First, the proportion of maternity insurance reimbursement in Henan Province
In accordance with the provisions of the population and family planning policy, and the employer pays the maternity insurance premium in full and on time, the maternity insurance fund shall pay according to the following limits:
(a) prenatal examination: 800 yuan/case;
(2) Normal delivery: 2200 yuan/case in the third-level designated medical institution; 2,000 yuan/case for designated medical institutions at level 2 and below;
(3) Abnormal delivery (dystocia): 2800 yuan/case in the third-level designated medical institution; 2,600 yuan/case for designated medical institutions at level 2 and below; Cesarean section: 4,500 yuan/case for three types of designated medical institutions; 2 and below designated medical institutions 4300 yuan/case;
(four) Cesarean section at the same time to do other related gynecological surgery 5000 yuan/case, no longer pay the fee standard stipulated in the third paragraph of this article.
If the actual medical expenses are lower than the above-mentioned limit standards, if the actual medical expenses are higher than or equal to the above-mentioned limit standards, they shall be paid according to the above-mentioned limit standards.
The employer shall pay the maternity insurance premium in full and on time, and the medical expenses incurred in the implementation of family planning operation shall be paid by the maternity insurance fund according to the following limits:
(1) Placement and removal of IUD (including inspection fee): 65,438 yuan +050 yuan/case for the third-level designated medical institution; Secondary and below designated medical institutions 130 yuan/case;
(2) vasectomy (including examination fee): 65,438 yuan +0.200 yuan/case for the third-level designated medical institution; 65,438 yuan +0.000 yuan/case for designated medical institutions at level 2 and below;
(3) Tubal ligation (including examination fee): 2,600 yuan for each case in the third-level designated medical institution; 2,400 yuan/case for designated medical institutions at level 2 and below;
(4) Vasectomy (including examination fee): 4,000 yuan/case for the third-level designated medical institution; 2 and below designated medical institutions 3800 yuan/case;
(5) Early pregnancy needs to be terminated in outpatient clinic (including pregnancy inspection fee): 300 yuan, a tertiary designated medical institution (except in special circumstances); 280 yuan, a designated medical institution at level 2 and below;
(6) Termination of pregnancy after hospitalization 12 weeks or more: three-level designated medical institutions 1 10,000 yuan/case; 800 yuan, a designated medical institution at level 2 and below;
(7) Induced labor: 65,438 yuan +0.500 yuan/case in the third-level designated medical institution; Designated medical institutions of Grade II and below 1300 yuan/case.
If the actual medical expenses are lower than the above-mentioned limit standards, if the actual medical expenses are higher than or equal to the above-mentioned limit standards, they shall be paid according to the above-mentioned limit standards.
For female employees who meet the requirements of population and family planning policies and the employer pays maternity insurance premiums in full and on time, the medical expenses for complications caused by childbirth during maternity leave shall be paid by the maternity insurance fund, and the remaining part of the eligible hospitalization expenses shall be paid in accordance with the provisions of Article 11. The proportion of medical payment for tertiary designated medical institutions is 80%, and the proportion of medical payment for secondary and below designated medical institutions is 85%. The cost of continuing treatment after the expiration of maternity leave shall be implemented in accordance with the provisions of basic medical insurance.
Two, Henan province maternity insurance reimbursement scope
Maternity medical expenses, that is, the medical expenses incurred by female workers during pregnancy and childbirth, include prenatal examination expenses, termination of pregnancy expenses, delivery expenses, operation expenses, hospitalization expenses, medicine expenses and the expenses for diagnosis and treatment of pregnancy complications during hospitalization.
Family planning medical expenses include medical expenses incurred by workers in placing or taking out intrauterine devices, tubal ligation or recanalization, induced abortion and induced labor.
Insured employees who have paid for nine months before giving birth can only apply for insurance payment and maternity allowance when the statutory maternity leave expires. If the insured employees have paid contributions for less than nine months before giving birth, they need to pay 12 months after giving birth to apply for insurance contributions and maternity allowance.
Maternity allowance shall be paid on a daily basis, and the daily standard shall be calculated by dividing the average monthly salary of employees in the previous year by 30, and paid from the maternity insurance fund. If the employee is not insured in the previous year, the average monthly salary of the employee paid by the employer shall be divided by 30.
The following maternity and family planning surgery medical expenses, maternity insurance fund will not pay:
(a) does not meet the national or provincial family planning regulations;
(two) does not meet the requirements of the province's basic medical insurance drug list, diagnosis and treatment projects and medical service facilities;
(three) the cost of treatment of reproductive complications;
(four) medical expenses caused by medical accidents;
(five) other expenses that do not belong to the scope of maternity insurance medical services.
Third, Henan Province maternity insurance reimbursement process
1. The medical expenses incurred by female workers due to childbirth and family planning operations shall be settled by the provincial medical insurance center and designated medical institutions when paid by the maternity insurance fund according to the project; Medical expenses that exceed the prescribed payment standards and should be borne by individuals according to the project settlement, and other maternity insurance funds will not be paid, which will be directly settled by individuals and designated medical institutions.
2. Medical expenses incurred by female workers (including male workers' spouses) due to childbirth or family planning operations in different places, and medical expenses incurred by emergency and first aid (including business trips, family leave and leave) in non-designated medical institutions for childbirth and family planning operations shall be paid by individuals in advance, and the application form for maternity insurance benefits shall be filled out in duplicate, and the application materials shall be submitted to the unit manager for declaration, and the provincial medical insurance center shall make settlement according to regulations.
Four, Henan province maternity insurance time.
Female employees of state organs and financial institutions who give birth or terminate pregnancy do not enjoy maternity allowance, and the wages during maternity leave are paid by the employer.
In principle, the maternity allowance shall be applied to the medical insurance agency by the employer, and the one-time maternity grants shall be applied to the medical insurance agency by himself or his client. To apply for maternity allowance or one-time maternity grants, the following materials shall be submitted:
(a) the birth certificate or family planning operation certificate issued by the administrative department of population and family planning;
(two) the beneficiary's identity card, if entrusted, submit the power of attorney issued by the client and the client's identity card;
(three) the birth, death or abortion of the baby, the family planning operation certificate, and the expense certificate issued by the designated medical institution (including the family planning technical service institution, the same below);
(four) if the spouse of a male employee has no work unit, submit the certificate of no work unit issued by the male employee's work unit and the village (neighborhood) Committee where the spouse lives;
(five) other supporting materials provided by the administrative department of human resources and social security and the medical insurance agency according to law.
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