(1) After a female employee becomes pregnant, before miscarriage or family planning surgery, the employer or the staff of the street or town labor and security service station should bring the application materials to the maternity insurance window of the district social labor insurance office; (2 ) After the staff accepts and approves the application, a medical certificate will be issued; (3) Within 30 days of maternity leave for female employees who give birth, the employer or the staff of the sub-district or town labor and security service station will bring the application materials to the maternity insurance window of the district social labor insurance office to handle the settlement of benefits. ; (4) After the staff accepts and approves the application, the maternity medical expenses and maternity allowances will be paid. [Edit this paragraph] Insurance benefits maternity allowance, maternity medical expenses, family planning surgery expenses, and other expenses stipulated by the state and this city; (1) Maternity allowance: Maternity allowance is the salary of a female employee during her maternity leave, and the maternity allowance is lower than her own salary Standard, the difference will be made up by the enterprise. Maternity allowance is calculated based on the female employee’s base payment for the month she gives birth divided by 30 and multiplied by the number of maternity leave days. (2) Employees who have participated in maternity insurance for a total of one year and are still participating in the insurance when giving birth (miscarriage) will enjoy maternity insurance benefits in accordance with relevant regulations. (3) Maternity insurance benefits. The maternity allowance payment standard is based on the per capita paid salary of the unit in the month when the childbirth (abortion) occurs and is calculated according to the prescribed holidays: Maternity allowance (per capita paid salary of the unit in the month/30 days x number of holidays) Number of holiday days : ① Normal maternity leave is 90 days (including 15 days for prenatal examination); ② Only child leave is increased by 35 days; ③ Late childbearing leave is increased by 15 days; ④ Difficult maternity leave. An additional 30 days will be added for caesarean section and third-degree perineal rupture; an additional 15 days will be added for induction delivery, forceps delivery, and breech delivery; ⑤ Multiple birth leave, an additional 15 days will be added for each additional baby; ⑥ Miscarriage leave: 15 days for less than 2 months of pregnancy ; Pregnancy for less than 4 months and 30 days; from 4 months and above (including 4 months) to 7 months and below for 42 days; 75 days for stillbirth, stillbirth and premature birth over 7 months; one-time childbirth nutrition subsidy ① Normal birth, miscarriage over 7 months old; the average monthly salary of city employees in the previous year × 25%; ② Dystocia, multiple births: the average monthly salary of city employees in the previous year × 50%. The male spouse of a male employee who receives the "One Child Preferential Treatment Certificate" enjoys 10 days of leave, which is calculated based on the unit's per capita salary in the month when the child is born. The male spouse’s holiday pay = the unit’s per capita paid salary for the month ÷ 30 (days) × 10 (days). Note: The processing time for maternity insurance subsidy is: within five months after the birth of the child, the female employee and the male spouse’s unit shall apply for maternity insurance benefits. Childbirth medical expenses Medical expenses for medical treatment after the childbirth medical status is confirmed shall be settled by the Municipal Labor and Social Security Bureau and the hospital at a fixed amount (the portion exceeding 10,000 yuan shall be settled according to the approved amount). Maternity Insurance Benefit Maternity Insurance Benefit = Maternity Allowance + Medical Subsidy Subsidy: Based on the average monthly salary of the employer’s employees 1. For normal childbirth, it is calculated as 3 months (90 days) 2. For late childbirth, it is calculated as 3.5 months (105 days) ) Calculation and payment 3. Those who have given birth and have received the "Only Child Certificate" will be calculated and paid 4.17 months (125 days) 4. Those who have given birth late and have received the "Only Child Certificate" will be calculated and paid the medical subsidy based on 4.67 months (140 days): The average monthly salary of enterprise employees in the special zone in the previous year is based on 1. The salary is calculated as 2 months for normal births. 2. The salary is calculated as 4 months for caesarean section or multiple births. [Edit this paragraph] Main features (1) The maternity insurance targets mainly female employees, so the group of people enjoying the benefits is relatively narrow. With social progress and economic development, some areas allow female employees to give their spouses a certain amount of leave to take care of their wives after giving birth, and pay them holiday wages; some areas also provide financial subsidies to the spouses of male employees. (2) The conditions for enjoying benefits are not consistent across countries. Some countries require recipients to have insurance records, years of employment, national citizenship, etc. my country's maternity insurance requires that the recipients must be legally married, that is, they must meet the legal age for marriage, go through legal procedures in accordance with the provisions of the Marriage Law, and comply with the national family planning policy. (3) Female employees can receive compensation in accordance with regulations regardless of the outcome of their pregnancy. That is to say, regardless of whether the fetus is alive or not, the mother can enjoy relevant benefits, including miscarriage, induced labor, and accidents between the fetus and the mother, etc., they can all enjoy maternity insurance benefits. (4) Medical services during childbirth mainly focus on health care, consultation, and examination, which are different from the medical services provided by medical insurance, which focus on treatment. Medical services during the childbirth period focus on guiding pregnant women to properly handle the relationship between work and cultivation, health care and exercise, so that they can successfully pass the childbirth period. Prenatal check-ups and delivery and midwifery help mothers to give birth smoothly through medical means.
Childbirth is a natural phenomenon and does not require special treatment under normal circumstances. (5) There are fixed requirements for maternity leave. Maternity leave should be arranged according to the childbearing period, divided into pre-natal and post-natal periods. Prenatal leave cannot be used earlier or later. Maternity leave must also be enjoyed during the childbirth period and cannot be accumulated for use at other times. Maternity leave periods vary from country to country. The normal maternity leave stipulated in our country is 90 days, of which 15 days are prenatal leave and 75 days are postpartum leave. (6) Maternity insurance benefits have a certain welfare component. Economic compensation during childbirth is higher than pension, medical and other insurance. The maternity allowance provided by maternity insurance is generally the original salary level of female employees who give birth, and is also higher than other insurance items. In addition, in our country, individual employees do not pay maternity insurance premiums, but are paid by the participating units according to a certain proportion of their total wages. [Edit this paragraph] The role of insurance Maternity insurance is to protect the basic rights and interests of female employees, reduce and solve the special difficulties caused by physiological characteristics of female employees during pregnancy and abortion, and enable them to obtain necessary economic income during childbirth and abortion. and medical care to ensure they recover in time and return to work. Its main functions are as follows: First, the implementation of maternity insurance is a recognition of women’s reproductive value. Women's childbearing is a need for social development. While they carry on the family lineage, they also make efforts for the reproduction of social labor force and should be compensated by society. Therefore, the protection of women's reproductive rights and interests has been accepted and given policy support by most countries. Currently, 135 countries in the world have passed legislation to protect women's legitimate rights and interests in childbearing. Second, the implementation of maternity insurance is to protect the basic life of female employees. Female employees leave their jobs during childbirth and cannot work normally. The state has formulated relevant policies to ensure that they enjoy relevant benefits while leaving their jobs. These include maternity benefits, medical services, and special protection policies when you are unable to continue working during pregnancy. It creates favorable conditions for the smooth delivery of pregnant women in terms of life security and health security. Third, the implementation of maternity insurance is necessary to improve the quality of the population. Women’s childbirth requires a lot of physical exertion and requires adequate rest and nutritional supplements. Maternity insurance provides them with basic wages so that their living standards do not decrease because they leave their jobs. It also provides them with medical services, including prenatal examinations, perinatal health care guidance, etc., to monitor the normal growth of the fetus. Necessary examinations should be done for women who are sick or exposed to toxic and harmful substances during pregnancy. If a deformed baby is found, the pregnancy can be terminated as early as possible. For women who experience abnormal phenomena during pregnancy, focus on protection and treatment. In order to protect the normal growth of the fetus and improve the quality of the population. [Edit this paragraph] Other relevant maternity insurance laws: In 1986, the Ministry of Health, the Ministry of Labor and Personnel, the All-China Federation of Trade Unions, and the All-China Women's Federation jointly issued the "Interim Provisions on the Health Care of Female Employees." This "Regulations" was formulated based on a 6-year nationwide investigation and research, scientific argumentation, and with reference to the laws and regulations of various countries. It plays a major role in protecting the legitimate rights and interests of female employees. In July 1988, the State Council promulgated the "Regulations on Labor Protection of Female Employees", which apply to female employees of all state agencies, organizations, enterprises and institutions in China. Units of the military system can be implemented as a reference. Its main content is to make detailed provisions on female workers’ employment, working hours, maternity leave, benefits, protection during pregnancy and other benefits. The "Trial Measures for Maternity Insurance for Enterprise Employees" issued by the Ministry of Labor in December 1994 stipulates that these measures apply to urban enterprises and their employees. Maternity insurance is organized according to the territorial principle, and the cost of maternity insurance is subject to social coordination. [1] How to reimburse for maternity insurance? Maternity insurance has four coverage items: 1. Maternity allowance; 2. Fertility medical expenses; 3. Medical expenses for family planning surgery; 4. Other expenses stipulated by the state and this city. Maternity insurance and medical insurance use a blue "Beijing Medical Insurance Manual" instead of the single-child maternity insurance manual. The settlement process is completely in accordance with the medical insurance process. The maternity allowance for female employees is calculated based on the payment base divided by 30 and multiplied by the number of maternity leave days. If the maternity allowance is lower than the salary standard, the enterprise will make up the difference. The maternity leave for female employees is 90 days for normal childbirth; 15 days are added for difficult births, 15 days are added for each additional baby born in multiple births, and 30 days are added for late births. The maternity leave for female employees who have a miscarriage of less than 4 months of pregnancy is 15 to 30 days, and the maternity leave for female employees who have a miscarriage of more than 4 months of pregnancy is 42 days. If a female worker's salary is 3,000 yuan, the maternity allowance is 100 yuan per day. Normal maternity leave can be 90 days, and for twins, it is 105 days.
What should I do if the expenses before and after delivery exceed the reimbursed expenses? If the cost exceeds the reimbursement, an agreement must be signed with the hospital for the portion that exceeds the hospitalization quota. According to regulations, medical institutions are not allowed to pay for fixed-amount items except for infant fees and bed fees that exceed the payment standard. Additional fees will be charged to insured employees. When insured employees require additional medical services or drugs, the medical institution must sign a self-pay agreement with the employee. Maternity expenses for non-Beijing households are covered by medical insurance. Maternity benefits for employees with non-local household registration can be covered by medical insurance. Director Zhang introduced that the medical expenses for family planning surgeries will be paid by the basic medical insurance fund in accordance with regulations. Those who do not participate in basic medical insurance will be paid by the employer. Their maternity leave benefits are implemented in accordance with relevant national regulations, and maternity leave wages are implemented in accordance with the provisions of the "Beijing Wage Payment Regulations" on maternity leave wages. Maternity insurance can reimburse up to 4,000 yuan. The reimbursement limit for maternity insurance and medical insurance is different. Since maternity insurance only benefits working female employees who have given birth, many people who do not meet the conditions have to rely on medical insurance to reimburse the cost of childbirth. Therefore, the diagnosis and treatment items and drug list of maternity insurance are consistent with those of medical insurance. However, the minimum payment for maternity insurance can reach 1,900 yuan, and there is also reimbursement for examination expenses. The maximum amount for maternity insurance is 4,000 yuan; while the minimum payment for medical insurance is 3,000 yuan, and the maximum payment ceiling is 70,000 yuan.
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