I. Reimbursement standard:
1, prenatal examination: 900 yuan;
2. Delivery hospitalization: 3,200 yuan for natural delivery and 4,500 yuan for cesarean section;
3. Abortion and induced labor caused by childbirth: 400 yuan who aborted within 2 months of pregnancy; 700 yuan is pregnant for 2 months and less than 3 months; Abortion and induced labor for more than 3 months but less than 7 months 1900 yuan; 7 months pregnant induced labor 2800 yuan.
2. What are the maternity insurance benefits?
Including maternity medical expenses, maternity allowance and one-time nutrition subsidy. Maternity medical expenses include maternity medical expenses, family planning medical expenses and other project expenses stipulated by laws and regulations.
3. What are the family planning medical expenses paid by the fund?
Including medical expenses incurred by insured workers in placing or taking out intrauterine devices, induced abortion or induced labor, tubal or vas deferens ligation and recanalization operations. , meet the requirements of maternity insurance.
The medical expenses for complications caused by family planning operation shall be paid by the fund in accordance with the provisions of maternity insurance during the operation and hospitalization; The above expenses incurred after the operation or discharge shall be paid by the employee basic medical insurance fund in accordance with the provisions of the employee basic medical insurance.
4. What is the reimbursement rate of medical expenses for maternity and family planning operations for insured employees?
In accordance with the provisions of maternity insurance, in two or less medical institutions, paid in full by the maternity insurance fund; In tertiary medical institutions, maternity insurance funds pay 80% and individuals pay 20%.
5. What is the standard for employees to enjoy maternity allowance during maternity leave or vacation?
Maternity allowance is calculated according to the number of days of maternity leave, family planning operation leave or nursing leave stipulated by the state and province, and the calculation base is the average monthly salary of employees in the previous year divided by 30.
(1) Maternity benefits 128 days, dystocia benefits 15 days; In the case of multiple births, the maternity allowance will be increased by 1 5 days for each additional birth1baby;
(2) pregnant less than 2 months, enjoy 20 days of maternity allowance; Those who are pregnant for more than 2 months but less than 3 months are entitled to 30 days of maternity allowance; Abortion or induced labor for more than 3 months but less than 7 months, enjoy 42 days of maternity allowance; Induced labor after 7 months of pregnancy, enjoy 98 days maternity allowance;
(3) Those who have tubal ligation are entitled to a maternity allowance of 2 1 day; Vasectomy, enjoy 7 days maternity allowance;
(4) Those who have fallopian tube recanalization surgery are entitled to 2 1 day maternity allowance; Those who have vasectomy are entitled to 14 days maternity allowance;
(5) If the IUD is placed or taken out, you will enjoy 2 days of maternity allowance;
(6) Those who enjoy nursing leave in accordance with the relevant provisions of the state and province shall enjoy maternity allowance 15 days.
If the maternity allowance enjoyed by employees during maternity leave or vacation is lower than their salary standard before maternity leave or vacation, the employer shall make up for it; If the salary is higher than that before maternity leave or vacation, the employer shall not withhold it.
6. What is the standard of one-time nutritional allowance for workers who give birth or induce labor after 7 months of pregnancy?
The standard is 2% of the average annual salary of employees in urban non-private units in this city last year.
7. What medical expenses does the unemployed spouse enjoy?
(1) Unemployed spouses of employees are entitled to maternity medical expenses according to 50% of the maternity medical expenses standard stipulated by the employee's insured place.
(2) If the unemployed spouse of an employee participates in the basic medical insurance for urban and rural residents, he/she shall enjoy the corresponding reimbursement of hospitalization delivery quota according to the maternity medical policy of the basic medical insurance for urban and rural residents, and the maternity insurance fund will no longer pay his/her maternity medical expenses.
(3) The unemployed spouses of employees shall enjoy the family planning technical services of basic projects stipulated by the state free of charge in accordance with the laws and regulations on population and family planning, and the maternity insurance fund shall not pay their family planning medical expenses.
Eight, workers in different places or the implementation of family planning surgery medical expenses, according to what standard to pay?
Pay according to the maternity insurance treatment standard of the employee's insured place.
9. What expenses are not covered by the fund?
(1) Maternity medical expenses, maternity allowance and one-time nutrition subsidy for giving birth or carrying out family planning operation in violation of the laws and regulations on population and family planning;
(two) does not meet the maternity insurance drug list, diagnosis and treatment items, medical service facilities and payment standards;
(three) the expenses that should be paid by the basic medical insurance fund;
(four) the expenses that should be borne by public health or other public services and free family planning technical services according to the regulations;
(5) Expenses that should be borne by a third party due to medical malpractice;
(6) Maternity medical expenses incurred abroad and in Hong Kong, Macao and Taiwan;
(7) Newborn disease screening, nursing and medical expenses;
(8) Maternity medical expenses for medical treatment in non-designated medical institutions without approval (except emergency and rescue);
(nine) other expenses stipulated by the state and the province that are not paid by the fund.
Ten, to participate in maternity insurance workers enjoy maternity insurance benefits or unemployed spouses enjoy maternity medical treatment, what procedures should be handled?
(1) Select designated medical institutions for maternity insurance;
(2) Submit the original and photocopy of my ID card, social security card and marriage certificate, the family planning certificate issued by the health and family planning administrative department and the medical certificate of birth or family planning operation issued by the medical institution;
(3) Unemployed female workers submit the original and photocopy of the Employment Unemployment Registration Certificate;
(4) The unemployed spouse of the employee submits the employment unemployment registration certificate or unemployment certificate issued by the village (neighborhood) committee where the employee and his spouse work, and the uninsured (combined) certificate issued by the medical insurance agency or the new rural cooperative medical insurance agency where the employee's spouse is registered.
The health administrative department or working institution shall issue a family planning certificate for the employees who participate in maternity insurance.
1 1. What are the standards for maternity insurance, maternity medical expenses and birth check-up fees?
Settlement standard of medical institutions: medical expenses (including complications and complications) that meet the requirements of maternity insurance, such as prenatal examination, hospital delivery and family planning operation, are paid by the unit according to the disease type.
(1) In the designated medical institutions of maternity insurance, the hospitalization and delivery medical expenses incurred according to the clinical pathway of the disease and the standardized diagnosis and treatment plan meet the requirements of maternity insurance, and those incurred in secondary and below medical institutions shall be paid in full by the maternity insurance fund; Medical expenses incurred in tertiary medical institutions that meet the requirements of maternity insurance shall be borne by the individual at 20%;
(II) If the complications and complications caused by childbirth are diagnosed and treated in the hospital, and the total medical expenses that meet the requirements of maternity insurance exceed the above-mentioned disease quota standard 1 times, and the individual withdraws from the clinical pathway of the disease after declaration and examination, he shall bear 20% of the total medical expenses that are out of pocket in the catalogue of maternity insurance, out of the catalogue and in line with the requirements of maternity insurance;
(3) Medical expenses that meet the requirements of maternity insurance, such as prenatal examination and family planning operation, are settled by the unit, and the settlement standard refers to the settlement standard of designated medical institutions, and some individuals pay for the excess.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.