(1) conforms to the family planning policy of Chuzhou City, Anhui Province;
(2) When giving birth or carrying out family planning operation, the employer has participated in Chuzhou 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 Chuzhou maternity insurance designated hospital for direct credit card settlement.
(4) To declare maternity allowance and one-time nutrition allowance, you need to fill in the Chuzhou 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 to the obstetrics department of the municipal medical insurance center for declaration procedures on working days between 1- 10 every month (relevant procedures should be handled within one year after delivery).
Chuzhou maternity insurance reimbursement process
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.
Proportion of maternity insurance payment in Chuzhou city
(a) unified basic medical and maternity insurance policies for urban workers.
1. Uniform coverage. Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with the regulations. Maternity insurance is paid by the employer, but not by individual employees.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees of the employer and other flexible employees may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premium in accordance with the regulations.
2. Unified payment standard. In accordance with the principle of "support by income, balance of payments and slight balance", unify the payment standards of medical insurance for employers and employees in the city; In accordance with the principle of "supporting fixed income and balancing income and expenditure", unify the payment standard of maternity insurance for employers in the city.
(1) Unified payment base for medical insurance and maternity insurance. The employer's medical insurance and maternity insurance payment base is the total wages of employees, and the employee's individual payment base is his salary income, which is declared monthly. The monthly payment salary of the employees of the employer shall be truthfully declared, and if it is lower than 60% of the average salary of the employees in the whole province in the previous year, it shall be paid at 60%; If it is higher than 300% of the average wage of employees in the province last year, it will be paid at 300%. Flexible employment personnel (including renewal personnel) shall be implemented according to the payment base of employees in the employing unit.
(2) unify the payment ratio of employers and employees. The contribution rate of medical insurance units is 6.5% of the total wages of employees, and the individual contribution rate of employees is 2% of their wage income. Flexible employment personnel (including renewal personnel) pay the basic medical insurance premium at 8.5% of the declared payment base.
The maternity insurance rate is 0.4% of the total wages of employees of state organs, social organizations and institutions, and 0.8% of the total wages of employees of various enterprises and individual industrial and commercial households with employees.
(3) unify the payment standard of medical assistance fund. The payment standard of medical assistance is per person per month 10 yuan.
(4) unify the minimum payment period. When the insured unit retires, the minimum payment period for participating in the basic medical insurance is 30 years for men and 25 years for women, before they can enjoy the basic medical insurance benefits for retirees. Before the establishment of the basic medical insurance system in our city on September 30, 2000, the length of service or the payment period of basic old-age insurance recognized by the relevant national policies was regarded as the payment period of basic medical insurance for employees. If the number of years is less than the prescribed period, the employer can enjoy the medical insurance benefits for retirees after paying in a lump sum according to the regulations.
When flexible employees (including those who renew their insurance) retire, their basic medical insurance premiums must be at least 30 years old for men and 25 years old for women (including the actual payment period 15 years) in accordance with relevant policies, before they can enjoy the basic medical insurance benefits for retirees. If the number of years is less than the prescribed period, the insured can enjoy the medical insurance benefits for retirees after paying in one lump sum according to the regulations.
Chuzhou maternity insurance benefits
(1) Unified proportion of individual medical insurance accounts in the whole city. On-the-job employees are included in their personal accounts according to their payment base; Retirees who receive pensions from pension insurance agencies shall be included in the base according to their pensions as personal accounts; If the retirement fee is approved by the organization and the human society department, the retirement fee will be included in the personal account as the base. 30 years old and under are included in 3%; 3 1 3.3% for the age of 45; 3.6% for those aged 46 and above; Retirees are counted as 4% of their monthly pension (retirement fee).
(2) unified hospitalization pooling fund Qifubiaozhun. Qifubiaozhun for the first hospitalization of on-the-job employees within one year is: 400 yuan in the first-level hospital, 500 yuan in the second-level hospital and 600 yuan in the third-level hospital; The second and third hospitalizations were less than the first and second hospitalizations 100 yuan respectively. Qifubiaozhun for the third and above hospitalization shall be implemented according to the third standard. The qifubiaozhun for hospitalized retirees is 70% of the employees.
(3) unify the proportion of out-of-pocket expenses of hospitalized individuals. Within a year, the insured person meets the hospitalization medical expenses stipulated in the basic medical insurance, and the Qifubiaozhun is above and below the maximum payment limit, and the proportion of the insured person's self-payment is implemented according to the current policy. Implementation of national and provincial medical insurance drug list, diagnosis and treatment projects, medical service facilities, artificial organs and materials placed in our city, the price limit standard, the insured individual pays the proportion according to the current policy.
(4) unify the maximum payment limit of basic medical insurance and the payment limit of medical assistance fund. The maximum payment limit for basic medical insurance is 90,000 yuan, and the annual maximum payment limit for medical assistance is 250,000 yuan. The municipal human resources and social security department shall make timely adjustments according to the operation of the medical insurance fund.
(5) unify the reimbursement standards for hospitalization outside the hospital and hospitalization in different places. If the insured is hospitalized outside the hospital or resettled in different places, it shall be implemented according to the current policy.
(6) unify chronic diseases and outpatient medical care. Within a year, the qifubiaozhun for outpatient treatment of chronic diseases is 500 yuan, and the part of outpatient treatment expenses exceeding qifubiaozhun within the prescribed scope shall be paid by the overall fund in proportion. The diseases, Qifubiaozhun and payment ratio of chronic diseases shall be implemented according to the current policy.
(7) Unify Medicaid treatment for civil servants. Counties (cities, districts), government agencies and institutions shall, on the basis of participating in the basic medical insurance for employees, implement medical subsidies for civil servants in accordance with the Interim Measures of Chuzhou Municipality on Medicaid for National Civil Servants (Chu Zheng [2000] No.39), and the specific subsidy standards shall be implemented according to the current policies.
(8) Unified settlement of hospitalization medical expenses. According to the fund revenue and expenditure budget, comprehensive settlement methods such as total amount control, per-person payment and per-disease payment are implemented.
(nine) unified maternity insurance benefits. Maternity insurance benefits include maternity medical expenses and maternity allowance, which are paid by the maternity insurance fund.
(10) unify the scope and standard of maternity allowance. The female employees of the employer who pay at the rate of 0.8% enjoy the corresponding maternity allowance stipulated in Article 11 of the Interim Provisions on Maternity Insurance for Employees in Anhui Province (DecreeNo. 195 of the provincial government). Maternity allowance is calculated and paid according to the average monthly salary of employees in the previous year of the employer.
What proof materials do you need for the reimbursement ratio of Chuzhou maternity insurance?
Now both men and women have bought maternity insurance in Chuzhou and produced it in Chuzhou Gulou Hospital. May I ask?
1. Can the medical expenses be reimbursed?
2. What is the reimbursement rate of medical expenses?
3. Can I apply for maternity allowance after reimbursement of medical expenses? How much is it?
4. Which department to go to, what supporting materials are needed, and is there a time limit?
Maternity insurance female employees who have been insured for more than 10 months can enjoy maternity insurance benefits. Before giving birth, it is necessary to bring a copy of the ID card, marriage certificate, reproductive health service certificate, medical insurance card and the above-mentioned documents to the medical insurance center in the jurisdiction for maternity insurance registration. The medical expenses for maternity are directly settled in the hospital (65,438 yuan for natural delivery and 2,800 yuan for cesarean section in tertiary hospitals; Secondary hospital delivery 1300 yuan, cesarean section 2600 yuan; To start maternity insurance, a first-class hospital needs to provide ID card, medical insurance card, bank account number, discharge summary and other materials (specifically subject to personal treatment) to receive an application form for maternity allowance.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.