1, in line with national, provincial and municipal family planning policies;

2. When giving birth or carrying out family planning operation, the employer has participated in maternity insurance and paid the maternity insurance premium in full continuously 10 month;

3. Prenatal check-up. The month of hospitalization due to birth complications for 4 months before or after delivery is the normal payment status.

Referring to Article 14 of the Regulations on Maternity Insurance for Employees in Jiangsu Province, if the employer where the employee works pays the maternity insurance premium in full and on time, the employee shall enjoy maternity insurance benefits in accordance with state regulations; Unemployed spouses of employees enjoy maternity medical expenses in accordance with national and provincial regulations. The required funds are paid from the maternity insurance fund. If the employee or employee's unemployed spouse gives birth, miscarries, induces labor or carries out family planning operation, and the employer continues to pay less than 10 months, the medical expenses for the employee's maternity or the medical expenses for the employee's unemployed spouse shall be paid by the maternity insurance fund; Maternity allowance and one-time nutrition subsidy for employees shall be paid by the employer continuously 10 months later, and shall be paid by the maternity insurance fund.

Reimbursement materials

First, the maternity insurance reimbursement materials for female employees

1, Nanjing maternity insurance benefits declaration form;

2. Original marriage certificate;

3. One-child certificate;

4. Discharge record;

5. Discharge summary;

6. hospitalization expenses;

Two, male workers maternity insurance reimbursement materials

1, Nanjing maternity insurance sporadic reimbursement application form

2. Marriage certificate;

3. One-child certificate;

4, discharge summary or outpatient medical records;

5, hospitalization bills, outpatient bills;

6. Spouse's employment registration certificate;

7. Unemployment certificate issued by street (township).

Reimbursement process

1, prepare the above information.

2, social security center maternity treatment payment calculation.

3. Audit by Finance Department of Social Security Center.

4. The Social Security Center is in charge of the leadership review.

Reimbursement standard

The reimbursement scope of Nanjing maternity insurance includes prenatal examination fees, delivery medical expenses, birth complications, family planning surgery fees, one-time nutrition subsidies, etc. The specific amount is as follows:

(1) The maximum reimbursement for medical expenses caused by delivery is 2,000 yuan, the maximum reimbursement for assisted delivery is 2,200 yuan, and the maximum reimbursement for caesarean section is 3,500 yuan.

(2) Maternity Complications: The medical expenses incurred by 27 kinds of maternity complications can be reimbursed in proportion if they all meet the scope and standard of maternity insurance payment.

(3) One-time nutrition fee: paid by maternity insurance fund, and the payment standard is 2% of the average salary of employees in Nanjing last year.

(4) Family planning operation expenses: different operations have different reimbursement rates.

(5) Prenatal check-up fee: In the registered designated hospital, you need to pay the check-up fee first, and then bring the relevant vouchers to the social security agency for reimbursement.

Reimbursement scope

The reimbursement scope of Nanjing maternity insurance includes the examination fee, delivery fee, operation fee, hospitalization fee and medicine fee paid by the maternity insurance fund. The medical service fee and medicine fee (including self-funded medicine and nutritional medicine) 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.

Reimbursement ratio

Maternity insurance reimbursement ratio is based on the average monthly salary of employees in the previous year, and it is paid in one lump sum according to a certain proportion. These include:

1, natural delivery was 270%;

2, dystocia is 320%;

3. Cesarean section is 420%.

Because there is no uniform regulation on the reimbursement ratio of maternity insurance in the country, the reimbursement ratio of maternity insurance can also vary from region to region, so the insured should consult the local social security bureau and take the local social security center as the standard.

Repayment cycle

Maternity insurance is generally reimbursed in the second month after delivery and can be reimbursed within one year at the latest. The time for reimbursement of maternity leave in Nanjing is generally after the end of maternity leave or within one year after delivery, but it is recommended to call for consultation before applying for reimbursement, or go directly to the neighborhood Committee for consultation to avoid unnecessary trouble. And when applying for maternity insurance reimbursement, it should be handled within working days, not on non-working days.

arrival time

Generally, in the second half of the application, the maternity allowance will be paid to the unit account, and then the unit will pay it to the individual. Simply put, after completing the application procedures for maternity allowance, you can declare and receive maternity allowance in the middle and late February.

Reimbursement scope

1, outpatient prenatal examination fee;

2. Medical expenses for childbirth;

3, the cost of family planning surgery;

4. One-time nutrition subsidy;

5. Maternity allowance;

6, gynecological special examination.

Nanjing Maternity Insurance Reimbursement Scope (Specific Items)

Sporadic reimbursement scope of Nanjing maternity insurance

Reimbursement standard

1, three-level designated medical institutions

Reimbursement standard for natural childbirth: 3 100 yuan.

Midwifery reimbursement standard: 3,400 yuan

Cesarean section reimbursement standard: 4,900 yuan

2, two designated medical institutions

Reimbursement standard for natural childbirth: 2,700 yuan

Midwifery reimbursement standard: 2,900 yuan

Cesarean section reimbursement standard: 4,400 yuan

3, there are designated medical institutions

Reimbursement standard for natural childbirth: 2,200 yuan

Midwifery reimbursement standard: 2,400 yuan

Cesarean section reimbursement standard: 3600 yuan

The proportion of the insured workers who pay by themselves.

Insured workers in maternity insurance designated medical institutions to "social security card" hospital delivery, in line with the scope and standard of maternity insurance payment of medical expenses:

1. In designated medical institutions at or below the second level, the maternity insurance fund is paid in full, and the individual does not bear it, that is, all expenses are reimbursed;

2. In the third-level designated medical institutions, natural delivery is 400 1 yuan, midwifery is 450 1 yuan, cesarean section is 600 1 yuan and above, and the individual pays 25% and the reimbursement rate is 75%.

3. In the third-level designated medical institutions, for the part below 400/kloc-0 yuan, the individual pays 5%, midwifery 450/kloc-0 yuan, cesarean section 600/kloc-0 yuan, and the reimbursement rate is 95%.

Is the overall fund payment, by the municipal social security center and designated medical institutions settlement; If the individual pays, it shall be settled by himself and the designated medical institution.

Notice of Nanjing Municipality on Adjusting Relevant Policies of Maternity Insurance for Employees

Guidelines for sporadic reimbursement of maternity insurance in Nanjing

Reimbursement conditions

1, in line with national, provincial and municipal family planning policies;

2. When giving birth or carrying out family planning operation, the employer has participated in maternity insurance and paid the maternity insurance premium in full continuously 10 month;

3. Prenatal check-up. The month of hospitalization due to birth complications for 4 months before or after delivery is the normal payment status.

Maternity insurance will not be reimbursed.

List and service scope of designated medical institutions for maternity insurance

Reimbursement materials

1, "Nanjing Maternity Insurance Benefits Declaration Form" and affix the official seal of the unit (if it is a flexible employee, it does not need to be stamped);

2. Original marriage certificate;

3. The original one-child certificate (the original and photocopy of the birth certificate approving the birth of another child are required for the birth of a second child);

4, a copy of the discharge record (outpatient abortion (lead) surgery to provide medical records and sick leave).

List of reimbursement materials for maternity insurance in Nanjing

Reimbursement process

Maternity allowance, one-time nutrition fee reimbursement process

1. Every month 1- 10 (postponed in case of holidays), the unit manager will bring relevant materials to the municipal medical insurance center to apply for maternity allowance and one-time nutritional subsidy.

2. If the medical insurance center confirms that it meets the conditions of maternity insurance benefits after reviewing the materials, the maternity allowance and one-time nutrition fee shall be included in the account of the insured unit according to the relevant provisions. Maternity allowance is paid monthly, and employees begin to enjoy it in the month of delivery or abortion.