Part I: Maternity insurance benefits
1, affected by the epidemic situation, the employer delayed the payment of maternity insurance premium, how to ensure maternity medical care?
According to the fifth point of the Notice of Guangzhou Medical Security Bureau on Doing a Good Job in Medical Security Service Management to Promote the Prevention and Control of Pneumonia Infection in novel coronavirus: "For those who cannot pay social medical insurance and maternity insurance fees on time and monthly due to the epidemic, they are allowed to pay back within three months after the end of the epidemic, and no late payment fee will be charged, which will not affect the medical treatment of the insured during the epidemic ...", the relevant treatment principles are as follows:
(1) Insured persons who have chosen to give birth in local medical institutions.
If the insured person has chosen a local medical institution for prenatal delivery, and the employer delays payment due to the epidemic situation, the insured person's related medical expenses (including prenatal delivery, natural delivery or family planning, the same below) can pay the deposit in advance, without settlement, and after the unit returns according to the regulations, it will be supplemented by the deposit certificate to the medical institution.
If the insured has settled the medical expenses, the employer may make up the payment according to the regulations, and then make up the account with the invoice to the medical institution for a refund.
(2) The insured who has chosen to give birth in a medical institution in another place.
The insured person chose a medical institution in a different place to give birth. Due to the epidemic situation, if the employer holds over the payment, the related medical expenses of the insured person can go through the reimbursement procedures at each medical insurance sub-center within one year after the employer pays back according to the regulations.
(3) The insured who has not yet chosen a medical institution to give birth.
The insured has not yet chosen a medical institution for delivery. If the employer delays payment due to the epidemic situation, the insured may apply for a medical certificate after normal payment. If the employer has completed the payment as required, the insured can contact the corresponding medical insurance sub-center, adjust the effective time of the medical certificate, and handle the related medical expenses according to the first and second points.
(4) During the epidemic period, how can employees who have not paid their fees for less than one year enjoy reproductive medical treatment?
Female workers who have paid less than one year need to enjoy reproductive medical treatment (including prenatal examination, delivery and family planning operation). During the period of unpaid maternity insurance premium, you can't enjoy maternity medical treatment for the time being. Units in accordance with the provisions of the payment, as a normal payment, did not terminate the pregnancy. If the payment is over one year (including the payment part), you can apply for the voucher first, and then adjust the treatment enjoyment time in the branches of Guangzhou Medical Insurance Center, and make supplementary accounting treatment according to the regulations. If the pregnancy has been terminated, you can take the information to the Guangzhou Medical Insurance Center Sub-center.
For example:
Ms. Li registered in April 20 19 and confirmed her pregnancy in June 2020+0. The expected delivery date is September 2020. However, due to the epidemic situation, Ms. Li Can failed to apply for maternity medical confirmation and temporarily enjoyed maternity medical treatment. If the company pays the relevant expenses in May, Ms. Li Can applies for medical confirmation after the company repays in May, and adjusts the date of treatment enjoyment in the medical insurance sub-center affiliated to the hospital. If the unit didn't pay the relevant expenses until June 5438 +2020 10, and Ms. Li has given birth, she can take the information to the medical insurance sub-center for handling according to the regulations (the specific handling method is subject to the acceptance of each medical insurance sub-center).
pay attention to
Insured persons who cannot apply for sporadic reimbursement of maternity insurance in time due to the epidemic situation: the reimbursement time limit for medical expenses of maternity insurance that meet the requirements for sporadic reimbursement of insured persons is adjusted from the date of original expenses 1 year to 1 year after the epidemic situation ends. Please try your best to handle the zero report business after the outbreak.
2. Will the unit pay maternity allowance in arrears during the epidemic?
According to the fifth point of the Notice of Guangzhou Medical Security Bureau on Doing a Good Job in Medical Security Service Management to Promote the Prevention and Control of Pneumonia Infection in novel coronavirus: "If the social medical insurance and maternity insurance fees cannot be paid on time and monthly due to the epidemic, it is allowed to pay them back within three months after the end of the epidemic, and the insured person is not affected by the epidemic ..." During this period, the employer temporarily fails to pay the maternity allowance, and if the employer pays according to the regulations, it will be regarded as normal payment.
Part II: Medical Insurance Benefits
1, during the epidemic, how to implement the medical insurance reduction and exemption policy for employees?
From February to June, 2020, the contribution rate of employee medical insurance units in Guangzhou was levied at 50% of the pre-fee reduction rate, that is, during the implementation of the policy of halving the contribution rate, the contribution rate of employee social medical insurance units was 3.5%, the contribution rate of maternity insurance units was 0.85%, and the total contribution rate was 4.35%. This measure is expected to reduce the burden on enterprises by about 8.325 billion yuan in five months, effectively support enterprises to return to work and promote stable employment.
2, affected by the epidemic, the employer failed to pay in time, how to protect the treatment?
In view of the medical impact that may be caused to some insured units and insured persons during the epidemic, the Municipal Medical Insurance Bureau timely optimized the treatment enjoyment policy and handling process. For those who cannot pay social medical insurance and maternity insurance premiums on time and monthly due to the epidemic, they are allowed to pay back within three months after the end of the epidemic, and no late fees are charged. During the epidemic, the insured person's medical treatment is not affected. During the epidemic period, the medical insurance system opened the medical insurance and maternity insurance benefits for the insured employees in batches. In terms of medical insurance benefits, the insured person will settle the medical expenses according to the regulations after seeing a doctor in a designated medical institution with a social security card (no need to go through the formalities of zero reporting separately); If it cannot be settled directly for various reasons, it can be made up within three months after the end of the epidemic, and the retrospective treatment can be made through making up the account in the hospital or zero report. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: the national social security medical insurance application reimbursement process in 2020!
3. Does the delayed payment of medical insurance during the epidemic affect the qualification examination of small and medium-sized buses?
In terms of indicators of small and medium-sized buses, in view of the fact that some enterprises in our city have delayed paying social security (medical insurance) due to the epidemic, the transportation department has introduced relevant measures to appropriately adjust the conditions for non-local household registration personnel to apply for incremental indicators on April 9, 2020. From April, the applicant's social medical insurance payment record for employees in our city last month will no longer be reviewed. For the latest news of policy adjustment, please pay attention to the index regulations of official website (/).
4. What are the changes in drug use during the epidemic?
During the epidemic period, medical insurance doctors implement long prescriptions, and the insured patients in this city (including the insured directly under the municipal medical insurance) who have applied for a class of outpatient specific diseases and are within the validity period can relax the prescription dose to 3 months after being evaluated by doctors in designated medical institutions. Medical insurance for employees and medical insurance for urban and rural residents, the maximum payment limit for outpatient specific diseases is adjusted from monthly limit to quarterly limit, which is 3 times of the original monthly limit.
For example:
The employees (residents) insured by medical insurance have applied for effective outpatient specific diseases such as diabetes, and the original insured can issue the monthly dosage to the designated medical institutions of medical insurance in February, and the medical insurance fund will pay a maximum of 200(50) yuan; At present, the insured can go to the designated medical institutions to apply for medical insurance in February, and after being evaluated by the doctors in the designated medical institutions, the amount of medicine will be distributed for three months from February to April, and the maximum payment will be 600 yuan from the medical insurance fund (150). (Contents of medical insurance for urban residents in brackets)
The policy document stipulates that:
During the epidemic period, the designated medical institutions of medical insurance will reasonably increase the dosage of single prescription according to the actual situation of patients and reduce the number of times patients go to designated medical institutions for medical treatment and dispensing; For patients with chronic diseases such as hypertension and diabetes who are insured by social medical insurance in this city, the prescription dose can be relaxed to 3 months after evaluation by doctors in medical treatment hospitals, and the monthly payment limit of medical insurance can be adjusted to quarterly limit, which is 3 times of the original monthly limit standard.
5. How to deal with the medical expenses of overseas returnees introduced from new coronary pneumonia?
According to the Notice of the Epidemic Prevention and Control Group of the Office of the Prevention and Control Headquarters of COVID-19, Guangdong Province on the Relevant Expenses of Overseas Returnees in Guangdong and other relevant regulations, those who enter the cases of overseas returnees in Guangdong and participate in the basic medical insurance will be subsidized by the finance after paying the medical expenses such as basic medical insurance, serious illness insurance and medical assistance according to the regulations. In principle, the medical expenses for those imported from overseas who have not participated in the basic medical insurance to come to Guangdong and return to Guangdong shall be borne by the patients themselves. Personnel who have participated in commercial health insurance shall be paid by the commercial insurance company according to the contract. Those who have not participated in the basic medical insurance and have difficulty importing cases from abroad may be given medical assistance according to the law if they are found to meet the requirements. In other words, the insured only needs to show the medical insurance card or social security card, and the related expenses are settled by the medical institution according to the medical insurance policy; The medical expenses of non-insured personnel shall be borne by the patient himself in principle. For details, please consult medical institutions or health administrative departments.
6. How to deal with the screening expenses in COVID-19?
According to the Notice of the Medical Prevention and Control Group of COVID-19 Prevention and Control Headquarters Office on Carrying out Nucleic Acid Detection and Investigation of Key Population at Different Levels forwarded by the Office of novel coronavirus Epidemic Prevention and Control Headquarters in Guangdong Province, at present, medical insurance participants in Guangdong Province are the key screening targets required by the provincial prevention and control, and the cost of nucleic acid detection in designated medical institutions is included in the scope of medical insurance payment according to regulations; Outside the clear investigation scope of the provincial prevention and control headquarters, the relevant units (enterprises) and individuals shall bear the expenses incurred by their own requirements for nucleic acid testing. In other words, the insured only needs to show the medical insurance card or social security card, and the related expenses are settled by the medical institution according to the medical insurance policy; Investigation expenses of non-insured persons or expenses beyond the scope of the provincial prevention and control headquarters of the insured. Consult medical institutions or health administrative departments for details.
Part III: Endowment insurance benefits
1. What's the impact on the endowment insurance for urban and rural residents during the epidemic?
During the epidemic period, if urban and rural residents fail to apply for insurance payment registration, payment declaration and treatment on time, they will be allowed to make up after the epidemic, and they will enjoy the old-age insurance treatment normally during the extended period, which will not affect the personal rights and interests of the insured. The replacement should be completed within three months after the outbreak is lifted.
2. During the epidemic, will the application for pension insurance benefits for urban and rural residents be delayed, which will affect the pension?
For urban and rural residents to apply for pension insurance benefits, in line with the conditions for the application of benefits, according to the provisions of the relevant benefits. For the deferred payment of social insurance premiums, it will be re-approved after the overdue payment, and the relevant treatment will be reissued. The qualification certification of urban and rural residential insurance benefits can be handled through Guangdong Social Security APP and WeChat Guangdong Province applet. If the certification is not completed on schedule, the payment will not be suspended.
3. I met the conditions for applying for pension during the epidemic. Can I wait until the epidemic is over? Will the delay affect my pension?
If the pension application business is not handled on time during the epidemic period, it will be allowed to be reissued within three months after the epidemic is lifted, and the pension amount will not be affected.
4. During the epidemic period, there are special policies to reduce or postpone the payment of social insurance premiums. If I reduce or postpone the payment of social insurance premiums, will it affect my pension application?
The social security fee reduction and exemption policy is only aimed at the unit payment, and will not affect the application for pensions, nor will it affect the amount of pensions.
Personal holdover of social insurance premiums, by the social insurance agency temporarily according to the holdover before payment to apply for pension insurance benefits of the insured payment of old-age insurance benefits, to be holdover after the actual payment, and then according to the normal payment re approved pension insurance benefits.
In terms of policy, employers are encouraged to give priority to employees who have reached retirement age.
5. During the epidemic, can I go to the social security front desk to apply for pension qualification certification? Is there any other convenient way?
Used during the epidemic.