How to use maternity insurance

Maternity insurance is a local law, and the reimbursement process of birth check-up expenses includes that maternity medical expenses are paid in advance by the insured, and the declaration procedures are handled at the subordinate units or neighborhood committees within 5 months after discharge. Bring information to the civil affairs service center. Local policies are different, and the relevant handling procedures and reimbursement ratios are also different. It is suggested to call relevant responsible departments for further consultation.

I. Registration

The handling personnel of the insured unit shall receive the Suzhou Maternity Insurance Registration Form (in triplicate, one for the medical insurance center, one for the employee's unit and one for the employee himself) from the medical insurance center within three months of the female employee's pregnancy and/or 0/5 days before the family planning operation, fill in the form according to the regulations, select the designated service organization, and carry the following materials (one original and one copy each) to the municipal medical insurance center for registration:

1, my ID card and photocopy, marriage certificate and photocopy, and three photos of 1 inch;

2, "reproductive health service certificate" or "birth medical certificate" and a copy; 3. others.

Second, designated medical care

The insured employees shall swipe their cards at the designated service institutions with the "Suzhou Maternity Insurance Registration Form", "Medical Insurance Certificate" and social security card. Insured employees only need to settle their out-of-pocket expenses when they leave the hospital, and the rest of the expenses will be settled with the medical insurance center by the designated service institutions on a monthly basis.

Three, non designated maternity expenses reimbursement

By the insured workers to fill in the "Suzhou maternity insurance workers referral approval form" or "Suzhou maternity insurance non-designated service institutions fertility application form", by the designated service institutions to make recommendations, to the relevant medical records and birth certificates to the city medical insurance center for. Within 60 days after delivery, the insured workers shall bring the following materials to the municipal medical insurance center for review and reimbursement (original and photocopy 1 copy):

1, maternity insurance registration approval form, medical insurance certificate, social security card;

2. Honorary certificate of only child parents;

3, entrust others to apply, should also submit the power of attorney issued by the applicant and the client's ID card;

4, reproductive medicine certificate (birth certificate, infant death certificate, expert appraisal certificate), discharge summary, a copy of the doctor's advice;

5, cost list and valid bills and other materials;

6, agency approval materials.

Four, non designated family planning operation expenses reimbursement

By the insured workers to fill in the "Suzhou maternity insurance workers referral approval form" or "Suzhou maternity insurance non-designated service institutions fertility application form", by the designated service institutions to make recommendations, to the relevant medical records and birth certificates to the city medical insurance center for. Insured employees should bring the following materials to the municipal medical insurance center for review and reimbursement within 60 days after the end of treatment (original and photocopy 1 copy).

1, maternity insurance registration approval form, medical insurance certificate, social security card;

2, entrust others to apply, it shall also submit the power of attorney issued by the applicant and the client's ID card;

3, family planning surgery medical certificate (abortion medical certificate, family planning surgery certificate), discharge summary, a copy of the doctor's advice; Expense list, valid bills and other materials;

4. Materials approved by the institution.

The use of maternity insurance is as follows:

Female employees can use 1 and maternity insurance in the Five Risks when giving birth, and the expenses such as birth check-up, delivery, operation, hospitalization and medicine can be reimbursed by employees to social security institutions with birth certificates and other materials. The conditions for employees to enjoy maternity insurance include that the employer and its employees have participated in maternity insurance in accordance with the regulations and have fulfilled their payment obligations for six months, but some places require payment of 12 months; Meet the statutory conditions and family planning regulations, or implement contraception and recanalization surgery;

The reimbursement process of maternity insurance includes: after pregnancy, before abortion or family planning operation, the employer or the staff of the street and town labor security service station will bring the application materials to the maternity insurance window of the district social labor insurance agency; After accepting the examination and approval, the staff will issue a medical certificate; Within 30 days of maternity leave, the employer or the staff of the street or town labor security service station shall bring the application materials to the maternity insurance window of the district social labor insurance department for treatment settlement; After accepting the examination and approval, the employee shall pay the maternity medical expenses and maternity allowance;

2. However, the medical service fee and medicine fee exceeding the prescribed amount shall be borne by the employees themselves.

Legal basis: Article 6 of the Trial Measures for Maternity Insurance for Enterprise Employees.

The examination fee, delivery fee, operation fee, hospitalization fee and medicine fee for the birth of female employees shall be paid by the maternity insurance fund. The medical service fee and medicine fee (including self-funded medicine and nutritional medicine) exceeding the prescribed amount shall be borne by the employees themselves.

After the female workers are discharged from the hospital, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; The medical expenses of other diseases shall be handled in accordance with the provisions of medical insurance benefits. After the expiration of maternity leave, if a female employee needs rest and treatment due to illness, it shall be handled in accordance with the relevant provisions on sick leave and medical insurance benefits.

Article 7

After a female worker gives birth or has an abortion, she shall go through the formalities at the local social insurance agency with the family planning certificate issued by the local family planning department and the certificate of birth, death or abortion of the baby, receive the maternity allowance and reimburse the maternity medical expenses.