Hello everyone, if you still don’t know much about the reimbursement conditions of maternity insurance, it doesn’t matter. Today, this site will share with you the knowledge of the reimbursement conditions of maternity insurance, including maternity in 2023. The insurance reimbursement conditions and standards will be analyzed for everyone. I hope it can solve everyone\’s problems. Let\’s get started!
Contents of this article
- What is the reimbursement standard for employee maternity insurance in 2023
- Medical abortion maternity insurance reimbursement process
- Maternity insurance reimbursement standards 2023
- Maternity insurance reimbursement conditions and standards in 2023
- Resident maternity insurance reimbursement in 2023 Standard
1. What is the reimbursement standard for employee maternity insurance in 2023
1. The maternity insurance fund will compensate the unit in the form of maternity allowance. The compensation standard is: If a female employee gives birth normally for more than 7 months of pregnancy (including 7 months) or gives birth prematurely for less than 7 months of pregnancy, she will enjoy 3 months of maternity allowance; if she has a difficult delivery or a cesarean section, half a month will be added. Maternity allowance: For multiple births, for each additional baby, the maternity allowance will be increased by half a month; for those who have had a pregnancy of more than 3 months (inclusive) and less than 7 months of pregnancy or induced labor, they will enjoy one and a half months of maternity allowance. Subsidy, if you miscarry due to pathological reasons within 3 months of pregnancy, you will enjoy 1 month of maternity allowance. Maternity allowances are calculated based on the average monthly maternity insurance paid wages of female employees in the 12 months before childbirth or family planning surgery.
2. Maternity nutrition subsidies and perinatal health care subsidies. Female employees who meet the national regulations for maternity leave of more than 90 days (inclusive) can enjoy maternity nutrition. The subsidy is 300 yuan, and the perinatal health subsidy is 700 yuan.
3. One-time maternity subsidy. After the female employee who originally participated in maternity insurance in the unit loses her job, and while receiving unemployment insurance benefits, she gives birth in compliance with the family planning regulations. Can enjoy one-time maternity subsidy: 400 yuan for miscarriage, 2,400 yuan for normal delivery, 4,000 yuan for difficult labor and multiple births. For male employees who participate in maternity insurance, their spouses are not included in the scope of maternity insurance and meet the family planning regulations when giving birth to their first child. , you can enjoy 50% of the one-time maternity subsidy.
4. Maternity allowances are compensated to the unit, and the basic salary, bonus and welfare fees of insured female employees during their maternity leave shall be paid by the unit as usual.
5. Family planning surgery fees, including placement (removal) of intrauterine devices, abortion, induction of labor, skin embedding, etc. due to family planning needs. The expenses incurred for sterilization and recanalization operations are included in the scope of payment of the maternity insurance fund.
Maternity allowance = 30 (days) per capita salary of the unit × number of vacation days
(1) Normal maternity leave of 90 days (including 15 days of prenatal examination);
(1) The medical expenses for medical treatment after confirming the birth medical status shall be borne by the municipal labor Settlement is settled with the Social Security Bureau and the hospital on a fixed basis (the amount exceeding RMB 10,000 shall be settled based on the approved amount).
(3) Medical expenses for delivery in other places will be reimbursed according to the actual amount if they are lower than the quota; if they are higher than the quota, they will be reimbursed according to the quota.
Normal delivery, abortion over 7 months old; average monthly salary of city employees in the previous year × 25%;
For those who give birth in first- and second-level hospitals, a one-time additional subsidy of 300 yuan per person will be provided.
2. Medical abortion birth insurance reimbursement process
1. Contact the insurance Company: Contact the insurance company through its customer service phone number or website and inform you that you need to apply for a medical abortion insurance claim.
2. Submit application materials: According to the requirements of the insurance company, submit application materials, which generally include valid identity documents, medical invoices, hospital diagnosis certificates, etc.
3. Review the claim application: The insurance company will review the application materials to confirm that the applicant meets the requirements within the scope of insurance liability.
4. Confirm the claim amount: After the insurance company has approved the claim amount, it will notify the applicant by phone or email.
5. Receive claim payment: Under normal circumstances, the insurance company will transfer the claim payment to the bank designated by the applicant within one working day after approval. in the account.
It should be noted that different insurance companies may have different claims settlement procedures for medical abortion insurance. Applicants should carefully read the insurance contract and terms when purchasing insurance to understand insurance responsibilities and claims settlement procedures.
3. Maternity insurance reimbursement standards 2023
1. The biggest new regulation on maternity insurance That is, maternity insurance and medical insurance have been officially merged. After the merger, it will not have any impact on the reimbursement of maternity insurance. The main thing is to simplify the insurance enrollment process and not increase the burden of payment. After the two insurances are merged, the prenatal examination fee will not be increased. It is no longer reimbursed separately, but can be reimbursed together with ordinary medical expenses. The settlement standards are the same as those of medical insurance. Women with social security cards can also directly swipe their social security cards when they are discharged from the hospital, and the maternity medical expenses will be deducted from the social security cards. p>
2. After the merger of maternity insurance and medical insurance, the unit contribution rate for employee basic medical insurance will be 10.5%, and the medical premium rate paid by individuals will remain unchanged at 2%. In addition, There are also many places that have increased medical expenses. For example, in Beijing, the payment standard for prenatal examinations has been increased from 1,400 yuan to 3,000 yuan per person; hospital delivery has been increased from 3,000 yuan to 5,000 yuan; cesarean section has been increased from 4,400 yuan to 5,800 yuan; The cost of artificial abortion has been increased from 270 yuan to 770 yuan. However, the specific policies vary in different places.
1. Reimbursement of maternity insurance includes medical expenses and family planning procedures. Different regions have different regulations on expenses and reimbursement ratios. Generally, the woman’s maternity insurance can reimburse 75%, and the man’s maternity insurance can reimburse 50%. Only one party can be reimbursed, which is worth paying attention to;
2. The maternity allowance payment standard is generally the unit\’s average monthly salary of employees in the previous year ÷ 30 × the prescribed number of vacation days, so the maternity allowances of different units are also different;
3. One-time maternity subsidy: 400 yuan for miscarriage, 2,400 yuan for normal delivery, 4,000 yuan for difficult labor and multiple births, only available to women with maternity insurance
4. Conditions and standards for maternity insurance reimbursement in 2023
1. 1. Maternity insurance fund with maternity allowance Compensation will be provided to the unit in the form of compensation. The compensation standard is: female employees who have a normal delivery for more than 7 months of pregnancy (including 7 months) or premature birth for less than 7 months of pregnancy will enjoy 3 months of maternity allowance; those who have difficult labor and cesarean section surgery , increase the maternity allowance by half a month. For multiple births, every additional childFor one baby, the maternity allowance will be increased by half a month; for those who have had a miscarriage or induced labor within 3 months of pregnancy (including 3 months) or less than 7 months of pregnancy, they will enjoy one and a half months of maternity allowance; for those who have had a miscarriage due to pathological reasons within 3 months of pregnancy , enjoy 1 month of maternity allowance. Maternity allowances are calculated based on the average monthly maternity insurance paid wages of female employees in the 12 months before childbirth or family planning surgery.
2. 2. Maternity nutrition subsidies and perinatal health care subsidies can be enjoyed by female employees who meet the national regulations and enjoy maternity leave of more than 90 days (inclusive). Childbirth nutrition subsidy is 300 yuan, and perinatal health subsidy is 700 yuan.
3. 3. One-time maternity subsidy: after female employees who originally participated in maternity insurance in the unit lost their jobs, while receiving unemployment insurance benefits, they can give birth in compliance with family planning regulations. , you can enjoy a one-time maternity subsidy: 400 yuan for miscarriage, 2,400 yuan for normal delivery, and 4,000 yuan for difficult labor and multiple births. For male employees who participate in maternity insurance, their spouses are not included in the scope of maternity insurance and meet the family planning regulations. When giving birth, you can enjoy 50% of the one-time maternity subsidy.
4. 4. Maternity allowances are compensated to the unit, and the basic salary, bonus and welfare fees of insured female employees during their maternity leave will be paid by the unit as usual.
5. 5. Family planning surgery fees, including insertion (removal) of intrauterine devices, abortion, induction of labor, and skin implantation due to family planning needs The expenses incurred for surgery, sterilization and recanalization operations shall be included in the payment scope of the maternity insurance fund.
5. Resident maternity insurance reimbursement standards in 2023
1. Maternity insurance reimbursement includes medical expenses and family planning procedures. Different regions have different regulations on reimbursement ratios. Generally, the woman can reimburse 75% for maternity insurance, and the man can reimburse 50% for maternity insurance. Only one party can be reimbursed;
2. The standard for payment of maternity allowance is generally the average monthly salary of the unit’s employees in the previous year ÷ 30 × the number of prescribed holidays;
3. One-time maternity subsidy: 400 yuan for miscarriage, 2,400 yuan for normal delivery, 4,000 yuan for difficult labor and multiple births, only available to women with maternity insurance. What is the scope of maternity insurance reimbursement?
【1】. Maternity allowance is the salary of a female employee during her maternity leave. If the maternity allowance is lower than her salary standard, the difference shall be borne by the enterprise. The maternity allowance shall be based on the female employee’s payment for the month she gives birth.The base is divided by 30 and multiplied by the number of maternity leave days.
【2】. The examination fees, delivery fees, operation fees, hospitalization fees and medicine fees for female employees\’ childbirth are paid by the maternity insurance fund, and the excess amount shall be borne by the individual employees.
【3】. After a female employee is discharged from hospital after giving birth, the medical expenses for diseases caused by childbirth will be paid by the maternity insurance fund.
Okay, the article ends here. If the maternity insurance reimbursement conditions and the 2023 maternity insurance reimbursement conditions and standards shared this time are of interest to you, Help, please pay attention to this site!
