Article 1 These Measures are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC), the Special Provisions on Labor Protection for Female Workers, the Provisions on Maternity Insurance for Guangdong Workers and other laws, regulations and rules, and in combination with the actual situation of this Municipality.

Article 2 State organs, enterprises and institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations and individual industrial and commercial households with employees (hereinafter referred to as employers) within the administrative area of this Municipality shall participate in maternity insurance for all employees of their own units (including employees, hereinafter referred to as employees) and pay maternity insurance premiums in accordance with regulations.

Article 3 An employer and its employees shall participate in maternity insurance at the place where the employer is registered. If the employing unit is a state organ or a people's organization, it shall participate in maternity insurance in the district where the unit is located.

Central units stationed in Guangdong, provincial units and their employees, employers belonging to non-military employees, armed police forces and their non-military employees who participate in social medical insurance in this city also participate in maternity insurance in this city.

Article 4 The municipal social insurance administrative department shall be responsible for the organization and implementation of these Measures and the management of maternity insurance in this Municipality. The social insurance administrative departments of each district shall be responsible for the management of maternity insurance within their respective administrative areas.

The social insurance premium collection agency is responsible for the collection of maternity insurance premiums.

City (District) social insurance agencies specifically undertake maternity insurance registration, maternity insurance premium verification, personal rights records, maternity insurance benefits payment and other matters, and are responsible for providing maternity insurance business consulting, information inquiry and other services.

City (District) development and reform, finance, health and family planning, auditing, industry and commerce, food and drug supervision, local tax, trade unions, women's federations and other relevant departments, in accordance with their respective responsibilities, coordinate the implementation of these measures.

Article 5 The maternity insurance fund shall be raised and used according to the principle of fixed income and expenditure and balance of payments. Maternity insurance premiums are paid by the employer, and individual employees do not pay.

When the maternity insurance fund fails to meet its expenses, it shall be supplemented by the finance at all levels. [ 1]

Article 6 The maternity insurance fund consists of the following funds:

(1) Maternity insurance premium;

(two) the interest of maternity insurance fund;

(3) late fees;

(4) financial subsidies;

(five) other funds incorporated into the maternity insurance fund according to law.

Article 7 The employing unit shall pay the maternity insurance premium on a monthly basis according to 0.85% of the total wages of all employees of the unit last month.

If the total wages of employees of the employing unit last month exceeded 3 times the average monthly wages of employees in the previous year of this Municipality multiplied by the product of the number of employees in this unit, the excess part will not be used as the payment base.

If the employer does not have the total wages of employees in a month, the total wages of employees in that month shall be the payment base.

Article 8 The maternity insurance fund of this Municipality shall be co-ordinated at the municipal level, raised and managed in a unified way.

Maternity insurance fund into the financial accounts of social security funds, the implementation of two lines of revenue and expenditure management, separate accounts, earmarking. No unit or individual may misappropriate it.

Article 9 Where an employing unit participates in maternity insurance in this Municipality for all its employees and pays maternity insurance premiums in full and on time, its employees (hereinafter referred to as the insured) shall enjoy corresponding maternity insurance benefits in accordance with regulations.

Maternity insurance benefits in this Municipality include maternity medical expenses (including maternity medical expenses and family planning operation medical expenses, the same below) and maternity allowance.

Tenth maternity insurance fund to pay the insured maternity medical expenses shall comply with the provisions of the national and provincial maternity insurance drug list and basic medical insurance diagnosis and treatment items, medical service facilities standards (hereinafter referred to as the "three directories").

The following medical expenses incurred by the insured for medical treatment are paid by the maternity insurance fund if they conform to the norms of diagnosis and treatment and the scope of the "three catalogues":

(1) Maternity medical expenses: refers to the medical expenses incurred by female workers during pregnancy and childbirth, including prenatal examination expenses, termination of pregnancy expenses, delivery expenses, operation expenses, hospitalization expenses, medicine expenses and pregnancy complications and complications diagnosis and treatment expenses. Prenatal check-up items shall be implemented in accordance with the Notice of guangdong provincial department of human resources and social security on the Prenatal Check-up Items of Maternity Insurance for Employees (Guangdong Social Regulation [2014] No.6). Prenatal check-up items are divided into routine items and reference items, and designated medical institutions can determine the check-up items and check-up times according to obstetric industry norms and the actual needs of the insured during pregnancy. [ 1]

(2) Medical expenses for family planning operation: including medical expenses incurred by workers in placing or taking out intrauterine devices, tubal ligation or recanalization, induced abortion, induced labor, etc.

(three) other project expenses as stipulated by laws, regulations and rules.

The medical expenses incurred by the insured during the maternity period that are not covered by the maternity insurance fund shall be included in the social medical insurance fund according to the regulations.

Eleventh the following expenses shall not be paid by the maternity insurance fund:

(1) Maternity medical expenses that should be borne by the party responsible for the accident according to law due to medical accidents;

(two) the expenses that should be borne by the public health or family planning technical service projects;

(three) the expenses that should be paid by the social medical insurance fund or the industrial injury insurance fund;

(4) Maternity medical expenses incurred abroad or in Hong Kong, Macao and Taiwan;

(five) the insured or their relatives choose special medical services or medical expenses and service facilities beyond the prescribed scope;

(six) other expenses stipulated by laws, regulations and rules that should not be paid by the maternity insurance fund.

Twelfth maternity allowance shall be paid by the maternity insurance fund according to the average monthly salary of the employees of the employer in the previous year when the insured person gives birth or carries out family planning surgery, divided by 30, and then multiplied by the prescribed number of vacation days.

The average monthly salary of employees in the previous year of the employing unit shall be determined according to the sum of the total monthly wages of employees insured in the previous natural year of the unit approved by the social insurance agency divided by the sum of the number of employees insured in each month. If the employer does not have the average monthly salary of employees in the previous year, the maternity allowance shall be calculated according to the average monthly salary of employees in this year.

Thirteenth insured persons enjoy maternity allowance holiday days, calculated in accordance with the following provisions:

(1) Maternity leave of the insured: 98 days for natural delivery; Dystocia (caesarean section, third degree perineal rupture) plus 30 days; Suction delivery, forceps delivery and breech traction delivery plus 15 days; Multiple births, multiple births 1 baby, increase 15 days. 15 days of pregnancy less than 2 months; Pregnant for more than 2 months but less than 4 months, 30 days; Pregnant for more than 4 months (including 4 months) to less than 7 months, 45 days; If stillbirth and premature birth do not survive after more than 7 months of pregnancy, it is 75 days. If the insured dies due to childbirth, the leave for enjoying maternity allowance shall be calculated according to the actual days from prenatal 15 and postpartum to death.

(two) the insured family planning operation holiday: take out the intrauterine device for 2 days; Placed intrauterine device for 3 days; Tubal ligation for 30 days; Vasectomy, 10 days; Tubal or vas deferens recanalization 14 days. At the same time, the above two kinds of birth control operations are carried out, and the holidays are calculated together.

(3) If it belongs to family planning incentive leave or late marriage, late childbearing incentive leave or breastfeeding leave, the insured person does not enjoy maternity allowance, and the employer shall pay maternity leave wages in accordance with relevant regulations.

If the state, province and city have new regulations on maternity leave or family planning operation leave, those regulations shall prevail.

Fourteenth insured persons enjoy maternity leave or family planning operation leave in accordance with the relevant provisions, maternity insurance fund in accordance with the following provisions:

(a) the insured to participate in the city's maternity insurance payment over 1 year, should enjoy the maternity allowance by the social insurance agencies to the employer on a monthly basis.

(II) During the period of enjoying maternity insurance benefits, if the employer stops paying maternity insurance premiums for the insured, the maternity insurance fund will stop paying maternity allowance to the employer from the month when the payment is stopped, and the maternity leave salary during the period when the insured stops paying will be paid by the employer.

Article 15 If the insured person has participated in the maternity insurance in this Municipality for a total of 1 year, the employer shall apply to the social insurance agency for the payment of maternity allowance from 1 year after the insured person gives birth or carries out family planning operation, and provide the following information: [1]

(1) An application form for enjoying maternity insurance benefits;

(2) The valid identity certificate of the insured (the original copy shall be kept after verification);

(3) A medical certificate of the birth or death of the baby;

(four) proof materials that meet the conditions of family planning (a copy of the original shall be retained after verification);

(5) In case of dystocia, multiple births, termination of pregnancy or family planning operation, a diagnosis certificate from a medical institution shall also be provided.

Article 16 If the insured person has participated in the maternity insurance in this Municipality for less than 1 year, the employer shall apply to the social insurance agency for the payment of maternity allowance within 1 year after the accumulated payment of 12 months. When applying for maternity allowance for such insured persons, the employer shall provide information in accordance with the provisions of Article 15 of these Measures, and shall also supplement the following information:

(a) the labor contract or the employer's recruitment certificate. If it is a labor dispatch, a labor dispatch agreement is also required;

(two) the employee's salary payment voucher during the on-the-job period;

(3) The business license, registration certificate or organization code certificate of the employing unit.

Seventeenth employers did not provide information to apply for maternity allowance, social insurance agencies will no longer pay maternity allowance for the insured.

The social insurance agency shall pay the maternity allowance within 30 days from the date of receiving the application from the employer, and it meets the payment conditions upon examination; Do not meet the payment conditions, it shall make a written decision not to pay within 30 days, and explain the reasons and basis.

Eighteenth municipal social insurance administrative department is responsible for determining the designated medical institutions of maternity insurance in this Municipality (hereinafter referred to as designated medical institutions). The social insurance agency shall sign a service agreement with the designated medical institutions, clarify the service items, the rights, obligations and responsibilities of both parties, and the relevant expense settlement standards, and announce the list of designated medical institutions to the public.

Nineteenth insured persons to participate in the city's maternity insurance payment period of 1 year, should be in 12 weeks after pregnancy, according to the following methods for medical confirmation procedures:

(a) the insured shall independently choose a designated medical institution in this Municipality to handle the medical confirmation procedures, and provide relevant information as required.

(2) The designated medical institution that has gone through the procedures for confirming the insured person's medical treatment shall immediately transmit the relevant information of the insured person to the social insurance agency.

(3) If the social insurance agency meets the conditions for enjoying maternity insurance benefits, it shall be marked in the maternity insurance information system and transmitted to the designated medical institution that has gone through the medical confirmation procedures, which will become the "selected medical institution" of the insured.

(4) When the insured who has gone through the medical treatment confirmation formalities goes through the check-in formalities at the selected medical institution for the first time, the selected medical institution will print the confirmation receipt as the medical treatment certificate of the insured.

(five) the insured person shall not change the selected medical institution in principle during the period of enjoying the treatment of maternity medical expenses. If it is really necessary to change the selected medical institution due to special reasons such as medical condition restriction and change of residence, it shall apply to the social insurance agency for the change formalities with the original medical confirmation certificate and relevant certificates of the reasons for the change.

(six) for medical confirmation procedures should provide the following information:

1. application form for medical confirmation of maternity insurance;

2. Guangzhou Maternal Health Care System Management Manual;

3. Proof of compliance with family planning regulations (a copy shall be kept after verification of the original);

4. A valid identity document (a copy shall be kept after the original is verified);

5. Photos of recent certificates.

Twentieth insured persons enjoy maternity insurance benefits in this Municipality, and shall implement the following medical management regulations:

(1) The insured shall go through the formalities of prenatal examination and medical confirmation of delivery at the selected medical institution. The medical institutions selected by the insured, as well as other designated medical institutions at the same level in this Municipality managed by the same legal person institution, can be regarded as the medical institutions selected by the insured (hereinafter collectively referred to as the selected medical institutions). The insured person can seek medical treatment in non-selected medical institutions due to emergency delivery, and should be transferred to selected medical institutions in time after his condition is stable.

(2) If the insured person needs abortion, induced labor or family planning operation, he/she does not need to go through the medical confirmation procedures, and he/she can choose the designated medical institutions in this Municipality for medical treatment with the supporting materials that meet the family planning regulations. [ 1]

(3) If the insured person needs to be transferred to a higher-level designated medical institution or a specialized designated medical institution for diagnosis and treatment due to illness, an application shall be made by the designated medical institution department and reported to the medical department of the institution for approval. When being transferred to a hospital, the transfer registration form of Guangzhou maternity insurance insured person (hereinafter referred to as the transfer registration form) should be filled out for the transfer and transfer to designated medical institutions.

(4) If the insured person needs medical examination, delivery or family planning in a different place due to special circumstances, the unit shall confirm that before going to a different place for medical treatment, he/she shall fill out the Application Form for Medical Treatment in a Different Place for the Employee Maternity Insurance Insured in Guangzhou (hereinafter referred to as the Application Form for Medical Treatment in a Different Place), hold relevant materials, and enjoy maternity insurance benefits in accordance with the regulations with the approval of the social insurance agency.

Article 21 The maternity medical expenses incurred by the insured for medical treatment that meet the requirements of maternity insurance shall be settled by social insurance agencies and designated medical institutions in accordance with the average quota standard of maternity medical expenses and family planning operation medical expenses (hereinafter referred to as the quota standard). Among them, the quota standard of delivery medical expenses is determined according to the quota standard of prenatal examination expenses and the quota standard of hospitalization delivery expenses.

The quota standard shall be separately determined by the municipal social insurance administrative department, and the social insurance agency shall sign a service agreement with the designated medical institution for implementation.

The scope of serious high-risk pregnancy diseases shall be implemented in accordance with the provisions of the "Guangzhou High-risk Pregnancy Management Measures" formulated by the municipal health and family planning administrative department.

If the total amount of maternity medical expenses incurred by the insured in the designated medical institutions after medical confirmation is within 6,543.8+0,000 yuan (including 6,543.8+0,000 yuan), the social insurance agency and the designated medical institutions shall settle according to the quota standard; The part exceeding RMB 6,543,800+0,000 yuan shall be settled according to the service items after being audited by the social insurance agency.

The insured person independently chooses special medical services such as "painless delivery", and part of the expenses beyond the basic medical services or the standards stipulated in the "three catalogues" shall be borne by the insured person; The cost of high-tech services beyond the scope specified in the "Three Catalogs" shall be chosen by the insured and borne by the insured in full.

Twenty-second insured maternity medical expenses, according to the provisions should be paid by individuals, by designated medical institutions to individuals; The expenses that should be paid by the maternity insurance fund shall be accounted for by the designated medical institutions first, summarized monthly, provided with the "Guangzhou Maternity Insurance Medical Expenses Settlement Declaration Form" and medical records and other related materials, and reported to the social insurance agency for settlement.

Maternity medical expenses (including prenatal examination and other expenses) incurred by the insured in a number of medical institutions deemed to choose medical treatment shall be summarized by the medical institutions selected by the insured, and shall be declared and settled to the social insurance agency according to the production type (or operation type) quota standard corresponding to a number of births.

Twenty-third referral and referral to designated medical institutions respectively by the "referral registration form" to the social insurance agencies to declare the settlement fee. Social insurance agencies are transferred out and transferred to designated medical care according to quota standards.