Conditions for reimbursement of Zhoushan maternity insurance in 2020
1, in line with the national family planning policy and statutory fertility conditions;
2. When the spouse gives birth or miscarries due to pathological reasons, the employer has participated in maternity insurance and paid maternity insurance premium for male employees for more than 10 months;
3, the spouse is not included in the scope of maternity insurance, and the birth of the first child.
The following situations cannot be reimbursed:
1, which does not meet the national and provincial basic medical insurance and maternity insurance drug list, diagnosis and treatment items, medical service facilities and related medical management regulations;
2. Expenses incurred due to medical accidents;
3, the cost of treatment of postpartum complications.
2020 Zhoushan maternity insurance reimbursement materials
Persons participating in maternity insurance
(1) flat delivery, cesarean section and midwifery:
1. Copy of family planning certificate.
2. A copy of the medical certificate of the baby's birth.
3. Copy of medical diagnosis certificate or discharge record
(2) Abortion, induced labor, birth control and recanalization;
1. A copy of the marriage certificate.
2 copies of medical records, discharge summary and detailed summary of hospitalization expenses.
Persons who have not participated in maternity insurance
1. Copy of family planning certificate.
2. A copy of the medical certificate of the baby's birth.
3. Copy of medical diagnosis certificate or discharge record
4. The woman is the uninsured person in this city, and provides the unemployment certificate or the uninsured certificate of the domicile.
The reimbursement process of Zhoushan maternity insurance in 2020
1. The insured unit shall fill in the Declaration Form for Payment of Maternity Insurance Expenses of Workers in Hangzhou (in duplicate) and affix the official seal of the unit.
2, reproductive health service certificate declaration account (copy), the issuing unit seal unclear copy, need to attach the original.
3, the baby's birth medical certificate (copy).
4, delivery of hospitalization medical invoice (copy).
5, reproductive medical diagnosis certificate issued by the medical department (original).
6. The medical record of the birth situation (original) at the time of hospitalization or discharge.
By the way, it needs to be declared within 6 months after delivery, otherwise it will not be accepted.
In addition, if the application materials are submitted before 12 every month, they will receive the receipt from the work-related injury maternity window on the first floor of the municipal human resources and social security comprehensive service center after the examination and approval (the regional enterprises will receive it from the social insurance agencies in various urban areas), and the maternity insurance benefits will be paid to the employee's unit in one lump sum through the settlement of the month.
How much is Zhoushan maternity insurance in 2020?
Maternity insurance can reimburse the costs of birth check-up, delivery, surgery, hospitalization, medicines, etc., but the payment methods are different.
1. The cost of pregnancy examination shall be paid by the maternity insurance fund.
The reimbursement limit for each inspection fee varies from 330 yuan to 1400 yuan. If the inspection fee is within the limit, it shall be reimbursed according to the actual expenditure, and if it exceeds the limit standard, it shall be reimbursed according to the limit standard.
2. For medical expenses, hospitalization expenses, medicine expenses, etc. During the period of hospital delivery, the maternity insurance fund takes a fixed payment.
1) Maternal natural childbirth can be reimbursed 3000 yuan.
2) Labor intervention can be reimbursed for 3300 yuan.
3) If the parturient adopts cesarean section, it can be reimbursed for 4,400 yuan.
4) For twins or multiple births, the fixed payment standard will be increased by 10% on the original basis for each additional birth.
3. Reimbursement by project
In view of the serious complications during hospitalization, the maternity insurance fund will fully reimburse the medical expenses and hospitalization medical service fees.
Flexible employees in our city have participated in the basic medical insurance for employees, and the payment before delivery exceeds 12 months, which is in line with the medical expenses of hospital delivery under the national family planning policy. Cesarean section allowance for dystocia 1.800 yuan, other hospital delivery allowance 1.200 yuan.
The medical expenses incurred by the insured persons of the basic medical insurance for urban and rural residents in line with the national family planning policy shall be subsidized by each person for cesarean section due to pathological factors 1.200 yuan, and other hospital deliveries shall be subsidized by 800 yuan.
The insured unemployed spouse conforms to the national family planning policy, and the medical expenses for hospital delivery are per person for dystocia cesarean section 1.200 yuan, and other hospital deliveries are subsidized by 800 yuan.
Those who have participated in the basic medical insurance for employees, paid a total of 12 months (inclusive) before the birth month and did not enjoy the maternity insurance benefits can enjoy the fixed subsidy for maternity medical expenses, and those who have undergone cesarean section due to pathological factors 1800 yuan and other hospital deliveries 1200 yuan do not enjoy the maternity allowance.
In-service male workers who have participated in basic medical insurance (including maternity insurance) for over 12 months, and their unemployed spouses who have not participated in basic medical insurance or participated in basic medical insurance but do not meet the policy of enjoying medical expenses for hospital delivery, can enjoy fixed subsidies for maternity medical expenses, subsidies for cesarean section per person due to pathological factors 1200 yuan, and other 800 yuan subsidies for hospital delivery, but do not enjoy maternity allowance.