Yunnan maternity insurance reimbursement standard 2022

Yunnan Maternity Insurance Reimbursement Standard 2022

A. Maternity Insurance Reimbursement Ratio:

1. 2500 yuan for normal delivery;

2. 3000 yuan for difficult delivery (forceps assisted delivery and fetal head attraction);

3. 4000 yuan for cesarean section;

4. 500 yuan for prenatal checkups;

5. 600 yuan for miscarriage under 4 months' gestation (including abortion);

6. 450 yuan for surgery to place intrauterine device (including intrauterine device);

6, placing intrauterine device surgery (including intrauterine device) 450 yuan;

7, removal of intrauterine device surgery 150 yuan;

8, childbirth nutritional subsidies 500 yuan (in the case of multiple births, an additional 500 yuan for each additional child.

Second, 2022 Yunnan maternity insurance reimbursement conditions:

1, female workers maternity or male workers spouse maternity continuous payment of maternity insurance for more than 6 months;

2, workers maternity in line with the relevant provisions of family planning.

Yunnan maternity insurance reimbursement process:

The employer with the local township (street) population and family planning work agencies issued by the relevant certificate to the local social insurance agency. One of the application for maternity allowance or a one-time childbirth nutritional subsidy treatment, should also hold a baby birth, death or termination of pregnancy certificate.

Third, Yunnan maternity insurance reimbursement materials:

1, female workers maternity insurance reimbursement materials

1, family planning department issued by the family planning certificate (original and copy);

2, medical department issued by the baby's birth (death) certificate (original and copy);

3, maternity female workers, family planning surgery workers own identity card (original and copy).

4, enterprise workers maternity medical license review and adoption form;

5, enterprise workers family planning surgery medical license application form;

6, enterprise workers maternity medical expenses reimbursement application form;

7, enterprise workers maternity insurance treatment approved settlement form;

8, enterprise workers maternity insurance application form for medical treatment abroad;

9, maternity medical bills, cost lists, medical records, discharge summary and so on. Medical records, discharge summary and other original information;

10, receipts.

2, the male worker is not employed spouse maternity insurance reimbursement materials

1, family planning department issued by the family planning certificate (original and copy);

2, the medical department issued by the birth (death) of the baby certificate (original and copy);

3, the male employee's own identity card (original and copy).

Legal basis

Article 2 of the Opinions of the General Office of the State Council on Comprehensively Promoting the Combined Implementation of Maternity Insurance and Employee Basic Medical Insurance:

(a) Unified insurance registration. Active employees who participate in basic medical insurance for employees shall participate in maternity insurance at the same time. In the process of implementation, the scope of participation should be improved, combined with the universal insurance registration program to identify the base, and promote the realization of the full coverage.

(B) unified fund collection and management. The maternity insurance fund is integrated into the basic medical insurance fund for employees, unified collection, the same level of integration. In accordance with the employer to participate in maternity insurance and employees' basic medical insurance contribution ratio and determine the new employer employees' basic medical insurance premium rate, individuals do not pay maternity insurance premiums. At the same time, a mechanism for determining and adjusting the rates is established in accordance with the principle of balancing revenues and expenditures, taking into account the expenditures of the Employees' Basic Medical Insurance Fund and the demand for maternity benefits. The Employees' Basic Medical Insurance Fund is strictly enforcing the financial system of the Social Insurance Fund, and no longer includes the income of the Maternity Insurance Fund as a separate line item; the Maternity Treatment Expenditures item is set up in the Expenditures of the Employees' Basic Medical Insurance Coordination Fund. Explore the establishment of a sound early-warning mechanism for fund risks, adhere to the openness of the fund's operation, strengthen internal control, and enhance the fund's administrative supervision and social supervision to ensure the safe operation of the fund.

(C) unified medical service management. After the two insurance merger implementation of unified designated medical services management. Medical insurance agencies and designated medical institutions to sign the relevant medical service agreement, to maternity medical service requirements and indicators added to the content of the agreement, and make full use of the agreement to strengthen the management of maternity medical services monitoring. Basic medical insurance, industrial injury insurance and maternity insurance drug catalogs, as well as the scope of diagnostic and treatment items and medical service facilities of basic medical insurance, should be implemented. Promote the standardization of maternity medical service behaviors. Maternity medical expenses have been included in the scope of medical insurance payment reform, and payment for hospitalized deliveries and other medical expenses has been promoted on a case-by-case basis, as well as on a per-person basis for prenatal checkups. In principle, direct settlement of maternity medical expenses between medical insurance agencies and designated medical institutions has been implemented. Make full use of the intelligent monitoring system of medical insurance, strengthen the monitoring and audit, and control the unreasonable growth of maternity medical expenses.

(d) Unified management and information services. After the merger of the two insurance, to unify the management, standardize the management process. The management and administration of the unified by the basic medical insurance agency responsible for the funds included in the financial budget at the same level. Making full use of the medical insurance information system platform, the implementation of the integrated operation of the information system. The original maternity insurance medical expense settlement platform can be temporarily retained, when conditions are ripe and integrated into the medical insurance settlement platform. Improve the statistical information system to ensure timely, comprehensive and accurate reflection of the operation of the maternity insurance fund, the entitlement of persons, treatment payments and other aspects of the situation.

(v) Ensure that the maternity insurance benefits during childbirth remain unchanged. Maternity insurance benefits include the "People's Republic of China *** and the State Social Insurance Law" provides for maternity medical expenses and maternity allowance, the funds required from the basic medical insurance fund for employees. The period of payment of maternity allowance is in accordance with the period of maternity leave stipulated in the Special Provisions on the Labor Protection of Female Employees and Workers and other laws and regulations.

(vi) Ensure the sustainability of the system. Localities should enhance the fund through the integration of the two insurance funds to enhance the fund **** relief capacity; study the current and future demographic situation on the impact of maternity insurance expenditures, enhance the awareness of risk prevention and the ability to protect the system; in accordance with the principle of "do their best, within the limits of their capabilities", adhere to the actual starting point from the protection of the basic rights and interests of the start, and reasonably guide the expectations; tracking and analyzing the operation of the fund after the implementation of the merger, the impact on the maternity insurance expenditure. Tracking and analyzing the operation of the fund and expenditure structure after the implementation of the merger, improve the monitoring indicators of maternity insurance; according to the demand for maternity insurance expenditure, the establishment of a dynamic adjustment mechanism of the fee rate, to prevent the transfer of risk, and realize the sustainable development of the system.