Notice of Fushun Municipal People's Government on printing and distributing the Interim Measures for the administration of health care and compensation services for women and children in Fushun City

Chapter I General Provisions Article 1 In order to protect maternal and infant health, improve the quality of the birth population, reduce the occurrence of birth defects and reduce the maternal and infant mortality rate, these measures are formulated in accordance with the Regulations of Liaoning Province on Maternal and Infant Health Care and relevant laws and regulations, combined with the actual situation of our city. Article 2 Women and children's health care and compensation service refers to that women and children who meet the insurance conditions voluntarily pay a certain amount of health care and compensation service fees to the maternal and child health care institutions or grass-roots maternal and child health care organizations (prevention and protection groups of hospitals or township hospitals, hereinafter referred to as underwriting units) in their places of residence, and the underwriting units provide them with corresponding health care and compensation services. Article 3 These Measures shall apply to all units within the territory of this Municipality, pregnant women and children aged 0 to 6 who meet the conditions for insurance. Fourth health administrative departments at all levels are the competent departments of women and children's health care and compensation services of the people's governments at the same level, and are responsible for the supervision and management of women and children's health care and compensation work within their respective jurisdictions.

All levels of finance, price, civil affairs, family planning, public security and other departments should assist in this work. Chapter II Scope and Responsibility of Health Insurance Services Article 5 A person who meets one of the following conditions shall be the object of health insurance services:

(a) pregnant 12 weeks to 42 days after delivery, women who are medically certified to be healthy and allowed to get married and have children;

(2) Children under 6 years old who have no obvious hereditary diseases, infectious diseases, serious organic diseases and other diseases that affect compensation. Article 6 The types of medical insurance include:

(1) Maternal health insurance. The coverage period is from 65-438+02 weeks of pregnancy to 42 days after delivery, and 0-28 days for newborns.

(2) Children's health insurance. The compensation period is from 28 days after the child is born to 6 years old.

(3) The whole process of maternal and child health care and compensation. The compensation period is from the first week of pregnancy 12 to the 42nd day after delivery, when the child is over 6 years old.

The object of compensation can choose the type of compensation according to the above provisions. Article 7 The responsibilities, obligations and rights of the insurer and the insured in health insurance shall be determined in the form of contracts.

The compensation contract for maternal and infant health care shall be uniformly formulated by the municipal public health administrative department. Article 8 A pregnant woman shall go through the insurance formalities at the underwriting unit designated by the health administrative department at the place where the registered permanent residence is located within/0/2 weeks before pregnancy, and receive the prenatal examination on time; Children's insurance procedures and birth certificates are handled at the same time. Article 9 The insured units shall provide regular prenatal check-up services for insured pregnant women, determine the mode of delivery, conduct postpartum visits, conduct screening and project management for high-risk pregnant women, and carefully fill in the maternity insurance manual and various registration forms and books. Article 10 Insured children enjoy a series of child health care services provided by the underwriting unit. The insured unit shall provide regular health examination, screen frail children for project management, and guide breastfeeding and scientific feeding. Eleventh health care objects that do not meet the conditions of insurance and uninsured insured objects shall provide quality health care services, carry out systematic health care management, and charge fees according to regulations. Twelfth health care objects must go to the place and time designated by the insured unit to receive health care services, and the insured pregnant women must go to the medical unit that has obtained the Practice License for Maternal and Child Health Care Technical Services in Liaoning Province to give birth. Chapter III Payment and Management of Indemnities Article 13 When a pregnant woman files an early pregnancy in 12 weeks, or when a child's parents issue a medical certificate of birth, she should go through the insurance formalities at the underwriting unit and pay the indemnity to the underwriting unit according to the selected form of indemnity. Fourteenth security funds by the city and county (District) health administrative departments responsible for supervision and management, according to the management of special funds, earmarking. The compensation is used for the following expenses:

(1) Paying compensation to the insured;

(2) Labor subsidies and technical study fees for maternal and child health care personnel;

(3) Material consumption and equipment depreciation expenses;

(four) the technical appraisal fees and labor subsidies of the relevant personnel. Fifteenth maternal and infant health insurance premiums shall be paid according to the standards approved by the price department. Chapter IV Compensation and Surrender Article 16 If the object of medical care insurance has received medical care insurance services according to regulations, the insured unit shall compensate the pregnant woman or child according to the contract due to technical reasons or liability reasons of the insured unit. Article 17 If the insured has multiple compensation conditions, the highest one shall be the compensation standard. Article 18 If the insured suffers from illness or death that meets the compensation conditions stipulated in the health insurance contract during the compensation period, he shall submit a written application for compensation to the insurer within 3 months. After receiving the application, the insured unit shall report to the county (district) maternal and child health care institution and the health administrative department at the same level within 7 days, and make a reply to the applicant whether to compensate within 15 days. Article 19 If the insured object refuses to accept the conclusion made by the underwriting unit, it may apply to the technical guidance group of the local county (district) within 15 days, and the expenses shall be paid by the insured in advance. After the county (district) technical guidance group accepts it, it should generally make an appraisal conclusion within 15 days. Article 20 If the compensation object refuses to accept the conclusion of technical appraisal at the county (district) level, it shall apply to the municipal technical guidance group for re-appraisal within 15 days from the date of receiving the appraisal book, and the municipal technical guidance group shall make an appraisal conclusion within 20 days after accepting it, and the municipal appraisal conclusion shall be final. The standard of appraisal fee can be implemented with reference to the standard of medical accident appraisal fee.