Insured employees can enjoy maternity insurance benefits in accordance with regulations under the condition of continuous normal payment. The following are the key points:
(1) When the insured female workers are diagnosed with pregnancy, they should apply for prenatal registration, and then directly settle the medical insurance in the hospital. Maternity allowance is automatically paid by the medical insurance center after the female employees of the enterprise give birth, and there is no need to apply separately;
(2) For the maternity medical expenses that have not been settled by medical insurance, you need to provide relevant materials and apply for manual reimbursement separately (including maternity allowance, see points 5 and 6 for details);
(three) inter-provincial birth, but also for the "inter-provincial off-site (birth) for the record";
(four) the insured can enjoy the mobile phone medical insurance settlement service through the "medical insurance electronic certificate";
(5) Prenatal registration, maternity allowance, inter-provincial off-site (maternity) filing, inter-provincial maternity insurance general office and opening medical insurance electronic certificate can all be handled online. See the second point for details.
Second, online processing flow
(1) Prenatal registration
"Prenatal registration" can be applied online through the Civil Administration APP. The specific operation process is as follows:
Click the medical insurance service, select the provincial level in the upper left corner of the insured city → click the prenatal registration in the business process → fill in the relevant information according to the prompt information and upload the required attachment materials → click Save. The review time limit is 1 working day.
(2) Application for maternity allowance
The "Maternity Allowance APPlication" can be applied online through the Civil Administration App. The specific operation process is as follows:
Click on the medical insurance service, select the provincial level in the upper left corner of the insured city → click on the maternity allowance declaration in the business process → fill in the relevant information according to the prompt information and upload the required attachment materials → click Save. The review time limit is 20 working days.
(3) Inter-provincial filing (birth)
"Inter-provincial and off-site (birth) filing" can be APPlied online through the civil administration app. The specific operation process is as follows: click on the medical insurance service, select the provincial level in the upper left corner of the insured city → click on the medical record in different places during business handling → fill in the relevant information according to the prompt information and upload the required attachment materials → click Save. The review time limit is 2 working days.
(four) maternity insurance across provinces.
Insured female workers can apply for sporadic reimbursement of maternity insurance benefits online through the "Inter-provincial Maternity Insurance Office". The specific operation process is as follows:
Open the civil administration, click on the medical insurance service, select the provincial level in the upper left corner of the insured city → click on the inter-provincial general office of maternity insurance in business handling → fill in relevant information according to the prompt information and upload the required attachment materials → click Save → post paper materials as required after the pre-trial. The review time limit is 20 working days.
(five) the opening of medical insurance electronic certificate.
The electronic medical insurance card can be opened online through the civil affairs APP. The specific operation process is as follows:
Click the medical insurance service, select the provincial level in the upper left corner of the insured city → click the medical insurance electronic certificate in the medical insurance settlement → complete the verification and opening according to the prompt information, and settle the account immediately.
The third to sixth points explain the specific process and precautions in detail according to the business type.
Third, prenatal registration, inter-provincial birth records
(1) Prenatal registration
After the insured female workers are diagnosed with pregnancy and handle the birth service registration form or birth service certificate according to the regulations, they need to provide birth service registration form (government information or paper materials), expected date of delivery diagnosis and bank account information. Apply for prenatal registration online through the civil administration APP, or go to the provincial hospital medical insurance service station and the service hall of the provincial medical insurance center for on-site handling.
note:
1. Female employees of enterprises enjoy the same treatment as ordinary outpatient clinics with basic medical insurance due to prenatal examination. If they fail to register in time due to special reasons, they can apply for prenatal registration at the latest before hospitalization;
2. The "Registration Form of Maternity Service" can be handled in the community where one of the men and women is registered, and then stamped with a special seal; Some residential areas can also be handled. Please consult the local health department for details.
3 because of abortion, the implementation of family planning surgery and other reasons did not apply for timely maternity service certificate of the insured, can provide a marriage certificate instead of maternity service registration form.
(2) Inter-provincial filing (birth)
If the insured female workers need to go to other co-ordinate areas in Fujian Province for prenatal examination and delivery due to reasons such as working in different places and living in different places, there is no need to apply for the record of giving birth in different places online. After the prenatal registration, you can swipe your card directly in the provincial intranet hospital with medical insurance designated and fertility qualification.
Insured female employees who need inter-provincial check-up and delivery due to reasons such as working in different places and living in different places need to apply for medical treatment in different places in advance through online or offline channels after completing prenatal registration (refer to points 2 and 3 of the online processing flow).
Fourth, medical insurance settlement.
After the insured female workers successfully apply for prenatal registration, the expenses incurred by the designated medical institutions that carry out reproductive medical services in the province (including the designated medical institutions in the provincial intranet) for prenatal examination and delivery shall be directly settled by medical insurance. If you give birth across provinces, you need to apply for prenatal registration and medical treatment in different places at the same time, so that you can directly settle medical insurance in medical institutions across provinces.
note:
1. Online settlement of maternity medical expenses in the province only supports project settlement and national unified coding settlement, and does not support local coding settlement;
2. Inter-provincial maternity medical expenses settlement, the insured shall remind medical institutions to choose "general outpatient service" or "general hospitalization" as the charging category, and shall not choose "maternity outpatient service" or "maternity hospitalization".
Verb (abbreviation of verb) maternity allowance
Insured employees of government agencies and institutions that have been allocated do not enjoy maternity allowance.
If the insured female employees of enterprises and self-supporting institutions give birth in the designated medical institutions with direct medical insurance settlement, the maternity allowance will be paid directly to my bank account at the end of the next month after credit card settlement. You can also apply for maternity allowance through civil administration or online maternity.
For the insured workers who carry out family planning surgery (including abortion), the subsidy application process is the same as above, and they can apply online through civil affairs, and automatic payment of maternity allowance is not supported.
The time limit for business review is 20 working days.
Six, maternity insurance benefits sporadic reimbursement
Insured employees who need manual reimbursement should apply to the provincial medical insurance center online or through the "Inter-provincial Office of Maternity Insurance" module with corresponding materials within 12 months from the date of birth or within 6 months from the date of family planning operation. Provide 1-6 and 8 unsettled maternity medical expenses due to system reasons; The application for maternity allowance only provides 1-3 and 8 materials.
1. expense reimbursement application form (it can be filled in on site, and online application can be replaced by acceptance form without filling in);
2. Discharge summary (stamped with the seal of the hospital, submitted the diagnosis certificate for those who were not hospitalized, only reimbursed the outpatient expenses, and failed to provide medical records as required);
3. My bank account information (including account name, account opening branch name and account number);
4. The bill of hospital charges (stamped with the special seal for hospital charges);
5. List of hospital expenses (stamped with special seal for hospital charges);
6 "No credit card maternity medical expenses record form"; (You can fill it in on the spot, and online application can be explained by looking at the reasons for reimbursement. )
7. Commitment letter of unemployed spouse of male employee; (Fill in only when the insured male employee applies for the maternity medical expenses of his unemployed spouse)
8. Maternity service registration form: choose one of the following three ways based on the principle of convenience and accessibility: prenatal registration information/government information inquiry * * * */materials provided by the insured employees in line with the family planning policy; Because of abortion, family planning operation and other reasons, the insured person who fails to apply for the maternity service certificate in time may provide the Marriage Certificate instead.
The time limit for business review is 20 working days.
Seven, the other one
Processing time: 8: 00- 12: 00, 14: 30- 17: 30 (winter).
15:00- 18:00 (summer)
Tel: 059 1- 12345-6
Venue: 4th Floor, Li Biao Building, No.99 Hudong Road, Gulou District, Fuzhou.
Postal code: 35000 1
Traffic Guide: Take the subway to Fuzhou Pingshan Station and walk 700 meters, or take the bus to Fuzhou Institute of Socialism Station and walk 100 meters.