Reimbursement conditions: 1. Comply with national, provincial and municipal family planning policies; 2. When giving birth or undergoing family planning surgery, the employer has participated in maternity insurance and paid maternity insurance premiums in full and continuously for 10 months; 3.
, prenatal check-up, hospitalization due to birth complications before delivery or within 4 months after delivery must be in normal payment status in the month.
With reference to Article 14 of the "Maternity Insurance Regulations for Employees of Jiangsu Province", if the employee's employer pays the maternity insurance premium in full and on time, the employee shall enjoy maternity insurance benefits in accordance with national regulations; the employee's unemployed spouse shall enjoy maternity insurance in accordance with national and provincial regulations.
Medical expense benefits.
The required funds are paid from the maternity insurance fund.
When an employee or the employee's unemployed spouse gives birth, has a miscarriage, induces labor, or undergoes family planning surgery, and the employer pays for the employee's continuous payment for less than 10 months, the employee's maternity medical expenses or the employee's unemployed spouse's medical expenses for childbirth shall be paid by the maternity insurance fund;
The employee's maternity allowance and one-time nutritional subsidy will be paid by the maternity insurance fund after the employer has paid continuously for 10 months.
Reimbursement materials 1. Reimbursement materials for maternity insurance for female employees 1. Nanjing maternity insurance benefit declaration form; 2. Original marriage certificate; 3. Only child certificate; 4. Discharge record; 5. Discharge summary; 6. Hospitalization note; 2. Male
Employee maternity insurance reimbursement materials 1. Nanjing Maternity Insurance sporadic reimbursement application form 2. Marriage certificate; 3. Only child certificate; 4. Discharge summary or outpatient medical records; 5. Hospitalization notes and outpatient notes; 6. Spouse's "Employment Registration Certificate"
;7. Unemployment certificate issued by the street (township).
Reimbursement process 1. Prepare the above information.
2. Calculation of benefits payment for the Fertility Department of the Social Security Center.
3. Review by the Finance Department of the Social Security Center.
4. The leader in charge of the Social Security Center shall review and distribute the funds.
Reimbursement standards The scope of reimbursement from Nanjing Maternity Insurance includes prenatal examination fees, childbirth medical expenses, birth complications, family planning surgery fees, one-time nutrition subsidies, etc.
The specific amounts are as follows: (1) The maximum reimbursement for medical expenses incurred during childbirth is 2,000 yuan, the maximum reimbursement for assisted delivery is 2,200 yuan, and the maximum reimbursement for caesarean section is 3,500 yuan.
(2) Fertility complications: Medical expenses incurred by 27 types of fertility complications, and all of them meet the payment scope and standards of maternity insurance, can be reimbursed on a proportional basis.
(3) One-time nutritional expenses: paid by the maternity insurance fund, and the payment standard is 2% of the average salary of Nanjing employees in the previous year.
(4) Family planning surgery costs: Different surgeries have different reimbursement rates.
(5) Prenatal examination fees: For examinations at registered designated hospitals, you must first pay the examination fees yourself, and then bring the relevant vouchers to the social security agency for reimbursement.
Reimbursement scope Nanjing maternity insurance reimbursement scope includes maternity examination fees, delivery fees, surgery fees, hospitalization fees and medicine fees, which are paid by the maternity insurance fund.
Medical service fees and drug fees (including self-paid drugs and nutritional drugs) that exceed the prescribed regulations shall be borne by the individual employees.
After a female employee is discharged from hospital after giving birth, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; the medical expenses for other diseases shall be handled in accordance with the provisions of medical insurance benefits.
After the expiration of maternity leave, female employees who need rest and treatment due to illness shall be handled in accordance with the relevant provisions on sick leave benefits and medical insurance benefits.
Reimbursement ratio: The reimbursement ratio of maternity insurance is based on the average monthly salary of employees in the location in the previous year, and is paid in one lump sum according to a certain proportion.
Among them: 1. Natural birth is 270%; 2. Dystocia is 320%; 3. Cesarean section is 420%.
Since the country does not have unified regulations on the reimbursement ratio of maternity insurance, and the reimbursement ratio of maternity insurance may vary in each region, insured persons should consult the local social security bureau and refer to the local social security center.
Reimbursement cycle: Maternity insurance is generally reimbursed in the second month after the child is born, and reimbursement can be made within the current year at the latest.
The time for Nanjing's maternity reimbursement is generally after the end of maternity leave or within one year after an abortion (induced abortion). However, it is recommended to call for consultation before applying for reimbursement, or go directly to the neighborhood committee for consultation to avoid unnecessary trouble.
Moreover, when applying for maternity insurance reimbursement, you should apply for it within working days and not on non-working days.
The maternity subsidy payment usually arrives in the unit's account in the middle or late month of the month following the month of application, and is then paid to the individual by the unit.
To put it simply, after completing the application procedures for maternity allowance, the maternity allowance can be applied for and credited in the middle to late second month.