How to reimburse for giving birth to a child with medical insurance, and how to reimburse medical in

Birth health insurance card.

The reimbursement process is as follows:

The reimbursement process for the cost of giving birth to a child for the purchase of resident medical care is relatively simple, and the reimbursement can generally be made directly at the hospital. Usually, the hospital will leave a social security card and a maternity service certificate when the mother goes through the hospitalization procedures.

After that, the reimbursement portion will be automatically crossed out at checkout. The reimbursement of purchasing employee medical care is relatively more troublesome, and you need to go to the Social Security Bureau with the approval form and diagnosis certificate and other materials, fill in **, and submit the materials. Taking the reimbursement of the cost of giving birth to a child by the residents' medical insurance as an example, a fixed subsidy of 300 yuan will be given for a smooth birth in a township-level designated hospital.

If you give birth in a designated hospital at or above the county level, you will receive a fixed subsidy of 450 yuan. But if it's a caesarean section.

If the general medical expenses exceed 2,000, they can be reimbursed, and between 2,000 and 7,000, they can be reimbursed by 45%; And the part over 7,000 can be reimbursed 65%.

Generally speaking, the medical expenses incurred by giving birth to a child belong to the scope of reimbursement of maternity insurance, and only if you participate in the social medical insurance and participate in the medical insurance for childbirth, you can enjoy the medical insurance reimbursement treatment.

Medical insurance is a type of insurance that compensates for the medical expenses incurred by illness. Social insurance is a social insurance in which an employee is provided with necessary medical services or material assistance by the society or enterprise when he or she is sick, injured or gives birth.

According to the provisions of the "Social Insurance Law", the medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance ** in accordance with national regulations.

The following medical expenses are not covered by basic medical insurance**:

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

Different cities have different medical insurance and maternity insurance reimbursement policies, generally speaking, the medical expenses incurred in giving birth to a child are covered by maternity insurance, and maternity medical expenses include the following:

1) Medical expenses for childbirth;

2) Medical expenses for family planning;

3) Other project expenses as provided for by laws and regulations.

Maternity insurance is specifically aimed at the employees of urban enterprises, and those young people who do not have a job but participate in the resident medical insurance, because they do not have maternity insurance, once they give birth, all the medical expenses will be paid out of their own pockets. Therefore, some cities have introduced medical insurance policies to include the medical expenses incurred by residents in hospital and childbirth into the scope of payment of residents' medical insurance**, so as to reduce the medical burden of insured residents.

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The reimbursement process for giving birth to a child is as follows:

1. The applicant submits an application on the official platform of social security insurance management;

2. Submission of materials;

3. Material review;

4. If the review is passed, a one-time notice of supplemental materials shall be issued and the relevant materials shall be supplemented if the audit is not passed;

5. Organize the acceptance materials;

6. Make a payment. For prenatal examination fees and production expenses, the parties concerned should bring their marriage certificates, social security cards (citizen cards) and family planning certificates issued by the street to the designated hospitals for maternity insurance to settle directly by swiping the card. Employees shall participate in maternity insurance, and the employer shall pay maternity insurance premiums in accordance with national regulations, and employees shall not pay maternity insurance premiums.

Social Insurance Law of the People's Republic of China

Article 54.

If the employer has already paid the maternity insurance premium, its employees are entitled to maternity insurance benefits; The unemployed spouse of an employee shall be entitled to maternity medical expenses in accordance with the provisions of the state. The required funds are paid out of maternity insurance**.

Maternity insurance benefits include maternity medical expenses and maternity allowances. Article 55.

Maternity medical expenses include the following:

1) Medical expenses for childbirth;

2) Medical expenses for family planning;

3) Other project expenses as provided for by laws and regulations.

If a female employee participates in the insurance herself, the reimbursement of maternity insurance can be settled at the time of childbirth in the hospital or after the local reimbursement is satisfied, and the applicant or the employer shall bring the application form, the certificate of hospitalization, the ID card of the insured person and other materials to the maternity department of the place of insurance for reimbursement.

If the woman is not employed (the spouse has purchased maternity insurance), she holds a valid unemployment registration certificate in the city; If the unemployed spouse does not enjoy the basic medical insurance benefits for urban and rural residents in the city or the place where his or her household registration is located, the employer of the insured male employee may handle sporadic reimbursement of maternity medical expenses.

Legal basis: Article 54 of the Social Security Insurance Law of the People's Republic of China provides that if an employer has paid maternity insurance premiums, its employees shall enjoy maternity insurance benefits; The unemployed spouse of an employee shall be entitled to maternity medical expenses in accordance with the provisions of the state. The required funds are paid out of maternity insurance**.

Maternity insurance benefits include maternity medical expenses and maternity allowances.

The amount of reimbursement for the birth of a child under the resident medical insurance: 1. The amount of maternity allowance is equal to the average salary of the unit in the current month divided by 30 (days) multiplied by the number of vacation days; 2. Maternity medical expenses, medical expenses after confirming the identity of maternity medical treatment, shall be settled by the Municipal Labor and Social Security Bureau and the hospital in a fixed amount; 3. Calculation methods for other types of subsidies.

Legal basis] Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses for emergency and rescue, and shall be paid from the basic medical insurance ** in accordance with national regulations. Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

If you still have questions about this issue, it is recommended that you organize the relevant information and communicate with a professional in detail.

The reimbursement of the birth of a child must be paid for one consecutive year of maternity insurance before Duan Bosun can be reimbursed, and the maternity insurance is included in the medical insurance. Go to the designated hospital for social security (generally larger hospitals are), bring your social security card and ID card. Reimbursement is available at the hospital.

Article 53 of the Social Insurance Law of the People's Republic of China stipulates that employees shall participate in maternity insurance, and the employer shall pay maternity insurance premiums in accordance with national regulations, and employees shall not pay maternity insurance premiums. Article 54 Where an employer has already paid maternity insurance premiums, its employees shall enjoy maternity insurance benefits; The unemployed spouse of the employee shall enjoy the treatment of maternity medical expenses according to the provisions of the state. The required funds are paid out of the maternity insurance chain**.