There is maternity insurance and medical insurance how to reimburse

Reimbursement process of maternity insurance: 1. After a female employee becomes pregnant, has a miscarriage or has a family planning operation, she shall be assisted by the employer or the staff of the labor security service station of the street or town; 2. After acceptance and approval, the medical certificate will be issued; 3. Within 30 days of maternity leave, the above-mentioned personnel shall assist in the settlement of benefits; 4. Apply for maternity allowance and nutrition subsidy, fill in the relevant **, and submit the information for processing.

No, you cannot. If you have hospital medical insurance, you can only enjoy medical insurance if you are sick and hospitalized, and you cannot use it for outpatient services.

If you are insured and paid maternity insurance, you can only enjoy maternity insurance benefits when you give birth to a baby.

If you do not participate in and pay maternity insurance, you will not be able to enjoy maternity insurance benefits.

If you have maternity insurance, you can generally reimburse about 50% of the cost.

If you need to know more about social security and medical insurance, you can log in to the local social security bureau and health bureau**, or go to the social security bureau and health bureau in person to understand and consult relevant policies, regulations, knowledge and problems.

There are two types of medical insurance: comprehensive medical insurance and hospitalization medical insurance.

If you are enrolled in comprehensive medical insurance, some prenatal check-ups are free of charge, and the hospital will automatically waive this part of the fee when you go to the hospital for a check-up.

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Legal Analysis]: The process of reimbursement of the medical insurance card for the birth of a child is as follows: the reimbursement process for the birth expenses of the purchase of resident medical care is relatively simple, and the reimbursement can be made directly in the hospital.

Usually, the hospital will leave the social security card and maternity service certificate when the mother goes through the hospitalization procedures, and then will automatically demarcate the reimbursement part at the time of checkout. The reimbursement of purchasing employee medical care is relatively more troublesome, and you need to take the approval form and diagnosis certificate and other materials to the social security bureau with the cover wheel, 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 amount of 450 yuan for the defense letter. However, if it is a caesarean section, the general medical expenses can be reimbursed if they exceed 2,000, and 45% can be reimbursed if they are between 2,000 and 7,000; And more than 7,000 muffled points, can be reimbursed 65%.

Legal basis]: "Social Insurance Law of the People's Republic of China" Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

The reimbursement methods for Medicare maternity insurance are as follows:

1. There is no unified provision on the reimbursement standard of maternity insurance, maternity insurance reimbursement includes medical expenses and family planning fees, and the reimbursement ratio has different regulations in different regions, generally 75% of the woman's maternity insurance can be reported, and the man's maternity insurance can be reported 50%, which can only be reported to one party;

2. The standard for the payment of maternity allowance is generally the average monthly salary of the employees of the unit in the previous year divided by 30 times the number of vacation days;

3. One-time birth subsidy: 400 yuan for miscarriage, 2,400 yuan for normal birth, 4,000 yuan for dystocia and multiple births, limited to the woman's maternity insurance;

4. The examination fees, midwifery fees, surgery fees, hospitalization fees and medicine fees for female employees who give birth shall be paid by maternity insurance**. The medical service fees and drug expenses (including the drug expenses for self-financed drugs and nutritional drugs) in excess of the prescribed regulations 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 the provisions of 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 provisions on sick leave and medical insurance benefits.

Legal basisArticle 8 of the Special Provisions on Labor Protection of Female Employees.

For female employees who have participated in maternity insurance, the maternity allowance during maternity leave shall be paid by maternity insurance according to the standard of the average monthly salary of employees in the previous year; For those who have not participated in maternity insurance, they shall be paid by the prudent employer according to the standard of the salary of the female employee before the maternity leave.

The medical expenses for childbirth or miscarriage of female employees shall be paid by the maternity insurance in accordance with the items and standards stipulated in the maternity insurance, and for those who have already participated in the maternity insurance**; For those who do not participate in maternity insurance, they shall be paid by the Kuanchun employer.

The reimbursement of medical insurance and maternity insurance for the birth of a child is as follows: after giving birth, the local family planning department shall issue a family planning certificate and the birth certificate of the baby, and the applicant or the enterprise shall apply to the local social insurance agency to receive the maternity allowance and repay the maternity medical expenses.

Social Insurance Law of the People's Republic of China

Article 28.

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.

Law of the People's Republic of China on Social Travel and Business Association Insurance

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.

Social Insurance Law of the People's Republic of China

Article 53.

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 the employee shall enjoy the treatment of the cost of maternity medical treatment 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.

Maternity allowance refers to the living expenses provided by national laws and regulations for working women during the period when they leave work due to childbirth. The maternity insurance issued by the enterprise shall be included in the corresponding accounting subjects according to the department to which the employee belongs, and the specific accounting treatment is as follows:

1. When the enterprise accrues maternity insurance (excluding wages, personal social security and individual income tax entries):

Borrow: management expenses, etc. - social security premiums.

Credit: Employee Remuneration Payable - Social Security Premiums (Unit Part).

When paying maternity insurance:

Borrow: Employee remuneration payable - social security premiums (unit part).

Credit: Bank deposits.

2. When the enterprise receives the maternity insurance subsidy:

Borrow: Bank deposit.

Credit: Its letter is payable - collection of social security maternity insurance.

3. When the enterprise pays the employee maternity insurance subsidy:

Borrow: Other payables - collection of social security and maternity insurance.

Credit: Donghong Bank Deposit (or cash on hand).

Maternity insurance is an employee welfare paid by the enterprise for its employees, which shall be paid by the enterprise in accordance with national regulations, and employees shall not pay maternity insurance premiums. The main body of payment of maternity insurance allowance is the social security institution, and the natan register is transferred from the social security institution to the enterprise social security account, and then to the female employee herself.

At the same time, according to Article 35 of the Regulations for the Implementation of the Enterprise Income Tax Law (Order No. 512), the basic social insurance premiums, basic medical insurance premiums, unemployment insurance premiums, work-related injury insurance premiums, maternity insurance premiums and other basic social insurance premiums and housing provident funds paid by enterprises for employees in accordance with the scope and standards stipulated by the relevant competent authorities or provincial people, are allowed to be deducted.

1. If an insured employee gives birth outside the overall planning area or in a non-designated medical institution due to emergency and first aid (including business trips, family visits, and vacations, etc.), the employer or himself shall report to the medical insurance agency within three working days. 2. The medical expenses incurred after the approval of the medical insurance agency shall be paid by the individual first. 3. Within 90 days after discharge, bring the above materials to the medical insurance agency for settlement according to the regulations.

Those who seek medical treatment outside the overall planning area or in non-designated medical institutions need to clarify the level of their hospitals, and those who cannot determine the level are regarded as first-class hospitals. This is how maternity insurance is reimbursed.

Article 55 of the Social Insurance Law provides that maternity medical expenses include the following: (1) medical expenses for childbirth; (2) Medical expenses for family planning; (3) Other project expenses provided for by laws and regulations. Article 56 of the Social Insurance Law stipulates that employees who have any of the following circumstances may enjoy maternity allowance in accordance with the provisions of the state:

1) Female employees are entitled to maternity leave when they give birth; (2) Enjoy leave for family planning surgery; (3) Other circumstances provided for by laws and regulations. The maternity allowance shall be calculated and paid according to the average monthly salary of the employee in the previous year.

Legal Analysis:1Submissions:

The employer needs to provide the application materials, and then the qualified employees will submit the materials to the local social insurance department. 2.Review materials: The social insurance department is to review the submitted materials and notify the applicant after the review is passed; 3.

Legal basis: Article 54 of the Social Insurance Law of the People's Republic of China 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 expenses of hospitalization when giving birth can be reported to the medical insurance and settled directly with the medical insurance card in real time. The cost of giving birth to a child includes hospitalization for normal childbirth and childbirth, and family planning surgery. Medical expenses for hospital delivery are settled directly online by the social security card.

Usually, the hospital will leave a social security card and maternity service card when the mother goes through the hospitalization procedures, and will automatically demarcate the reimbursement part at the time of checkout. Proportion of reimbursement of medical insurance hospitalization expenses. 1. Urban workers:

90% for Level 1 hospitals, 80% for Level 2 hospitals, and 70% for Level 3 hospitals. 2. Urban residents: the reimbursement ratio is 65%.

3. Cooperative medical care: 27% for Level 1 hospitals, 50% for Level 2 hospitals, and 60-70% for Level 3 hospitals.

Article 8 of the detailed rules for the implementation of the Social Insurance Law of the People's Republic of China Article 8 The medical expenses incurred by the insured persons in the agreed medical institutions shall be paid from the basic medical insurance in accordance with the provisions of the state if they meet the standards of the basic medical insurance drug catalog, diagnosis and treatment items and medical service facilities. If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue purposes may be appropriately relaxed. The specific management measures for emergency and rescue medical services for insured persons shall be formulated by the Qichai overall planning area according to the actual local situation.