(A) Suzhou maternity insurance reimbursement standards for female employees

1. Maternity medical expenses reimbursement standard

Maternity medical expenses, such as inspection fees, delivery fees, operation fees, hospitalization fees, medicine fees, etc., which meet the payment conditions of medical insurance settlement, shall be paid by the maternity insurance fund according to the quota standard; The medical expenses with complicated diseases during the birth period shall be settled by the maternity insurance fund if they meet the settlement conditions after examination by the center. The insured female workers only need to pay at their own expense, and the rest are paid directly by the center and designated hospitals.

2. Family planning operation expense reimbursement standard

Insured female workers need to place intrauterine devices (IUDs), bury skin (buried skin), sterilize and re-operate due to family planning. The operation expenses and routine medicine expenses that meet the requirements of maternity insurance settlement are paid by the maternity insurance fund according to the quota standard.

3. Reimbursement standard for birth in different places

The maternity insurance expenses incurred by the insured female workers in giving birth in other places or in non-maternity insurance designated hospitals due to emergencies shall be paid in cash by themselves first, and then the relevant materials shall be submitted to the center for review and payment procedures. Maternity medical expenses are higher than the quota standard of similar hospitals in the park, and shall be paid according to the quota standard; Below the quota standard, according to the actual payment.

3. Reimbursement standard of medical expenses for termination of pregnancy

Medical expenses incurred by insured female workers due to diseases, ectopic pregnancy and hydatidiform mole termination of pregnancy, medical expenses incurred by complications of family planning operation and treatment expenses for diseases other than family planning operation shall be settled according to the provisions of medical insurance.

4. Natural childbirth (including dystocia) reimbursement standard

First-class hospitals are reimbursed 2000 yuan, second-class hospitals are reimbursed 2500 yuan, and third-class hospitals are reimbursed 3000 yuan.

5. Cesarean section reimbursement standard

The first-level hospital will reimburse 3,000 yuan, the second-level hospital will reimburse 4,000 yuan, and the third-level hospital will reimburse 4,500 yuan.

(two) Suzhou City, the standard of reimbursement for male maternity workers

1. Spouses of insured male employees who are not covered by maternity insurance and do not enjoy maternity-related benefits can enjoy a one-time maternity allowance.

2. The medical expenses for the birth or abortion of the spouse of a male employee shall be borne by the individual. In addition to enjoying the one-time maternity allowance according to the regulations, it does not enjoy other maternity insurance benefits such as maternity nutrition allowance, perinatal health care allowance and maternity allowance.

3 male employees' spouses participate in residents' medical insurance, and the residents' medical insurance fund pays a one-time maternity allowance, and male employees no longer enjoy a one-time maternity allowance.

4. Abortion: One-time maternity allowance in 200 yuan.

5. Natural childbirth: one-time maternity allowance 1200 yuan.

6. Dystocia and cesarean section: a one-time maternity allowance of 2,000 yuan.

Second, Suzhou maternity insurance reimbursement conditions

1, participate in maternity insurance and pay maternity insurance premiums normally;

2, in line with the national family planning policy and statutory fertility conditions.

Three, Suzhou maternity insurance reimbursement materials and processes

1. When giving birth, I will go to the designated medical institution for maternity insurance with the social security card and the contact form of maternity insurance. If it is confirmed by the hospital that it meets the maternity insurance benefits, it shall be filled out by the attending doctor and signed by me for confirmation.

2. Self-funded items or special services (family delivery room, accompanying delivery, diapers, milk, baby touching, baby health belt, postpartum visit, meals, birth certificate, etc.). ) It can only be used after being informed in writing by the hospital and obtaining my consent.

3. When discharged from the hospital, the insured person only needs to pay for drugs and special services at his own expense, and the rest of the maternity medical expenses that meet the requirements are paid by the municipal social security center and designated medical institutions according to regulations.

4, the city social security center in the next month and the designated medical institutions to pay maternity medical expenses, maternity allowance will be allocated to the employer; One-time prenatal check-up allowance and maternal nutrition allowance will be transferred to the debit account of Suzhou Bank on the insured's social security card.

Four, Suzhou maternity insurance reimbursement application materials

Before the expenses of maternity and family planning operation occur in the designated maternity hospital, the insured female workers shall go to the family planning department where the household registration is located (non-Suzhou) to issue the contact list of maternity insurance or the contact list of birth control operation service:

1. ID cards of both husband and wife;

2. Marriage certificate;

3. Household registration certificate;

4. The certificate of marriage and childbearing of employees or the certificate of birth control operation of employees issued by the employer;

5 floating population at the same time issued a "floating population marriage certificate".

If you return to your domicile, you need to provide:

1. Original and photocopy of marriage certificate and ID card of both parties.

2. Original and photocopy of relevant household registration certificate or household registration book.

Legal basis:

People's Republic of China (PRC) social insurance law

Fifty-third employees should participate in maternity insurance, the employer should pay maternity insurance premiums in accordance with state regulations, and employees do not pay maternity insurance premiums.

Fifty-fourth employers have paid maternity insurance premiums, and their employees enjoy maternity insurance benefits; Unemployed spouses of employees enjoy maternity medical expenses in accordance with state regulations. The required funds are paid from the maternity insurance fund.

Maternity insurance benefits include maternity medical expenses and maternity allowance.

Fifty-fifth maternity medical expenses include the following:

(1) Maternity medical expenses;

(two) family planning medical expenses;

(3) Other project expenses stipulated by laws and regulations.

Fifty-sixth employees in any of the following circumstances, can enjoy maternity allowance in accordance with state regulations:

(1) Female employees enjoy maternity leave;

(2) Enjoy family planning operation leave;

(3) Other circumstances stipulated by laws and regulations.

Maternity allowance is calculated and paid according to the average monthly salary of employees in the previous year of the employer.