Maternity insurance is an insurance for pregnant female employees, but in practice, if the spouse of a male employee is pregnant, he can also enjoy maternity insurance benefits, and then reimburse maternity insurance. This is a very important thing in maternity insurance and is also valued by everyone. Next, I will bring you the reimbursement scope of pregnancy test and maternity insurance, hoping to help you.
I. General provisions
1, maternity medical expenses.
The examination fee, delivery fee, operation fee, hospitalization fee and medicine fee for the birth of female employees shall be paid by the maternity insurance fund. Medical business expenses and medicine expenses (including self-funded drugs and nutritional drugs) exceeding the prescribed amount shall be borne by the employees themselves.
After the female workers are discharged from the hospital, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; The medical expenses of other diseases shall be handled in accordance with the provisions of medical insurance benefits. After the expiration of maternity leave, if a female employee needs rest and treatment due to illness, it shall be handled in accordance with the relevant provisions on sick leave and medical insurance benefits.
2. Maternity allowance.
Female employees shall enjoy maternity allowance according to law during maternity leave, which shall be calculated and paid by maternity insurance fund according to the average monthly salary of employees in the previous year.
Second, the regulations of Guangdong Province
1, maternity medical expenses.
Medical expenses incurred by female workers during pregnancy, childbirth or termination of pregnancy.
2. Maternity allowance.
Female employees enjoy maternity allowance during maternity leave. Maternity allowance is based on the average monthly salary of employees in the last year as a whole, and is calculated and paid in accordance with the provisions of maternity leave. If the maternity allowance is lower than my salary standard, it shall be made up by the employer.
Maternity allowance = the average payment salary of this unit in the current month ÷30 (days) × holiday days.
Maternity leave calculation:
Basic maternity leave is 98 days, including prenatal leave 15 days;
Maternity leave can be increased by 30 days in case of death during childbirth (such as caesarean section and third degree rupture of perineum);
If the pregnancy is less than four months, according to the opinions of the medical department, maternity leave will be given 15 to 30 days;
If you are pregnant for more than four months (including four months), you will be given 42 days maternity leave;
Voluntary birth of an only child, an increase of 35 days;
Late childbearing, increased by 15 days;
3. One-time childbirth nutrition subsidy.
According to a certain proportion of the average monthly salary of employees in the overall planning area last year. The specific proportion shall be determined by the people's government of the overall planning area.
4, the cost of family planning surgery.
Including medical expenses incurred by workers in placing or taking out intrauterine devices, abortion, induced labor, sterilization and recanalization due to family planning.
5. Holiday allowance for male employees.
The nursing leave allowance enjoyed by the insured male workers according to the regulations shall be calculated and paid according to the stipulated holiday time based on the average monthly salary of employees in the last year in the overall planning area.
Nursing leave allowance = the average payment salary of this unit in the current month ÷30 (days) × holiday days.
Maternity insurance fund shall not pay the following fees:
1, which does not meet the national and provincial basic medical insurance and maternity insurance drug list, diagnosis and treatment items, medical service facilities and related medical management regulations;
2. Expenses incurred due to medical accidents;
3, the cost of treatment of postpartum complications.
I have made a detailed analysis of the scope of maternity insurance reimbursement in Guangdong Province as an example, hoping to help you. Because the regulations on the scope of maternity insurance reimbursement vary from place to place, if you want to know more about maternity insurance reimbursement in your place, I suggest you consult the local fertility department.
What are the basic benefits of maternity insurance?
Childbirth, as the only way for many families, brings hope to families, but also makes women bear many risks. In an era of avoiding risks, we should not only guard against risks, but also know how to transfer risks. This paper introduces the basic benefits of maternity insurance for you, so that you can have a carefree production and enjoy all the benefits brought by maternity insurance from conception to final production.
One is maternity leave.
Refers to the paid vacation enjoyed by professional women for a certain period of time before and after delivery. Its purpose is to maintain, restore and improve the physical health, working ability and personal life management ability of protected pregnant women, and to enable babies to be carefully cared for and nurtured by their mothers. According to the requirements of maternity protection convention No.3 19 19, maternity leave should be at least 12 weeks. 1952 recommendation no 95 on maternity protection also proposes that maternity leave should be extended to 14 weeks. In 2000, the 183 (Amendment) Convention 1952 stipulated that maternity leave should not be less than 14 weeks. At present, most countries have adopted the recommendations of the International Labour Organization. In recent years, with the development of economy and the emphasis on maternal and child health care, the maternity leave regulations in some countries have a tendency to be extended.
The second is maternity allowance.
It means that professional women leave their jobs because of childbirth, and their income is interrupted because they no longer engage in paid work, and they are given regular cash subsidies in time to safeguard and guarantee the normal life of women and babies. 19 19 Maternity Protection Convention 13 established the international general standard of maternity allowance for the first time. 1952 in the revision of the convention, it was clarified that "the allowance standard shall not be lower than two-thirds of the woman's previous income". Proposal No.95 on maternity protection (1952) and proposal No.95 19 1 amendment on maternity protection (1952) both proposed that maternity allowance should be equal to the woman's total income before giving birth.
Maternity allowance is generally paid according to a certain proportion of income. Countries generally adopt more favorable policies when formulating maternity allowance standards, and many countries stipulate that it is equivalent to 100% of the original salary of female employees before childbirth. Some countries or regions stipulate not less than half of the original salary.
The third is medical services.
Refers to the medical care and necessary hospitalization for professional women during pregnancy, childbirth and postpartum. After pregnancy, various systems in women's bodies have changed, and the burden on major organs has increased. Regular physical examination of pregnant women and provision of a series of medical services from pregnancy to delivery are of great significance for ensuring the health of women and babies and improving the quality of the population. The medical services provided by maternity insurance for pregnant women in various countries are generally based on their own economic strength and the affordability of insurance funds. Most countries provide medical care and treatment for female workers from pregnancy to postpartum.
It should be pointed out that maternity insurance is entirely borne by enterprises, and individuals do not pay any fees.
As long as you are working, as long as you want to get married and have children, you have to take maternity insurance. In this era of efficient work, it is almost nothing to ask for maternity leave for a period of time, and you can be fired easily. But through today's article, at least we can take up legal weapons and safeguard some welfare benefits that we should have. While not excessively demanding maternity leave, we should also ensure our due rights and interests.
Can the man file for divorce on the grounds that the woman is infertile?
The lack of children in family life is like a piece of family in China. The traditional family can't accept the fact that the family has no children, so can the woman's infertility be the reason for divorce? This article will give you a detailed introduction.
From a medical point of view, people often blame the woman for spontaneous abortion, which is one-sided and unfair. According to experts' estimation, about 10 ~ 15% of married couples suffer from infertility, of which about13 is caused by male infertility, which is caused by many reasons, including chromosomal abnormalities, accounting for 18 ~ 20% of all male infertility. There are 8 million to/kloc-0,000 newlyweds in China every year, among which 400,000 to 500,000 couples may be infertile.
Men with abnormal chromosomes often produce only abnormal sperm if they produce a small amount of sperm. Even if the wife is pregnant, the embryo will not develop safely, but 100% will die in the uterus. Expert research shows that about 6.5438+0.5 million pregnant women are aborted, that is, spontaneous abortion accounts for about 654.38+0.5% of the total number of pregnancies, and about half of them are caused by various chromosomal abnormalities. Some of these anomalies occur in women and some in men.
It can be seen that infertility may lead to emotional breakdown and divorce, but it is not the legal reason for direct divorce.
Relevant laws:
Article 32 If a man or a woman requests a divorce, the relevant department may mediate or directly file a divorce lawsuit with the people's court.
When trying divorce cases, the people's court shall conduct mediation; If the relationship has really broken down and mediation fails, divorce shall be granted.
In any of the following circumstances, if mediation fails, divorce shall be granted:
(a) bigamy or a spouse living with others;
(2) committing domestic violence or abusing or abandoning family members;
(3) Having bad habits such as taking drugs and refusing to change after repeated education;
(four) separated for two years due to emotional discord;
(5) Other circumstances that lead to the breakdown of the marriage relationship.
If one party is declared missing and the other party files a divorce lawsuit, the divorce shall be granted.
What is the coverage of maternity insurance?
The reimbursement scope of maternity insurance includes the following aspects:
First, the maternity insurance fund compensates the unit in the form of maternity allowance. The compensation standard is: female employees who have been pregnant for more than 7 months (including 7 months) and delivered naturally or who have been born prematurely for less than 7 months will enjoy a maternity allowance of 3 months; In case of dystocia or cesarean section, the maternity allowance will be increased for half a month; For multiple births, the maternity allowance will be increased by half a month for each additional baby.
Pregnant for more than 3 months (including 3 months) but less than 7 months, those who have miscarried or induced labor are entitled to maternity allowance 1.5 months; Abortion due to pathological reasons within 3 months of pregnancy is entitled to 1 month maternity allowance. Maternity allowance is based on the average monthly payment salary of maternity insurance for female employees before prenatal or family planning operation 12 months.
Two, maternity nutrition subsidies and perinatal health care subsidies, who meet the requirements of the state to enjoy maternity leave for more than 90 days (including 90 days) can enjoy maternity nutrition subsidies in 300 yuan, perinatal health care subsidies in 700 yuan.
3. One-time maternity allowance. Female employees who participate in maternity insurance in the unit are unemployed and meet the family planning regulations during the period of receiving, and can enjoy a one-time maternity allowance: 2,400 yuan for abortion, 2,400 yuan for natural delivery and 4,000 yuan for multiple births in difficult labor; Male employees who participate in maternity insurance, whose spouses are not included in the scope of maternity insurance, can enjoy a one-time maternity allowance of 50% if they have their first child in line with family planning regulations.
Four, maternity allowance compensation to the unit, the insured female workers during maternity leave my basic salary, bonus and welfare expenses paid by the unit.
Five, the cost of family planning operation, including the implementation of placing (taking out) IUD, induced abortion, induced labor, skin burial, sterilization and recanalization surgery due to family planning needs, included in the settlement scope of maternity insurance fund.
Maternity insurance reimbursement scope
The reimbursement scope of maternity insurance includes maternity medical expenses, maternity allowance, one-time maternity nutrition allowance, family planning operation fee and holiday allowance for male employees. Please read the following about the reimbursement scope of maternity insurance.
Maternity insurance reimbursement scope
general clause
1, maternity medical expenses.
If a female worker gives birth, the examination fee, delivery fee, operation fee, hospitalization fee and medicine fee shall be paid by the maternity insurance fund. Medical business expenses and drug expenses (including self-funded drugs and nutritional drugs) exceeding the prescribed amount shall be borne by the employees themselves.
After the female workers are discharged from the hospital, the medical expenses for diseases caused by childbirth shall be paid by the maternity insurance fund; The medical expenses of other diseases shall be handled in accordance with the provisions of medical insurance benefits. After the expiration of maternity leave, if a female employee needs rest and treatment due to illness, it shall be handled in accordance with the relevant provisions on sick leave and medical insurance benefits.
2. Maternity allowance.
Female employees shall enjoy maternity allowance according to law during maternity leave, which shall be calculated and paid by maternity insurance fund according to the average monthly salary of employees in the previous year.
Regulations of Guangdong Province
1, maternity medical expenses.
Medical expenses incurred by female workers during pregnancy, childbirth or termination of pregnancy.
2. Maternity allowance.
Female employees enjoy maternity allowance during maternity leave. Maternity allowance is based on the average monthly salary of employees in the last year as a whole, and is calculated and paid in accordance with the provisions of maternity leave. If the maternity allowance is lower than my salary standard, it shall be made up by the employer.
Maternity allowance = the average payment salary of this unit in the current month ÷30 (days) × holiday days.
Maternity leave calculation:
Basic maternity leave is 98 days, including prenatal leave 15 days;
Maternity leave can be increased by 30 days in case of death during childbirth (such as caesarean section and third degree rupture of perineum);
If the pregnancy is less than four months, according to the opinions of the medical department, maternity leave will be given 15 to 30 days;
If you are pregnant for more than four months (including four months), you will be given 42 days maternity leave;
Voluntary birth of an only child, an increase of 35 days;
Late childbearing, increased by 15 days;
3. One-time childbirth nutrition subsidy.
According to a certain proportion of the average monthly salary of employees in the overall planning area last year. The specific proportion shall be determined by the people's government of the overall planning area.
4, the cost of family planning surgery.
Including medical expenses incurred by workers in placing or taking out intrauterine devices, abortion, induced labor, sterilization and recanalization due to family planning.
5. Holiday allowance for male employees.
The nursing leave allowance enjoyed by the insured male workers according to the regulations shall be calculated and paid according to the stipulated holiday time based on the average monthly salary of employees in the last year in the overall planning area.
Nursing leave allowance = the average payment salary of this unit in the current month ÷30 (days) × holiday days.
Maternity insurance fund shall not pay the following fees:
1, which does not meet the national and provincial basic medical insurance and maternity insurance drug list, diagnosis and treatment items, medical service facilities and related medical management regulations;
2. Expenses incurred due to medical accidents;
3, the cost of treatment of postpartum complications.
Materials to be submitted for reimbursement of maternity insurance in different places
In hospitals at or above the county level, the following documents are required for reimbursement of maternity insurance in different places:
1. Original and photocopy of my valid ID card (copy of the front and back of the second-generation ID card);
2, "one-child certificate" or "one-child honor certificate" and a copy of the original;
3. If the certificate of honor for the one-child has not been obtained, the original and photocopy of the marriage certificate, the household registration book of both husband and wife (for collective household registration, the household registration certificate issued by the public security department where the household registration is located), and the "Shanghai Floating Population One-child Birth Service Registration Certificate" or "One-child Birth Service Certificate" issued by the people's government at or above the township (town) or subdistrict office, as well as the women registered in other provinces and cities;
4. Original and photocopy of reproductive medicine certificate issued by medical institution;
5. Original and photocopy of real-name registration system Bank settlement account card opened by me in this city;
6. According to different personal circumstances, you also need to bring the following materials:
(1) If you entrust others to handle it, you need to bring the power of attorney and the original and photocopy of the client's ID card (copy of the front and back of the second-generation ID card);
(2) Women who give birth in other provinces and cities need to carry the original and photocopy of the discharge summary and the child's birth medical certificate issued by hospitals at or above the county level indicating the birth situation (dystocia or natural delivery);
(3) If the male is a soldier, the original and photocopy of the military card or military officer's card shall be provided;
(4) If the second child is born according to family planning, the registered women in this city shall carry the original and photocopy of the notice of re-birth of children approved by the municipal or district population and family planning administrative department; Women registered in other provinces and cities need to carry the birth certificate issued by the population and family planning department of the county where the household registration is located;
⑤ Childbearing women who participate in rural social insurance in this Municipality are required to carry the maternity insurance treatment application form (agricultural insurance) issued by the agricultural insurance agency in the district (county) where their registered permanent residence is located, and the maternity women in foreign-invested enterprises are also required to carry a detailed list of the payment base of employees of foreign-invested enterprises.
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