The reimbursement process of maternity insurance in public institutions

Conditions for reimbursement of maternity insurance As a social insurance system, maternity insurance is only applicable to married female employees who have reached the legal age of marriage, and must also abide by and obey the national family planning regulations. Married female workers who have not reached the legal age and those who do not meet or obey the national family planning regulations cannot enjoy maternity insurance benefits. Then, what is the reimbursement process of maternity insurance in public institutions? Let me introduce you. Please read it. I hope the following information can help you.

First, maternity insurance reimbursement process maternity insurance reimbursement process

As for the maternity insurance for female employees in state organs and institutions, it is borne by the state finance alone, and individuals do not need to pay any fees. The employing units that have not participated in the social pooling of maternity insurance shall bear the maternity expenses of female employees. Maternity Insurance Reimbursement Process Maternity Insurance Reimbursement Process refers to a procedure in which employers and employees themselves reimburse maternity medical expenses, maternity allowance and other expenses of female employees and nursing leave allowance of male employees' spouses during childbirth to the overall regional maternity insurance fund.

1, after a female worker is pregnant, has an abortion or has a family planning operation, the employing unit or the staff of the street or town labor security service station will bring the application materials to the maternity insurance window of the district social labor insurance for handling;

2, the staff to accept the examination and approval, issued a medical certificate;

3. Within 30 days of maternity leave, the employer or the staff of the street or town labor security service station shall bring the application materials to the maternity insurance window of the district social labor insurance agency for treatment settlement;

4, workers accept the examination and approval, pay maternity medical expenses and maternity allowance. Insured employees who meet the following conditions can enjoy maternity insurance benefits according to regulations:

(1) conforms to the national, provincial and municipal family planning policies;

(2) When giving birth or carrying out family planning operation, the employer has participated in maternity insurance and paid the maternity insurance premium in full 12 months.

(3) Prenatal check-up fee and production fee, the parties bring marriage certificate, social security card (citizen card) and family planning certificate issued by the street to the designated maternity insurance hospital for direct credit card settlement.

(4) To declare maternity allowance and one-time nutrition allowance, you need to fill in the maternity insurance benefits declaration form and affix the official seal of the unit, provide marriage certificate, one-child certificate (for children), discharge summary and other materials, and go through the declaration formalities at the obstetrics department of the municipal medical insurance center on the working day between 1- 10 every month. (Go through relevant formalities within one year after delivery)

2. What are the reimbursement materials for maternity insurance?

One original and one copy of the marriage certificate and one original and one copy of the maternity service certificate (it is best for employees who participate in maternity insurance in other places to provide Beijing maternity service certificate, and if they cannot provide it, they need to provide a formal maternity service certificate in other places); One original and one copy of the birth medical certificate, one original and one copy of the medical blueprint, one original and one copy of the diagnosis certificate issued by the hospital, the original documents of all hospitals, and two copies of the maternity reimbursement approval form, with official seals.

1, original and copy of hospital medical records;

2. The original and photocopy of the hospital diagnosis certificate;

3. Special receipts or invoices for medical expenses printed by financial and tax departments;

4. Detailed list of medical expenses consistent with the receipt (invoice) amount (or manual record list with hospital seal);

5. The original and photocopy of the birth certificate or the original and photocopy of the family planning service certificate.

In addition, the following situations should be noted: 1. Failing to apply for the medical confirmation certificate of maternity insurance for enterprise employees in Guangzhou (hereinafter referred to as the medical confirmation certificate), and failing to apply for the birth certificate or family planning service certificate, the family planning department of the street where the husband and wife are located shall issue a certificate. 2, off-site delivery (has been in the city medical insurance center for off-site delivery application filing procedures), you need to provide the "Guangzhou enterprise employee maternity insurance off-site delivery application form" or "maternity insurance selection designated hospital application form". 3. Having obtained the medical certificate and having an emergency abortion or delivery in a non-designated hospital: 1 original and photocopy of the medical certificate; A written report issued by the insured or his family. 4. The medical expenses under various special circumstances of maternity insurance shall be determined by the Municipal Medical Insurance Center, 1 A written report shall be issued by the insured or his family; 2 information provided by the municipal medical insurance center according to various situations. The reimbursement amount of maternity insurance The maternity insurance fund shall pay the examination fee, delivery fee, operation fee, hospitalization fee and medicine fee for female workers. The medical service fee and medicine fee (including self-funded medicine and nutritional medicine) exceeding the prescribed amount shall be borne by the employees themselves. After the female workers are discharged from the hospital, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; The medical expenses of other diseases shall be handled in accordance with the provisions of medical insurance benefits. After the expiration of maternity leave, if a female employee needs rest and treatment due to illness, it shall be handled in accordance with the relevant provisions on sick leave and medical insurance benefits.

relevant knowledge

1, in line with the national family planning policy or family planning operation.

2, in accordance with the provisions of the unit to participate in maternity insurance and continuous full payment for employees for more than one year. Workers who are still insured during childbirth (abortion) shall enjoy maternity insurance benefits according to relevant regulations. The employer shall pay no more than 1% of the total wages of the unit to the social insurance agency, and the state shall pay indirect subsidies in the form of pre-tax expenses. It can be seen that the maternity social insurance fee is still borne by the employer.