What are the benefits of maternity insurance? How much can be reimbursed for reproductive medical expenses… The response is here!
1. How to collect and pay the expenses for the employer to participate in maternity insurance? What is the rate?
Answer: The expenses of the employer participating in maternity insurance and the basic medical insurance premium is collected and paid together, are included in the basic medical insurance fund, and are no longer listed separately as the income of the maternity insurance fund.
Employers participate in basic medical insurance for their employees and also participate in maternity insurance, and pay basic medical insurance premiums according to the following regulations:
(1) For those who participate in unified account integration, 7.5% of the employee's salary shall be paid every month, of which the employer shall pay 6% (including 0.5% of the maternity insurance fee), and the individual pays 1.5%.
(2) If participating in the overall planning of individual construction, the employer shall pay 2.5% of the employee's salary (including 0.5% of the maternity insurance fee) every month, and the employee shall not pay the fee.
The part of the employee's salary that exceeds 300% or more of the average monthly salary of the on-the-job employees in the previous year implemented by this Municipality shall not be charged for basic medical insurance; Basic medical insurance premiums are levied on 60% of the average monthly salary of on-the-job workers.
2. What are the benefits of employee maternity insurance in Zhuhai?
Answer: Maternity insurance benefits include maternity medical expenses and maternity allowances, maternity medical expenses include maternity expenses and family planning expenses, and maternity allowances include maternity leave allowances and family planning allowances.
3. What are the expenses for maternity and childbirth?
Answer: Maternity expenses refer to medical expenses incurred due to childbirth, including prenatal examination expenses and medical expenses that meet the prescribed scope for hospital delivery.
4. What are the family planning expenses?
Answer: Family planning expenses refer to the medical expenses incurred for family planning operations such as placing (removing) intrauterine devices, subcutaneous implantation, abortion (including spontaneous abortion), labor induction, sterilization, and reversal.
5. What items are included in the prenatal examination fee?
Answer: Routine items: general obstetric examination, blood routine, blood type, blood sugar, urine routine, leucorrhea routine, liver function, kidney function, two and a half of hepatitis B, hepatitis C antibody, coagulation function, thalassemia screening, G6PD screening, electrocardiogram, fetal Cardiac monitoring, and color Doppler ultrasonography were performed once.
Items for review: 15-20 weeks of pregnancy aneuploidy maternal serological screening, hemoglobin electrophoresis test, anti-D titer test (Rh negative), thyroid function screening, cervical exfoliation cytology, cervical secretion detection Lymphoma Chlamydia trachomatis detected in cocci and cervical secretions.
6. Which maternity medical expenses can be included in the payment scope of the basic medical insurance pooling fund?
A: The fertility medical expenses incurred by the assured should meet the following ranges:
(1) Catalogue of medicines for basic medical insurance and maternity insurance implemented by this city.
(2) The scope of basic medical insurance diagnosis and treatment items and medical service facilities implemented by this city.
(3) Maternity and childbirth items are listed in the medical service price items of non-profit medical institutions in this city.
(4) Items of family planning surgery specified in these Measures.
7. How much can the insured employees' maternity medical expenses be reimbursed?
Answer: The medical expenses for maternity incurred by the insured employees in the municipality's second-level and below maternity agreement institutions (hereinafter referred to as the agreement institutions) shall be paid by the basic medical insurance pooling fund, and the individual shall not pay;
80% of the medical expenses for maternity in the city's third-level agreement institutions shall be paid by the basic medical insurance pooling fund, and 20% shall be paid by the individual. Expenses beyond the payment scope of the basic medical insurance pooling fund shall be paid by the assured employees themselves.
8. What is the standard for the basic medical insurance pooling fund to pay the bed fee of the insured employee for hospital delivery?
A: The settlement standard for hospital beds shall be implemented by the relevant provisions of basic medical insurance.
9. What information do insured employees need to provide when applying for their unemployed spouse's maternity expenses benefits?
A: The information to be provided is:
(1) My social security card;
(2) Discharge summary/record;
(3) Fee vouchers and a detailed list of fees;
(4) Marriage certificate and ID card of spouse;
(5) Inform the letter of commitment.
10. Is there a payment period for maternity insurance benefits?
Answer: The maternity insurance benefits will not be paid by the basic medical insurance pooling fund if the insured employee fails to apply for benefits within 24 months from the date when the insured employee gives birth or undergoes a family planning operation.