Practical! ! Understand maternity insurance reimbursement policy

Maternity insurance is a social insurance system that provides necessary economic compensation and medical security for employees who temporarily interrupt their labor due to pregnancy, childbirth or family planning surgery, which better guarantees the basic medical needs of insured employees for childbirth. Every expectant mother will go through the process of reimbursement of maternity insurance from October of pregnancy to hospital delivery. Here is a brief introduction to the reimbursement methods and policies for medical expenses of pregnant women who are insured in Beijing for prenatal examination and hospital delivery.

1. Prenatal medical expenses reimbursement process

From the date of pregnancy to the end of hospital delivery, expectant mothers can't use social security card to settle the medical expenses incurred by your prenatal examination in obstetrics and gynecology clinic in real time. These expenses need to be paid in full in personal cash first, and the outpatient invoice, bottom side and diagnosis certificate should be kept. After you give birth in hospital, submit the relevant materials to your unit or street social security office for reimbursement of prenatal examination expenses.

2. The hospitalization delivery medical expenses reimbursement process

Pregnant in October, finally ushered in the hospital delivery day! When you are excited, you should also remember that when you go through the hospitalization registration formalities, you need to go through the hospitalization formalities at the admission window with your social security card, hospitalization certificate and birth registration service form, and hand over the above materials to the admission window for retention. Under the condition that the materials are complete and the social security card is in normal condition, the medical expenses of this hospital delivery can be reimbursed in real time in the hospital. Expectant mothers must prepare relevant materials in advance to ensure that the medical expenses of this hospital delivery can be successfully reimbursed in the hospital.

If the materials are incomplete, it doesn't matter if the hospital delivery expenses can't be reimbursed in the hospital. You can settle in full at the hospital first, and fill in the relevant materials after discharge. The family members will take all the materials to the medical insurance office of the hospital where they live to issue the Certificate of Full Settlement of Medical Insurance Expenses in Beijing, and hand over the materials and certificates to the unit or the street social security office for manual reimbursement.

3. Maternity insurance reimbursement policy

1) From the confirmation of pregnancy to the termination of pregnancy, the prenatal examination expenses incurred by outpatient medical treatment shall be paid 3,000 yuan according to the fixed standard. If it is lower than the quota standard, it shall be paid according to the actual expenses, and if it is higher than the quota standard, it shall be paid according to the quota standard.

2) Hospital delivery includes natural delivery, manual intervention delivery and cesarean section. Different levels of hospitals, hospitalization reimbursement costs are different.

3) See the following table for specific fixed payment standards:

Maternity insurance is a social insurance system in which the state and society provide necessary living security and material assistance to working women who are unable to obtain economic resources due to pregnancy and childbirth. Mainly through the provision of maternity allowance, medical services, maternity leave and other ways to return to normal.

This insurance system mainly consists of two parts, one is to distribute money, and the other is to provide necessary medical services and daily necessities for pregnant women and babies.

Conditions for granting maternity insurance:

First of all, maternity insurance should be paid in full and on time. Secondly, female employees should reach a certain working life.

Duration of maternity insurance holiday:

Normal maternity leave totals 90 days. For dystocia, the maternity leave will be increased by 15 days, and for multiple births, the maternity leave will be increased by 15 days for each additional baby. Abortion leave for more than four months, rest for 42 days. Maternity leave 15~30 days for those less than four months.

Maternity allowance. Female employees are not allowed to reduce their basic work during pregnancy. In addition, the price subsidies stipulated by the state can be paid and cannot be deducted for various reasons.

How long does maternity insurance expire?

Because most provinces and cities will formulate relevant regulations according to local actual conditions, the reimbursement time of maternity insurance varies from place to place. The reimbursement time of maternity insurance should be subject to the regulations of the local social security center, and the long one can be reimbursed within 18 months, but some regions and cities are limited to 6 months.

Time limit for reimbursement (overdue bids of relevant institutions will not be accepted):

1. Maternity medical expenses: the application should be made before the female employee is pregnant until delivery or termination of pregnancy;

2. Maternity allowance: female employees apply for one-time maternity nutrition allowance and medical expenses for maternity treatment in different places within 1 year after giving birth or terminating pregnancy;

3, family planning surgery costs: should be applied before surgery;

4. Vacation allowance for male employees: the spouse shall apply within 1 year after giving birth.

The role of maternity insurance:

First, recognize the reproductive value of female workers. The birth of female workers is for the development of society and the reproduction of social labor force, and should be compensated by society;

Two, the implementation of maternity insurance is the guarantee of the basic life of female workers. Female workers can't get economic resources during their childbirth. Basic guarantees are needed to ensure their basic living conditions. Make pregnant women give birth smoothly and restore their state;

Third, good reproductive conditions can improve the quality of the population. Maternity insurance provides them with adequate rest and nutrition, so that they can enjoy a normal living standard, and at the same time provide them with medical services to monitor the normal growth of the fetus.

When female employees are pregnant and take maternity leave, the unit needs to actively cooperate. Maternity insurance, paid by the insurance agency. This is the right of female employees stipulated by law, and no individual or unit may infringe upon it.

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