1. Who can enjoy maternity insurance?

According to reports, in order to ensure that female workers in this city get necessary economic compensation and medical security during childbirth, this city has established a maternity insurance system. At present, the Provisions of Tianjin Municipality on Maternity Insurance for Urban Workers are widely applicable to all types of employers. According to the regulations, all kinds of urban enterprises and their employees within the administrative area of this Municipality shall participate in maternity insurance. State organs, institutions, social organizations, private non-enterprise units and other urban social organizations and their employees will also implement these provisions.

The conditions that employees who enjoy maternity insurance benefits should meet include: (1) The employer participates in maternity insurance according to regulations and pays maternity insurance premiums in full monthly; (two) the birth or implementation of family planning operations in line with the provisions of the state and the city's family planning.

2. How to enjoy the maternity insurance fund?

The expenses paid by the maternity insurance fund, that is, maternity insurance benefits, mainly include four items: (1) prenatal examination fees; (2) Maternity medical expenses; (3) maternity allowance; (4) the cost of family planning operation.

The "Regulations" clarify that female employees who give birth or terminate pregnancy shall enjoy maternity allowance on a daily basis, and the standard of maternity allowance shall be calculated on a daily basis. The daily standard of maternity allowance is calculated by dividing my average monthly salary in the previous year by 30.4.

(1) Pregnancy dissatisfaction 12 weeks to terminate pregnancy, maternity allowance 15 days; (2) If the pregnancy is terminated after12 weeks or more 16 weeks, the maternity allowance will be enjoyed for 30 days; (3)/kloc-If the pregnancy is terminated for more than 0/6 weeks but less than 28 weeks, the maternity allowance is 42 days; (4) If the normal delivery or termination of pregnancy is over 28 weeks, 90 days' maternity allowance will be granted.

3. How to pay maternity insurance premium?

It is clear in the regulations that the employer shall pay maternity insurance premiums on a monthly basis according to 0.8% of the sum of the average monthly wages of employees in the previous year. Self-employed workers do not pay maternity insurance premiums. If the average monthly salary of individual employees in the previous year is lower than 60% of the average monthly salary of employees in this Municipality, it shall be calculated according to 60% of the average monthly salary of employees in this Municipality in the previous year; If the average monthly salary of individual employees in the previous year is higher than 300% of the average monthly salary of employees in this Municipality in the previous year, it shall be calculated according to 300% of the average monthly salary of employees in this Municipality in the previous year. If it is impossible to determine the average monthly salary of employees in the previous year, it shall be calculated according to the average monthly salary of employees in this city in the previous year.

In order to fully protect the rights and interests of maternity insurance for female employees, if the employer is legally declared to be revoked, dissolved, bankrupt or terminated for other reasons, at the time of asset liquidation, maternity insurance premium shall be reserved for pregnant female employees who terminate or terminate their labor relations according to the maternity insurance benefits paid by the per capita maternity insurance fund of this Municipality in the previous year.

4. Increase maternity allowance in four cases.

(1) In case of dystocia, the maternity allowance shall be increased by 15 days; (2) For multiple births, the maternity allowance will be increased by 15 days for each additional baby; (3) If tubal ligation is performed during delivery, the maternity allowance will be increased by 14 days; (4) If a female worker gives birth late (the first child is 24 years old at birth) and receives the one-child certificate, the maternity allowance will be increased for 30 days.

If complications occur during childbirth (except childbirth), the medical expenses shall be paid by the medical insurance fund in accordance with the provisions of the basic medical insurance for urban workers in this Municipality.

5, four cases do not pay maternity insurance.

The "Regulations" on (1) medical expenses incurred in violation of the family planning regulations of the state or this Municipality; (2) Medical expenses incurred due to medical accidents; (3) Medical expenses incurred in non-designated medical institutions; (4) The maternity insurance fund does not pay four expenses, such as medical expenses, which shall be borne by individual employees according to regulations.

6, maternity insurance designated medical management

According to the requirements of the "Regulations", the scope of medication, diagnosis and treatment items and standards of medical service facilities of maternity insurance shall be implemented in accordance with the relevant provisions of the basic medical insurance for urban workers in this Municipality in addition to the provisions on increasing payment. The payment standards and settlement methods for prenatal examination fees, maternity medical expenses and family planning operation medical expenses shall be formulated separately by the municipal labor and social security administrative department. Maternity insurance implements a designated medical management system. The municipal social insurance agency will sign an agreement with the designated medical institutions of basic medical insurance with midwifery skills and family planning technical service qualifications, and announce it to the public.

7. Don't forget to apply for maternity insurance.

In addition, the municipal labor and social security department specially reminds employers to implement the registration system of maternity insurance in accordance with the requirements of the Regulations. Where an employer needs to participate in maternity insurance, it shall, within 30 days after the implementation of these regulations, go through the registration formalities of maternity insurance at the social insurance agency in the district or county where it is located. The social insurance agency shall complete the audit within 10 working days from the date of accepting the registration. Those who meet the conditions shall be registered, those who do not meet the conditions shall not be registered, and the employer shall be notified. Where the registered items of maternity insurance of the employer are changed, it shall go through the formalities of change at the social insurance agency within 30 days from the date of change.

8, maternity insurance benefits in three parts

Maternity insurance benefits include three parts: (1) maternity leave. Maternity leave refers to paid leave enjoyed by professional women for a certain period of time before and after delivery. Its purpose is to maintain, restore and enhance the physical health, working ability and personal life management ability of protected women, and to enable babies to be carefully cared for and nurtured by their mothers. (2) allowance. Maternity allowance refers to the regular cash allowance paid in time when professional women leave their jobs and stop working in paid jobs because of childbirth, so as to safeguard and guarantee the normal life of women and babies. (3) medical services. Medical service refers to the medical care and necessary hospitalization provided by hospitals, medical practitioners or midwives for professional women during pregnancy, childbirth and postpartum. Regular physical examination of pregnant women, and provide a series of medical services from pregnancy to delivery.

● Beijing

On July 1 day, 2005, the Regulations of Beijing Municipality on Maternity Insurance for Enterprise Employees will be fully implemented. It is understood that the goal of maternity insurance in 2005 is 2 million, and at present, there are no more than 3 million employees in enterprises in Beijing. It is preliminarily estimated that female workers of childbearing age 165438+ 10,000. This article interprets the new regulations as follows.

■ When will the new regulations be implemented?

The Provisions of Beijing Municipality on Maternity Insurance for Enterprise Employees have been deliberated and adopted at the 35th executive meeting of the Municipal People's Government on February 28, 2004 and will come into force on July 28, 2005.

■ What does maternity insurance cover?

Maternity insurance is one of the basic social security, which ensures that employees of enterprises get necessary economic compensation and medical security during childbirth. Maternity insurance covers four aspects:

1. Maternity allowance; Second, maternity medical expenses; Three, family planning surgery medical expenses; Four, other expenses stipulated by the state and the city.

The implementation of maternity insurance will mean that from July 1 2005, female employees in Beijing enterprises can have children without spending a penny if there are no special requirements. At this point, Beijing's social pension, medical care, unemployment, work injury and maternity insurance will be fully implemented, and the social security system will be gradually improved.

■ Who will the new regulations apply to?

The new maternity insurance regulations apply to all kinds of enterprises in Beijing and their employees who have formed labor relations with them, and they must have permanent residence in this city, which means that people without Beijing residence, work unit or labor contract cannot enjoy maternity insurance.

It is worth mentioning that maternity insurance is not a patent for female employees, but also for male employees. The protection of female workers includes medical expenses for family planning operation, maternity allowance (that is, wages during maternity leave) and maternity medical expenses; Male employees mainly bear the related surgery and medical expenses arising from family planning.

■ Who pays, how and how much?

The new regulations stipulate that "maternity insurance premiums are paid by enterprises on a monthly basis, and individual employees do not pay maternity insurance premiums."

Enterprises pay maternity insurance premiums at 0.8% of the total payment base. The total payment base of an enterprise is the sum of the eligible employee payment bases of the enterprise.

The employee payment base is calculated according to the average monthly salary of the previous year; If it is lower than 60% of the average monthly salary of employees in this Municipality in the previous year, it shall be calculated according to 60% of the average monthly salary of employees in this Municipality in the previous year; If it is more than 3 times the average monthly salary of employees in this Municipality in the previous year, it shall be calculated according to 3 times the average monthly salary of employees in this Municipality in the previous year; If it is impossible to determine my average monthly salary in the previous year, it shall be calculated according to the average monthly salary of employees in this city in the previous year.

Take 2004 as an example. In 2003, the average monthly salary in Beijing was 2003.75 yuan. If the employee's salary is fixed at 3,000 yuan, the enterprise will pay 24 yuan's maternity insurance premium every month. If the employee's salary does not reach 1202 yuan (that is, 60% of 2003.75 yuan), then the enterprise shall pay the minimum maternity insurance in 9.6 yuan according to 1202; If the employee's salary exceeds 60 1 1 yuan, the enterprise shall pay the highest maternity insurance premium in 48 yuan according to 60 1 1 yuan.

■ What expenses can be reimbursed?

Medical expenses for family planning operation, maternity allowance (i.e. salary during maternity leave), maternity medical expenses and family planning related expenses of insured female employees.

Maternity medical expenses include medical examination expenses, delivery expenses, operation expenses, hospitalization expenses and medicine expenses incurred by female employees due to pregnancy and childbirth.

The medical expenses of family planning operation include the expenses of placing (taking out) IUD, abortion, induced labor, sterilization and recanalization.

■ What is the guarantee for female employees to have children?

The calculation method of maternity allowance for female employees is to divide the payment base by 30 and multiply it by the number of days of maternity leave. If the maternity allowance is lower than my salary standard, the difference will be made up by the enterprise. The normal maternity leave for female employees is 90 days; The number of dystocia increased 15 days, multiple births increased 1 baby increased 15 days, and late childbirth increased by 30 days. Maternity leave is 15 to 30 days for female employees who are less than 4 months pregnant and have an abortion, and 42 days for female employees who are more than 4 months pregnant.

The income of female employees is 3,000 yuan, and the maternity allowance is 100 yuan per day. Normal maternity leave can be subsidized for 90 days, and twins can be 105 days.

You can get 2 yuan for having a baby.

1\ Maternity allowance (i.e. maternity leave salary of employees)

Maternity allowance shall be paid in full by the social insurance agency according to the maternity leave period of female employees stipulated by the state and according to the payment wage base when employees give birth; If the maternity allowance paid by the social insurance agency is lower than the wage standard of the employer during maternity leave, the difference shall be made up by the employer.

The duration of maternity leave with maternity allowance is as follows:

(1), normal delivery for 3 months. Dystocia increased by 0.5 months; Multiple births, each additional baby, an increase of 0.5 months.

(2) Natural (artificial) abortion within 3 months of pregnancy is counted as 1 month;

(3) If the pregnancy is more than 3 months but less than 7 months, the spontaneous abortion or induced labor shall be calculated as 1.7 months;

2. Maternity medical expenses.

Medical expenses incurred by female workers during pregnancy, childbirth and puerperium that meet the requirements of prenatal examination, delivery, surgery, treatment, hospitalization, medicine expenses and delivery complications shall be paid according to the following standards.

Natural delivery (including induced labor for more than 7 months) is 2300 yuan per person;

Assist in the delivery of 2600 yuan per person;

Caesarean section 4300 yuan per person;

Induced labor under 7 months per person 1600 yuan;

Induced abortion 600 yuan per person.

The employee's unit participates in maternity insurance in accordance with the regulations, and employees who have paid maternity insurance premiums for employees for more than 3 months enjoy maternity insurance benefits.

Personally, I suggest you consult the local area, because the laws and regulations of each place are different, and the content of maternity insurance is different.