How is maternity insurance reimbursed and what are the conditions?

1. Relevant persons who meet the requirements of the state, autonomous region and municipal family planning regulations; 2. Before childbirth, the employer has paid the maternity insurance in full for more than half a year. The employer shall assist in the application procedures for maternity insurance benefits. Among them, those who apply for maternity allowance or one-time childbirth nutrition subsidy shall also present a certificate of birth, death or termination of pregnancy.

China's ** requires employers to pay maternity insurance premiums for employees on time and in full in accordance with regulations. Its main purpose is to ensure that maternity workers receive medical care in a timely manner and to ensure their basic livelihood during childbirth. However, employees who do not have to pay maternity insurance can enjoy maternity insurance benefits, and reimbursement of maternity medical expenses must meet certain conditions.

According to China's maternity insurance regulations and the provisions of maternity insurance policies of various provinces and cities, if female employees of enterprises who give birth need to enjoy maternity insurance benefits and reimburse maternity insurance costs, they must meet the following conditions:

1. Employers and employees participate in maternity insurance in accordance with regulations;

2. Conform to national, provincial and municipal family planning policies;

3. Female employees continue to pay maternity insurance after childbirth;

4. Some areas have restrictions on the payment time of maternity insurance, for example, Changsha requires maternity employees to pay for 10 consecutive months, but Shenzhen has no restriction on the payment time of maternity insurance.

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1. How to reimburse maternity insurance?

1. Reimbursement materials: ID card, marriage certificate of husband and wife, basic medical insurance certificate for employees, medical certificate of birth of baby, original and copy of birth registration service certificate (i.e., birth certificate), original discharge record, original list of hospitalization expenses.

2. Reimbursement steps: The time for the employer to pay maternity insurance reaches the time limit of the local social security department, which is generally more than half a year or more than one year.

3. Reimbursement time: Generally, it is handled after childbirth and childbirth are discharged from the hospital. Generally, the baby's "birth medical certificate" should be handled in the local maternal and child health care and other institutions, and it cannot be done on the day of discharge.

It is also valid for half a year, or for three months, or for a full year.

4. Handling agency: In the social security department or social insurance agency of the hospital, you can consult the social security department or social security hall of the hospital.

5. Reimbursement method: Reimbursement of maternity insurance is divided into reimbursement according to the proportion of actual maternity expenses and fixed reimbursement. Reimbursement on a pro-rata basis, according to 85% of the total cost of maternity hospitalization or other proportions, and fixed reimbursement, that is, regardless of the actual expenses incurred in maternity hospitalization, will be issued according to a certain amount.

2. What are the conditions for reimbursement of maternity insurance?

1. Conform to family planning or carry out family planning surgery.

2. If the employer participates in the maternity insurance and pays the full amount of the employee for more than one year, and the employer pays the maternity insurance fee to the social insurance agency not more than 1% of the total salary of the unit, the method of pre-tax expenditure is adopted to indirectly subsidize the trouble, which shows that the maternity social insurance fee is still borne by the employer. As for the maternity insurance for female employees of public institutions, there is no need to pay any fees.

Employers that do not participate in the social pooling of maternity insurance shall bear the maternity expenses of their female employees. Reimbursement ratio of maternity insurance: Based on the average monthly salary of employees in the previous year in the locality, it will be paid in a lump sum according to a certain proportion.

Among them: 270% for normal delivery; dystocia was 320%; Caesarean section was 420%. The examination fees, midwifery fees, surgery fees, hospitalization fees and medicine expenses for female employees who give birth are paid by maternity insurance**.

The excess medical service fees and drug expenses (including the drug expenses for self-financed drugs and nutritional drugs) shall be borne by the employees. After a female employee is discharged from the hospital after giving birth, the medical expenses for diseases caused by childbirth shall be paid by maternity insurance**; Medical expenses for other diseases shall be handled in accordance with medical insurance benefits. After the expiration of maternity leave, if a female employee needs to rest due to illness, it shall be handled in accordance with the relevant sick leave benefits and medical insurance benefits.

1. What are the reimbursement conditions for maternity insurance?

If a woman wants to be reimbursed for maternity insurance, she must meet three conditions:

1. The time of paying maternity insurance is 1 year or more;

2. At the time of childbirth, the payment status of maternity insurance is normal, and it cannot be a state of severance;

3. Meet the national family planning regulations.

Therefore, after one year of resignation, you can not enjoy the reimbursement of maternity insurance, which is stipulated by the state, when participating in maternity insurance, you must be participated by Zheng Hong company, and then purchased for employees, employees can only pay maternity insurance with the employer, once the employee leaves, then the unit has no obligation to pay social security for it, so the maternity insurance will be interrupted, and it will not be able to enjoy the benefits of maternity insurance.

However, women can also be reimbursed through their husband's maternity insurance, and male employees also pay maternity insurance. If the maternity insurance of a male employee has been paid for 1 year, the maternity insurance of the male employee can be used for the wife when giving birth. At the same time, men can also take maternity leave to accompany their wives when they give birth, and the specific number of maternity leave days depends on the relevant local policies.

Second, personal maternity insurance to ** handle

Maternity insurance is an insurance program specially set up for childbirth, and generally speaking, maternity insurance is paid by units and individuals. When employees give birth, they can reimburse various expenses incurred in the process of childbirth through maternity insurance, and they can also escort the childbirth.

Maternity insurance cannot be handled by individuals, but can only be handled by the individual's unit and at the local social security department for their employees, and maternity insurance can be paid.

Maternity insurance is not difficult to handle, but when applying for maternity insurance, there are a lot of materials that need to be paid, and only when all the materials are collected can it be easy to handle maternity insurance. When applying for maternity insurance, there are many materials that need to be paid, such as the registration form of the unit in duplicate. Enrollment in maternity insurance filled in by the insured person and payment of maternity form, etc.

The items covered by maternity insurance generally include maternity allowance, maternity medical expenses, and expenses incurred by employees due to the implementation of family planning surgery, so when the maternity insurance is reimbursed, it is necessary to prepare relevant materials to be compensated quickly. It should be noted that maternity insurance is not only purchased for female employees, but also for male employees in the unit. However, the reimbursement standards are different between the two.

The employer shall apply to the social insurance agency within 18 months after the employee's childbirth or surgery, and shall fill in the Application Form for Maternity Benefits and provide the following information:

Birth certificate issued by the family planning administrative department;

Original materials such as maternity medical certificates, outpatient medical records, discharge summaries, and family planning surgery records;

Baby's birth certificate.

The social insurance agency shall, within 15 working days from the date of acceptance of the application, review the materials provided by the employer, and after the review is completed, the maternity insurance premiums shall be allocated to the employee's employer, and the employer shall issue the maternity insurance benefits to the employee in accordance with the items and standards of maternity insurance provided for in these Measures.

If the employer fails to go through the formalities for the employee to participate in the maternity insurance in accordance with the regulations, the employer shall pay the maternity insurance rebate expenses incurred by the employee in accordance with the maternity insurance treatment items and standards stipulated in these Measures.

The materials that need to be brought for reimbursement are:

Medical Expense Declaration;

ID card or social security card;

My bank card with the UnionPay logo;

My medical record;

Original production charges;

Itemized Expenses;

Discharge summary. It's a good idea to bring your birth permit with you. If you are collected by someone else, you need to bring the ID card of the person who collects the socks on your behalf.

<> maternity insurance refers to a social insurance system introduced in order to promote childbirth, encourage couples to have children, improve the physical health of children, and protect the economic rights and interests of couples to have children. The reimbursement policy of maternity insurance mainly includes the following points:

1. Scope of reimbursement of maternity insurance:

1. The reimbursement scope of maternity insurance includes prenatal examination, prenatal diagnosis, prenatal**, prenatal care, postpartum care, postpartum**, etc.

2. The reimbursement scope of maternity insurance also includes reimbursement for maternity hospitalization, reimbursement for maternity hospitalization nursing, reimbursement for maternity hospitalization drugs, reimbursement for maternity hospitalization examination, reimbursement for maternity hospitalization surgery, etc.

2. Reimbursement standards for maternity insurance:

1. The reimbursement standard of maternity insurance is mainly determined in accordance with the prescribed standards, and the general reimbursement ratio is 80%, and the maximum reimbursement amount does not exceed the specified maximum limit.

2. The reimbursement standard of maternity insurance can also be determined according to the actual situation in different regions, and the general reimbursement ratio is 80%, and the maximum reimbursement amount does not exceed the specified maximum limit.

3. Reimbursement process for maternity insurance:

1. Applicants first need to prepare relevant application materials, including ID card, medical insurance card, and disbanded inpatient medical records.

2. Then submit the application materials to the local social insurance agency, which will review the materials and confirm that the reimbursement conditions are met, and then issue the reimbursement amount.

3. Finally, the applicant needs to pay the reimbursement amount to the hospital and complete the reimbursement process.

4. Precautions for maternity insurance reimbursement:

1. Applicants need to understand the local maternity insurance reimbursement policy in advance in order to better apply for reimbursement.

2. Applicants need to prepare relevant application materials and ensure the authenticity of the materials so as not to affect the reimbursement.

3. The applicant needs to submit the application materials according to the specified time to avoid delay in reimbursement.

4. The applicant needs to be reimbursed in accordance with the prescribed reimbursement standards and the prescribed reimbursement ratio, so as not to affect the reimbursement.

In short, the reimbursement policy of maternity insurance mainly includes the scope of reimbursement, reimbursement standards, reimbursement process and reimbursement of family matters, etc., applicants need to understand the local maternity insurance reimbursement policy in advance, prepare relevant application materials, submit application materials according to the specified time, and reimburse according to the prescribed reimbursement standards, so as not to affect the reimbursement.

Maternity insurance process:

Maternity insurance is a compulsory insurance, paid by the unit where I belong, and the employer must pay for you, individuals are unable to pay, maternity insurance is a social policy to protect the rights and interests of female employees under the national law of the state, and regardless of whether the fetus is born normally, even if the fetus dies, miscarriage and so on can enjoy maternity insurance.

1.Before enjoying the maternity allowance, the unit needs to apply for maternity insurance for itself, and needs to prepare three forms, the basic pension, work-related injury and maternity insurance declaration summary table for enterprise employees, the social security registration form, and the increase and decrease table of pension, work and maternity insurance personnel, and these three forms are prepared by the enterprise;

2.The unit shall go to the social labor insurance department with these three forms to declare, and after the labor insurance department accepts the application, it will return two stamped forms;

3.Wait until the next month, the unit can normally pay the maternity insurance premiums of the new employees, which must be paid by the tax department;

5.After giving birth, a female employee submits materials to the social labor insurance department for insurance payment before the maternity leave reaches 30 days (pay attention to the time, it is more troublesome to handle it overdue);

6.After waiting for review, the staff will issue an application form for maternity insurance premiums for employees of urban enterprises;

7.The materials for insurance payment mainly include: the birth status form of employees of urban enterprises, identity information, birth certificates, medical certificates of hospitals, medical settlement lists, etc.;

8.After the approval of the social labor insurance department is completed, I can bring the relevant official documents to the social security department to receive the reimbursement of maternity insurance.

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Prerequisites for reimbursement of maternity insurance: the existence of an employment relationship between the employer and the employee; The employer has paid contributions for the employee for more than one year and continues to pay for him/her; Comply with national and provincial population and family planning regulations; Other. If the employer has already paid the maternity insurance premium, its employees shall enjoy the benefits of maternity insurance, and the unemployed spouses of the employees shall enjoy the treatment of maternity insurance expenses in accordance with the provisions of the state.

[Legal basis].Article 54 of the Social Insurance Law of the People's Republic of China.

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. All funds required are paid out of maternity insurance**.

Maternity insurance benefits include maternity medical expenses and maternity allowances.

1. Application materials: copies of the front and back of the ID card of the giving birth woman; "Certificate of Application for Maternity Insurance Benefits for Family Planning Status in Shanghai" issued by the township (town) people** or sub-district office.

2. If you have children in this city, you need to bring the "Maternity Medical Certificate" issued by the medical institution; If you have a child in another province or municipality, you must bring a maternity situation (difficult, normal or miscarriage) issued by a medical institution certified by the health administrative department. Present the child's abstract or medical records, the original and photocopy of the child's "Medical Certificate of Birth" and the baby; Those who give birth abroad or in Hong Kong, Macau and Taiwan must bring medical records and other materials issued by local medical institutions certifying the condition (difficult, normal or miscarriage) and a Chinese translation.

3. In the designated financial institutions (choose Industrial and Commercial Bank of China, China Construction Bank, Agricultural Bank of China, Postal and Savings Bank, Bank of Shanghai, Shanghai Pudong Development Bank, Shanghai Rural Commercial Bank, Bank of China, China Merchants Bank, Minsheng Bank, Bank of Communications, Everbright Bank, Huaxia Bank, CITIC Bank, Industrial Bank).

4. If you entrust someone else to handle it, you need to bring the power of attorney, the original of the principal's citizen ID card, and both sides.