursement standards set according to different levels of hospitals and delivery methods.

3. Abortion expenses: the amount of reimbursement is set according to the type of abortion and the level of hospital.

4. Family planning surgery costs: such as birth control surgery, sterilization surgery, etc. The reimbursement rates are also set according to different items and hospital levels.

It should be noted that the exact amount and percentage of reimbursement may vary depending on the region and hospital grade. When making reimbursements, employees should bring along relevant documents and medical expense invoices and follow the prescribed procedures.

I. Understanding the conditions for reimbursement

Employees should first confirm whether they are enrolled in maternity insurance and understand the policies related to childbirth during the enrollment period. At the same time, make sure that medical expenses are eligible for reimbursement, such as prenatal checkups, labor and delivery, and abortion.

Second, prepare reimbursement materials

When applying for reimbursement, employees need to prepare relevant documents, such as ID cards, social security cards, marriage certificates, etc., as well as reimbursement materials, such as invoices for medical expenses and detailed lists of expenses.

Third, submit the reimbursement application

The employee will submit the prepared reimbursement materials to his/her unit or social security agency, and apply for reimbursement according to the stipulated procedures.

Four: Review and Reimbursement

The social security agency will review the submitted reimbursement materials, confirm that they are correct, and then reimburse them in accordance with the stipulated standards and ratios. The reimbursement amount will be credited directly to the employee's personal bank account.

In summary:

Sichuan maternity insurance reimbursement conditions and standards are mainly based on the "Sichuan Maternity Insurance Measures", the employee needs to meet the conditions of insurance, medical expenses meet the scope of reimbursement and other conditions, and prepare the relevant materials for reimbursement in accordance with the prescribed procedures and standards. The amount of reimbursement will be calculated according to the standards set for different programs and hospital levels.

Legal basis:

Sichuan Maternity Insurance Measures

Article 6 stipulates:

State organs and institutions, all kinds of urban enterprises and private non-enterprise units, social organizations, individual industrial and commercial enterprises with employees (hereinafter collectively referred to as the employers) and their employees or employees (hereinafter collectively referred to as the employees) within the administrative area of the province shall participate in maternity insurance in accordance with the provisions of these Measures. Measures shall participate in maternity insurance in accordance with the provisions of these Measures.

Article 8 stipulates:

The Maternity Insurance Fund shall compensate units in the form of maternity allowances. The criteria for compensation are as follows: in the case of a female worker who has had a normal delivery at or above seven months' gestation or a premature delivery at or below seven months' gestation, she shall be entitled to a maternity allowance of three months; in the case of a difficult delivery or caesarean section, the maternity allowance shall be increased by half a month; in the case of a multiple birth, the maternity allowance shall be increased by half a month for each additional child; in the case of a miscarriage or induced abortion at or above three months' gestation and at or below seven months' gestation, the maternity allowance shall be one and a half months; and in the case of a miscarriage or induced abortion at three months' gestation and below seven months' gestation, the maternity allowance shall be increased by half a month. The maternity allowance shall be increased by half a month for each additional child; for miscarriages or induced miscarriages of more than three months but less than seven months of pregnancy, the allowance shall be one and a half months. The maternity allowance is calculated on the basis of the average monthly wages paid for maternity insurance in the 12 months prior to the delivery or family planning surgery of the female worker.

The Social Insurance Law of the People's Republic of China

Article 54 stipulates that:

Where an employer has paid maternity insurance premiums, its employees are entitled to maternity insurance benefits; the employee's unemployed spouse is entitled to maternity medical expenses in accordance with State regulations. The necessary funds are paid from the Maternity Insurance Fund. Maternity insurance benefits include maternity medical expenses and maternity allowance.