During the epidemic, will various social security benefits be affected?

Today, the editor will work with you to learn about the benefits of maternity, medical care, pension, unemployment, and work-related injury insurance during the epidemic.

Part One: Maternity Insurance Benefits

1. Affected by the epidemic, the employer is late in paying maternity insurance premiums. How to ensure maternity medical benefits?

According to "Guangzhou The fifth point of the Notice of the Municipal Medical Security Bureau on Effectively Managing Medical Security Services to Promote the Prevention and Control of the Pneumonia Epidemic of New Coronavirus Infection: "For those who are unable to pay social medical insurance and maternity insurance fees in a timely manner due to the epidemic, the epidemic will be allowed to The reissue and payment will be made within three months after the end of the period, and no late payment fees will be charged. During the epidemic period, the insured will not be affected by the medical treatment benefits..." The relevant treatment principles are as follows:

(1) Local medical treatment has been selected Insured persons who undergo prenatal check-up and delivery in institutions

If the insured person has selected a local medical institution for prenatal check-up and delivery, and the employer is late in paying dues due to the impact of the epidemic, the insured will be responsible for the relevant medical expenses (including prenatal check-up, delivery or delivery). Family planning, the same below) can pay the deposit first without settlement. After the employer pays it back as required, the employer can go to the medical institution with the deposit voucher to handle the supplementary accounting.

If the insured person has settled medical expenses, he or she can wait for the employer to pay them back as required, and then take the invoice to the medical institution to process the refund and then make the payment into the account.

(2) The insured person has chosen a medical institution in another place for prenatal check-up and delivery

The insured person has chosen a medical institution in another place for prenatal check-up and delivery. Due to the impact of the epidemic, the employer is late in paying the fee , the relevant medical expenses of the insured person can be reimbursed at each medical insurance branch center within one year after the epidemic ends after the employer pays them back as required.

(3) The insured person who has not yet selected a medical institution for prenatal check-up and delivery

If the insured person has not yet selected a medical institution for prenatal check-up and delivery, and the employer is late in paying dues due to the impact of the epidemic, The insured person can first apply for a medical treatment voucher after paying the premium normally. If the employer has completed the back payment as required, the insured person can contact the corresponding medical insurance sub-center to adjust the effective time of the medical treatment voucher and handle it according to the first and second points. Medical expenses.

(4) How can employees who have paid for less than one year enjoy maternity medical treatment if their unit has not paid during the epidemic?

Female employees who have paid for less than one year need to enjoy maternity medical treatment. Benefits (including prenatal check-ups, childbirth and family planning surgeries). During the period when the unit is in arrears with the maternity insurance premiums, you will not be able to enjoy the maternity medical benefits. If the unit makes up the payment in accordance with the regulations, it will be regarded as normal payment. The pregnancy has not been terminated, and the payment has been completed. For one year (including the repayment part), you can apply for a voucher first, and then go to any branch center of the Guangzhou Medical Insurance Center to adjust the benefit enjoyment time, and then make additional accounting processing according to regulations; if the pregnancy has been terminated, you can bring the information to the Guangzhou Medical Insurance Center Handled by each branch center.

For example:

Ms. Li registered for insurance in April 2019 and paid the premium normally. She was confirmed to be pregnant in January 2020 and the expected date of delivery is September 2020. However, her employer failed to pay dues due to the epidemic. Therefore, Ms. Li cannot apply for medical confirmation of maternity treatment and enjoy maternity medical treatment for the time being. If the unit pays the relevant fees in May 2020, Ms. Li can apply for medical confirmation after the unit pays in May and go to the medical insurance sub-center of the hospital. After adjusting the benefit entitlement date, the prenatal check-up expenses incurred before will be accounted for by the medical institution in accordance with regulations. If the unit only pays the relevant fees in October 2020, and Ms. Li has already given birth, she can bring the information to the medical insurance branch center for processing according to regulations (the specific processing method is subject to the acceptance of each medical insurance branch center).

Note

Insured persons who are unable to apply for sporadic maternity insurance reimbursement in time due to the impact of the epidemic: the reimbursement time limit for maternity insurance medical expenses incurred by the insured that meet the sporadic reimbursement regulations, The original fee will be processed within 1 year from the date of occurrence, to 1 year after the epidemic ends. Insured persons are advised to try their best to apply for zero reporting business after the epidemic is over.

2. If the unit fails to pay during the epidemic, will the maternity allowance still be paid?

According to the "Guangzhou Municipal Medical Security Bureau's Guide to Promoting the Management of Medical Security Services to Promote Novel Coronavirus Infection" Point 5 of the "Notice on Pneumonia Epidemic Prevention and Control Work": "For those who are unable to pay social medical insurance and maternity insurance fees in a timely manner due to the epidemic, they are allowed to make up the payment within three months after the epidemic ends, and no late payment fees will be charged. During the epidemic period, no late payment fees will be charged. "Affecting the insured persons' enjoyment of medical treatment..." requires that during the period when the employer is in arrears with the maternity insurance premiums, maternity benefits will not be paid temporarily. If the employer makes up the payment in accordance with regulations, it will be regarded as normal payment, and the Guangzhou Medical Insurance Center will allocate it in accordance with regulations.

Part 2: Medical Insurance Benefits

1. How to implement the employee medical insurance tax reduction policy during the epidemic?

Guangzhou from February to June 2020 The municipal employee medical insurance unit payment rate is levied at 50% of the rate before the fee reduction. That is, during the implementation of the halved collection policy, the employee social medical insurance unit payment rate is 3.5, and the maternity insurance unit payment rate is 0.85. The total unit payment rate is is 4.35. This measure is expected to reduce the burden on enterprises by approximately 8.325 billion yuan in five months, effectively support the resumption of work and production, and promote stable employment.

2. Affected by the epidemic, if the employer fails to pay in time, how can the benefits be guaranteed?

In view of the possible impact on medical treatment of some insured units and insured persons during the epidemic, the city The Medical Insurance Bureau has promptly optimized the benefits entitlement policy and handling process. For those who are unable to pay social medical insurance and maternity insurance premiums in a timely manner due to the epidemic, they will be allowed to make repayments within three months after the epidemic ends, without charging late fees. During the epidemic, the insured will not be affected by their enjoyment of medical treatment. During the epidemic period, the medical insurance system opened batches of employee medical insurance and maternity insurance medical benefits for insured persons. In terms of medical insurance benefits, insured persons will settle medical expenses according to regulations after seeking medical treatment at designated medical institutions with their social security cards (no need to go through additional zero-declaration procedures); if due to If direct settlement cannot be made for various reasons, repayment can be made within three months after the epidemic ends, and benefits can be traced back through additional accounting in the hospital or zero reporting. Regarding the guide to medical insurance reimbursement, I have just compiled the relevant content. I hope it will be helpful to you: 2020 National Social Security and Medical Insurance Application Reimbursement Process!

3. Will the delay in payment of medical insurance during the epidemic affect the review of qualifications for small and medium-sized passenger vehicles?

Regarding the issue of small and medium-sized passenger vehicles, some enterprises in our city have delayed payment of social insurance (medical insurance) due to the epidemic. ) situation, the transportation department has issued relevant measures on April 9, 2020 to appropriately adjust the conditions for applying for incremental indicators for people who are not registered in this city. Starting from April, applicants will not be reviewed for the social medical insurance payment records of employees in this city in the previous month. . For the latest news on policy adjustments, please pay attention to the official indicator regulation website (/).

4. What are the changes in medication use during the epidemic?

During the epidemic period, medical insurance will implement long prescriptions for medical treatment. Insured patients in this city who have applied for a specific type of outpatient disease and are within the validity period (Including those insured by municipal medical insurance), after evaluation by doctors at designated medical institutions, the prescription dosage can be relaxed to 3 months. The maximum payment limits for specific outpatient diseases in employee medical insurance and urban and rural residents' medical insurance are adjusted from monthly limits to quarterly limits, with the quarterly limit being three times the original monthly limit.

For example:

Employee (resident) medical insurance participants have applied for a valid specific type of diabetes outpatient service. The original insured person can go to the designated medical institution of the medical insurance to get the prescription in February. For the monthly dosage, the medical insurance fund will pay a maximum of 200 (50) yuan; now the insured can go to a medical insurance designated medical institution in February, and after evaluation by a doctor at the designated medical institution, a ***3-month dosage will be prescribed from February to April. , the maximum payment from the medical insurance fund is 600 (150) yuan.

(In parentheses are the contents of urban medical insurance participants)

The policy document stipulates:

During the epidemic, medical insurance designated medical institutions will reasonably increase the dosage of a single prescription based on the actual situation of the patient. , reducing the number of patients visiting designated medical institutions for prescriptions; for patients with chronic diseases such as hypertension and diabetes who are insured by the city’s social medical insurance, after evaluation by doctors at the diagnosis and treatment hospital, the prescription dosage can be relaxed to 3 months, and the monthly payment limit of medical insurance can be adjusted It is a quarterly limit, and the quarterly limit standard is three times the original monthly limit standard.

5. How to deal with the medical expenses of imported cases of COVID-19 for people returning from overseas?

According to the "Guangdong Provincial New Crown Pneumonia Prevention and Control Command Office Epidemic Prevention and Control Team's Notice on Persons Returning to Guangdong from Abroad" "Notice on Expenses" and other relevant regulations, among the imported cases of overseas returnees to Guangdong, those who participate in the basic medical insurance will be subsidized by the finance department after paying the medical expenses according to the basic medical insurance, critical illness insurance, medical assistance, etc. Among the imported cases of people returning to Guangdong from abroad who do not participate in basic medical insurance, the medical expenses will in principle be borne by the patients themselves. People who participate in commercial health insurance will be paid by the commercial insurance company according to the contract. Among the imported cases of people returning to Guangdong from abroad who have not participated in basic medical insurance and are indeed in difficulty, if they are determined to meet the conditions, they can be provided with medical assistance in accordance with laws and regulations. That is to say, insured persons only need to present their medical insurance card or social security card, and the relevant expenses will be settled by medical institutions in accordance with medical insurance policies; in principle, the medical expenses of non-insured persons shall be borne by the patient personally. For specific circumstances, please consult the medical institution or health care institution. Administration.

6. How to handle the screening costs for COVID-19?

According to the "Guangzhou COVID-19 Prevention and Control Command Office Medical Prevention and Control Group forwarded to the Guangdong Provincial Novel Coronavirus Pneumonia Epidemic Prevention and Control Headquarters" "Notice of the Office on Carrying out Nucleic Acid Testing and Screening of Key Populations in Different Regions and Levels", currently the medical insurance participants in Guangdong Province are the key screening objects required by the provincial prevention and control, and the nucleic acid testing expenses incurred in designated medical institutions will be included in the medical insurance payment according to regulations. scope; outside the scope of investigation specified by the Provincial Prevention and Control Headquarters, the costs incurred by relevant units (enterprises) and individuals for nucleic acid testing at their own request shall be borne by them. That is to say, insured persons only need to present their medical insurance card or social security card, and their related expenses will be settled by medical institutions in accordance with medical insurance policies; inspection expenses for non-insured persons or expenses for insured persons that fall outside the scope of the inspection clearly stated by the Provincial Prevention and Control Headquarters , please consult medical institutions or health administrative departments for specific circumstances.

Part Three: Pension Insurance Benefits

1. What impact will the epidemic have on the application of pension insurance for urban and rural residents?

During the epidemic period, urban and rural residents failed to apply for pension insurance on time. Insurance payment registration, payment declaration, benefit application and other services are allowed to be reissued after the epidemic is over. During the extension period, pension insurance benefits can be enjoyed normally without affecting the personal rights and interests records of insured persons. The reissue should be completed within three months after the epidemic is lifted. .

2. If the application for pension insurance benefits for urban and rural residents is delayed during the epidemic, will it affect the pension?

For those who apply for pension insurance benefits for urban and rural residents, those who meet the conditions for applying for benefits , handle relevant treatment according to regulations. For delayed payment of social insurance premiums, the payment will be re-assessed and relevant benefits will be reissued. The qualification certification for receiving urban and rural residence insurance benefits can be processed through the Guangdong Social Security APP and the WeChat Guangdong Province Mini Program. If the certification is not completed on time, the payment of benefits will not be suspended.

3. I have met the requirements for applying for a pension during the epidemic. Can I wait until the epidemic is over? Will the delay affect my pension?

If I fail to apply on time during the epidemic, Those who handle pension application business are allowed to re-apply within three months after the epidemic is over, and the pension amount will not be affected.

4. During the epidemic period, there are special policies for reducing or deferring social security premiums. If social security premiums are reduced or postponed, will it affect my application for pension?

Social security premiums are reduced or postponed. The policy only targets the unit payment part and will not affect pension applications or pension amounts.

If the individual payment of social insurance premiums is partially deferred, for the insured person who applies for pension insurance benefits, the social insurance agency will temporarily issue pension insurance benefits based on the payment situation before the postponement until the deferred payment is actually paid. After the payment is received, the pension insurance benefits will be re-assessed as normal payments and the difference in benefits will be reimbursed.

Policies encourage employers to give priority to employees who have reached retirement age.

5. During the epidemic, can I go through the pension qualification verification procedures without going to the social security front desk? Is there any other convenient way?

Used during the epidemic