Insured employees should register with the social security agency where the insured person is located with the following information from the pregnancy 16 weeks (including the termination of pregnancy), fill in the Declaration Form for the Selection of Designated Hospitals for Maternity Insurance for Employees in Foshan City, apply for the Medical Confirmation Certificate for Maternity Insurance for Employees in Foshan City (hereinafter referred to as the Medical Confirmation Certificate), and choose the designated medical institutions in the city.
1, the original and photocopy of the identity certificate of the entitled person.
2. The marriage certificate and family planning service certificate (or relevant certificates provided by the family planning department of our city) are stamped with the original and photocopy of the quasi-birth opinion (note: the family planning certificate (or quasi-birth certificate) issued by the non-family planning department of this city needs to go to the family planning department of the town (street) where the current residence of this city or the man's household registration is located. If your current residence is not in this city, you need to go to the family planning department of the town (street) where the insured employee unit is located to confirm the family planning certificate. )
3. The original pregnancy diagnosis certificate issued by the designated medical institution (indicating the expected date of delivery)
4. 1 recent color bareheaded photo one inch smaller.
5. Insured employees who have worked in different places for a long time (180 days or more) also need to provide proof of long-term work in different places, and they can choose designated medical institutions in different places to receive medical services such as prenatal examination and delivery hospitalization.
Note: 1. The Declaration Form for Confirmation of Maternity Insurance for Employees in Foshan City can be downloaded from the Internet (website) and needs the company's seal.
2. Off-site inspection is limited to employees who work off-site for a long time (180 days or more).
3. Please choose the designated hospital carefully. Once selected, it shall not be changed in principle. If it is really necessary to change, the maternity insurance fund for medical expenses incurred before the change will not be paid.
4, due to special circumstances in the city's designated medical institutions for prenatal examination of the insured workers need to give birth in different places, or long-term work in different places of the insured workers need to give birth in the city's designated medical institutions, in addition to providing the above materials, but also need to provide a personal written application, approved by the social security agencies, in the selected medical institutions for delivery.
(2) Medical management
1. When an insured employee goes to a designated medical institution in a selected city for medical treatment for the first time with a medical treatment confirmation certificate, the designated medical institution shall register him in the medical insurance system. Maternity medical expenses that meet the requirements of maternity insurance after medical registration shall be accounted for by designated medical institutions and paid by individuals, and shall be directly settled by designated medical institutions and insured employees.
2. Insured employees who have given birth or miscarried in non-selected medical institutions due to emergency rescue shall provide emergency rescue certificates issued by medical institutions within 5 working days from the date of admission, and go through the examination and approval procedures at the social security agency of the insured place.
3. If the insured workers need to be transferred to the designated medical institutions at the higher level in the city or the designated medical institutions at the same level with better technology and conditions due to their illness, the designated medical institutions originally selected shall apply for transfer within the medical insurance system, print the receipt of the application for transfer in the city, and affix the seal of the medical department of the medical institution to the applicant. The applicant shall go through the examination and approval formalities at the social security agency where the hospital is transferred with the Receipt of Application for Transfer in the City.
4. If the insured employee needs to be transferred to a medical institution outside the city for treatment due to illness, the applicant shall provide the Filing Form for the Employee's Transfer to a Hospital Outside the City from Foshan Maternity Insurance, which shall be filled in by the attending physician of the designated referral medical institution, sealed by the Medical Department (one for the social security agency and one for the insured employee) and other relevant materials, and go through the referral examination and approval procedures at the social security agency where the insured employee is located (urgent and dangerous patients can be transferred first, and the applicant will be transferred from the date of admission).
5. Insured employees change medical institutions halfway because of work and life needs. If the original selected medical institution has incurred accounting expenses, it is necessary to settle the expenses at its own expense, and go through the change formalities with the social security agency that originally handled the medical confirmation procedures with the medical confirmation certificate and related expense settlement documents; If there is no bookkeeping fee in the original selected medical institution, it is necessary to provide a written application and go through the change procedures with the medical confirmation certificate to the social security institution that originally handled the medical confirmation procedures.
6, the insured workers choose the designated medical institutions in the city for prenatal examination and delivery or choose different medical institutions for prenatal examination and delivery, pregnancy complications and complications in hospital medical institutions must be consistent with the choice of delivery medical institutions; If you choose a medical institution in the city for prenatal examination or a medical institution in a different place for delivery, the medical institution in which pregnancy complications and complications are hospitalized must be consistent with the selected prenatal examination medical institution.
(3) Sporadic reimbursement
1. Maternity medical expenses incurred in the following circumstances can be applied for sporadic reimbursement at the social security agency where the insured person is located:
(1) Maternity medical expenses incurred by insured employees who have gone through the examination and approval procedures for medical treatment in different places and have worked in different places for a long time in the selected medical institutions in different places.
(2) The maternity medical expenses of the insured workers who have received the Medical Confirmation Certificate for emergency treatment, rescue delivery or abortion in non-selected medical institutions.
(3) The maternity medical expenses of the insured workers who are hospitalized in the medical institutions outside the city approved by the social security agency.
2. For sporadic reimbursement, the following information shall be provided:
(1) Original and photocopy of the identity certificate of the person who enjoys the treatment.
(2) The following materials stamped with the financial seal of the medical institution issued by the medical institution: the original receipt or invoice of medical expenses printed by the finance and taxation department, the original detailed list of medical expenses with the same amount as the receipt (invoice), the original certificate of disease diagnosis, the original outpatient medical record or discharge summary and their copies.
(3) the original and photocopy of the family planning service certificate or the relevant certificate provided by the family planning department of our city. (Remarks: The family planning certificate (or birth certificate) issued by the family planning department outside this city needs to go through the confirmation formalities at the family planning department of the town (street) where the man lives or the city's household registration is located. If your current residence is not in this city, you need to go to the family planning department of the town (street) where the insured employee unit is located to confirm the family planning certificate. )
(4) Insured employees who have received the medical treatment confirmation certificate must also provide the original medical treatment confirmation certificate.
(5) Original and photocopy of current passbook or debit card of Agricultural Bank of China of the personnel who enjoy the treatment.
(6) Insured employees who have given emergency treatment or rescued delivery or abortion in non-selected medical institutions shall also provide emergency treatment and rescue certificates recognized by social security agencies.
(7) The original and photocopy of the baby's birth certificate.
(8) Other materials required by social security institutions.
Insured employees should provide the above information to the social security agency in the insured area to apply for sporadic reimbursement within 12 months after delivery or abortion. If it is impossible to go through the reimbursement procedures within 12 months due to special circumstances, a written application shall be submitted and reported after being approved by the social security agency where the insured person is located.
3, sporadic reimbursement treatment standard:
Insured workers meet the settlement conditions for applying for spontaneous abortion, prenatal examination, delivery and other sporadic reimbursement of medical expenses, and if the expenses stipulated in maternity insurance are lower than the settlement standards of designated medical institutions at the same level in this Municipality, they shall be reimbursed according to the actual expenses stipulated in maternity insurance (see the table below for settlement standards); If it is higher than the settlement standard of designated medical institutions at the same level in the city, it will be reimbursed according to the settlement standard.
(4) The unemployed spouse of the insured employee.
1. If the unemployed spouse of the insured employee meets the following conditions at the same time, he/she shall enjoy the maternity medical expenses subsidy of the basic medical insurance for residents in this Municipality according to the regulations, and the expenses shall be paid by the maternity insurance fund.
(1) did not enjoy the basic medical insurance for urban and rural residents or the maternity benefits of the new rural cooperative medical system;
(2) have registered for unemployment or obtained other employment certificates prescribed by government departments at or above the county (district).
2, the spouse of the insured workers meet one of the following conditions as unemployed:
(1) Unemployed people in cities and towns hold the Employment Unemployment Registration Certificate and affix the special seal for unemployment registration.
(2) Have a disability certificate issued by the civil affairs department, and provide a certificate of complete incapacity issued by the relevant departments at or above the county level.
(3) Other unemployed persons need to provide household registration certificate (household registration book) and unemployment certificate issued by village (neighborhood) committee.
3. The unemployed spouse of the insured employee who meets the conditions of applying for maternity insurance medical expenses subsidy shall provide the following information within 12 months after discharge and apply to the social security agency of the insured employee's insured place:
(1) Information required in the above-mentioned sporadic reimbursement.
(2) The original and photocopy of the ID card of the insured employee.
(3) The original and photocopy of the marriage certificate
(4) spouse's employment certificate
Note: If the unemployed spouse of the insured employee participates in other insurances such as residents' medical insurance and new rural insurance, it shall go to the social security agency where the insured employee is located according to the regulations.
(5) Maternity allowance
Within 12 months after the birth, abortion and family planning operation of the insured employee, the unit where the insured employee works shall apply for maternity allowance to the social security agency of the insured place, and provide the following information:
1, the original and photocopy of the identity certificate of the entitled person.
2, "Foshan city worker maternity allowance declaration form" and need to be sealed by the unit.
3. The original and photocopy of the family planning service certificate or the original and photocopy of the relevant certificate provided by the family planning department of our city. (Remarks: The family planning certificate (or birth certificate) issued by the family planning department outside this city needs to go through the confirmation formalities at the family planning department of the town (street) where the man lives or the city's household registration is located. If your current residence is not in this city, you need to go to the family planning department of the town (street) where the insured employee unit is located to confirm the family planning certificate. )
4 original and photocopy of the bank account of the insured unit.
5. The insured unit has issued the full proof of maternity leave salary to the insured employees according to the regulations.
6. According to the following different situations, provide the following relevant information at the same time:
(1) Normal or dystocia delivery.
(1) Baby's birth certificate (original and copy)
② Diagnostic certificate of medical institution (original and photocopy)
(2) Maternal or infant death
① Death certificate (original and photocopy)
② Diagnostic certificate of medical institution (original and photocopy)
(3) Abortion
Diagnostic certificate of medical institution (original and photocopy)
(4) family planning surgery.
Original and photocopy of diagnosis certificate of medical institution (name of operation must be indicated)
Note: Before the business license is revoked, ordered to close, revoked or dissolved in advance, the employer shall go through the filing formalities with the social security agency where the insured is located. The insured employees of the employing unit who have gone through the filing formalities shall provide the above materials (except the fourth item) and the original and photocopy of the current passbook or debit card of the Agricultural Bank of China, and apply for maternity allowance at the social security agency of the insured place.
Other matters:
1. The calculation method of maternity leave working days is: the number of days of maternity leave or family planning leave is divided by 7, the quotient is multiplied by 5, and the remainder is the number of working days.
2. The year mentioned in this notice is the social security year (i.e. from July 1 day of the current year to June 30th of the following year).
3. Enjoy maternity insurance benefits according to the approved delivery date.
From 4.20 13 65438+ 10/0/day, the unemployed who enjoyed the period of unemployment insurance benefits, the flexible employees in our city and the injured employees who went through the formalities of disability retirement did not participate in maternity insurance, and those who have participated in the basic medical insurance for urban employees in our city, and the female insured person meets the national family planning policy for pregnancy and childbirth, the basic medical insurance fund for urban employees pays maternity Medicaid in one lump sum (including prenatal)
5. The expenses incurred by the insured employees in seeking medical treatment after pregnancy 16 weeks, as well as the expenses incurred in seeking medical treatment in non-selected medical institutions due to emergency treatment, rescue and diagnosis of pregnancy complications, shall be paid in accordance with the relevant provisions of the basic medical insurance for urban employees. The maternity insurance fund and the basic medical insurance fund for urban workers will not pay the expenses incurred by the insured workers from pregnancy 16 weeks (inclusive) to medical treatment before medical confirmation procedures. (△ In order to avoid your loss, please go to the social security agency of your insured place to go through the medical confirmation formalities from the 0/6th week of pregnancy).
Note: 1. In case of policy adjustment for the above maternity insurance benefits, the latest document shall prevail.
2. The above maternity insurance benefits are only applicable to normal intrauterine pregnancy. Medical expenses for pathological pregnancy (such as ectopic pregnancy and hydatidiform mole). ) with reference to the basic medical insurance policy for employees.
Note: Insured employees belonging to municipal government agencies should go to the Medical Insurance Department of the Municipal Social Security Bureau for maternity insurance business and consultation; If it is an enterprise or institution in each district, please go to the medical insurance department (unit) of the social security bureau in each district to handle maternity insurance business and consultation. ;