Maternity insurance reimbursement standard:
First, the maternity insurance fund compensates the unit in the form of maternity allowance. The compensation standard is: if a female employee is pregnant for more than 7 months (including 7 months) and gives birth naturally or gives birth prematurely less than 7 months, she will enjoy the maternity allowance for 3 months; Cesarean section in dystocia, giving birth allowance for half a month; If there are multiple births, a maternity allowance of half a month will be given for each additional baby; And abortion or induced labor for more than 3 months (including 3 months) but less than 7 months, enjoy 60 months. Maternity allowance is based on the average monthly payment salary of maternity insurance for female employees before prenatal or family planning operation 12 months.
Two, maternity nutrition subsidies and perinatal health care subsidies, who meet the requirements of the state to enjoy maternity leave for more than 90 days (including 90 days) can enjoy maternity nutrition subsidies in 300 yuan, perinatal health care subsidies in 700 yuan.
3. One-time maternity allowance: female employees who take part in maternity insurance in our company are unemployed, and if they give birth in accordance with family planning regulations during the period of receiving unemployment insurance benefits, they can enjoy one-time maternity allowance: 2,400 yuan for miscarriage in 400 yuan, 4,000 yuan for dystocia multiple births, and 50% for male employees whose spouses are not included in maternity insurance and give birth to their first child in accordance with family planning regulations.
Four, maternity allowance compensation to the unit, the insured female workers during maternity leave my basic salary, bonus and welfare expenses paid by the unit.
Five, the cost of family planning operation, including the implementation of placing (taking out) IUD, induced abortion, induced labor, skin burial, sterilization and recanalization surgery due to family planning needs, included in the settlement scope of maternity insurance fund.
Maternity allowance:
(1) Female employees enjoy maternity leave.
(2) Enjoy family planning operation leave.
(3) Other circumstances stipulated by laws and regulations.
(Average monthly salary of employees in the last year of the employer where employees work /30 days × holiday days)
Holidays:
① Normal maternity leave is 90 days (including prenatal examination 15 days).
② The one-child leave is increased by 35 days.
③ Late maternity leave increased by 15 days.
4 maternity leave is difficult. Caesarean section and third degree rupture of perineum increased by 30 days; Suction delivery, forceps delivery and breech delivery increased 15 days.
⑤ The maternity leave of multiple births is increased by 15 days for each additional baby.
⑥ Abortion leave: less than 2 months pregnant 15 days; Less than 4 months and 30 days pregnant; 4 months or more (including 4 months) to 7 months is 42 days; In case of stillbirth, stillbirth or premature delivery for more than 7 months, the survival time is less than 75 days.
How much can medical insurance reimburse for caesarean section expenses?
Abortion of 400 yuan, natural delivery of 2400 yuan, dystocia of multiple births of 4000 yuan.
Natural delivery 1 100 yuan, midwifery 1300 yuan, caesarean section 2 100 yuan.
Normal production reimbursement 1000 yuan; Cesarean section reimbursement 2000 yuan.
Reimbursement of maternity insurance refers to the supplementary behavior of maternity insurance to employees who meet the following conditions: giving birth in line with the national family planning policy or carrying out family planning surgery. Or employees who have participated in maternity insurance for a total of one year and are still insured when giving birth (abortion) shall enjoy maternity insurance benefits according to relevant regulations.
How is the maternity insurance treatment specifically stipulated?
Maternity insurance medical expenses reimbursement quota system. Insured employees of state organs and institutions with full financial allocation can be reimbursed for medical expenses of 2,660 yuan for flat delivery and 3,660 yuan for caesarean section (including examination expenses during delivery, delivery expenses, operation expenses, hospitalization expenses and medical expenses for birth complications during maternity leave), and do not enjoy maternity allowance.
During maternity leave, female employees of enterprises can enjoy 3 months maternity allowance in addition to the above normal medical expenses; Additional maternity allowance in the following cases:
1, if caesarean section is performed, the maternity allowance will be increased for half a month;
2, in line with the conditions of family planning and late childbirth, an increase of one month's maternity allowance;
3, multiple births, each birth of a baby, an increase of half a month maternity allowance;
4, during the maternity leave to apply for the "one-child honor certificate", an increase of one month maternity allowance.
3. What is the non-payment scope of the maternity insurance fund?
Expenses for neonatal treatment, nursing or maternal and child supplies during hospitalization;
(two) the cost of embryo transfer and in vitro fertilization;
(three) pregnancy 14 weeks or more meets the statutory fertility conditions, and the pregnancy is terminated by itself due to non-medical needs and other circumstances that do not meet the requirements of the family planning department;
(four) medical expenses for termination of pregnancy caused by accidents such as alcoholism, drug abuse and self-injury;
(five) do not have the clinical proof of caesarean section, personal request caesarean section, beyond the cost and allowance of flat delivery surgery;
(six) medical expenses incurred in giving birth or carrying out family planning operations in different places and non-designated medical (service) institutions without approval;
(seven) the medical expenses incurred during the birth or family planning operation were identified as medical accidents;
(eight) beyond the scope of maternity insurance, diagnosis and treatment projects, service standards and drug costs;
(nine) other fees that should not be paid according to the regulations.
legal ground
People's Republic of China (PRC) social insurance law
Article 26
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Article 30
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.