How to claim maternity insurance when giving birth in another place? Maternity insurance reimbursement standards

Maternity insurance is a social insurance system that the state and society provide medical services, maternity allowances and maternity leave to pregnant and childbearing women workers when they temporarily stop working. The state or society provides necessary economic compensation and medical care to workers who give birth. Usually, everyone is relatively busy and does not have a thorough understanding of social security policies. After reading the following introduction, do you understand the reimbursement standards for maternity insurance?

Contents of this article

1. How to claim maternity insurance when giving birth in another place

2. Maternity insurance reimbursement standards

3. What are the materials for maternity insurance reimbursement?

How to claim maternity insurance when giving birth in another place

1. First of all, you need to understand clearly whether the local social security includes reimbursement of childbirth expenses. In some places, childbirth expenses are not covered by social security reimbursement.

2. If the child is born in a different place within the reimbursement scope, relevant procedures must be completed and approved by the local joint management office before the expenses incurred can be reimbursed according to regulations. For the reimbursement ratio, please directly consult the local social security management center, which is different in different places.

3. If the insured person is hospitalized in a different place, if it is an emergency, the insured person shall first pay the medical expenses. When discharged from the hospital, he/she must bring the basic medical insurance card, personal ID card, disease diagnosis certificate, discharge summary, official medical invoice and detailed list of medical expenses, and the registration form for medical treatment in different places to the Social Security Bureau (Medical Insurance Division) to go through the reimbursement procedures.

4. Social security reimbursement is done on a proportional basis, generally ranging from 20-85%. The reimbursement ratio and amount are related to one's own examination and medication, medical level and other factors. For example, Class A drugs can enjoy full reimbursement, Class C drugs need to be fully borne by the patient, and Class B drugs are reimbursed 80% and borne 20%.

Maternity insurance reimbursement standards

The three necessary conditions to apply are:

1. If you have purchased social insurance, you must participate in the maternity insurance among the five insurances for a full year.

2. The birth is in compliance with national policy (not exceeding the limit of birth).

3. Maternity insurance must be in the participating status in the month of delivery. If you resign, the social insurance you can buy in your own name is only pension and medical insurance, and the other three insurance types (work injury, unemployment, and childbirth) cannot be purchased. (If you resign) the maternity insurance is discontinued, it is less than one year, and you are not in the participating status in the month of delivery, so of course you cannot be reimbursed. As for whether it will be invalid after reimbursement, it depends on the situation: the second child can be reimbursed if it meets the three necessary conditions. If the second child is an extra birth and does not comply with national policies, then of course it cannot be reimbursed.

What are the materials for maternity insurance reimbursement?

One original and two copies of the "Marriage Certificate", one original and two copies of the "Birth Service Certificate" (for employees who are not registered in Beijing and participate in maternity insurance, it is best to provide a Beijing birth service certificate. If it cannot be provided, a regular birth service certificate from another place is required) and two copies. One original and two copies of the "Birth Medical Certificate", one original and two copies of the "Medical Blueprint", one original and two copies of the "Diagnosis Certificate" issued by the hospital, all original documents from the hospital, and two copies of the "Birth Reimbursement Approval Form", with official seals.

1. Original and copy of hospital medical records.

2. Original and copy of hospital diagnosis certificate.

3. Special receipts or invoices for medical expenses printed by the finance and taxation department.

4. A detailed list of medical expenses that matches the amount on the receipt (invoice) (or a manual record list with the hospital seal).

5. The original and a copy of the Birth Certificate or the original and a copy of the Family Planning Service Certificate.

In addition, the following situations require attention:

1. If a person has undergone emergency abortion or delivery without obtaining the "Guangzhou Enterprise Employee Maternity Insurance Medical Treatment Confirmation Certificate" (hereinafter referred to as the "Medical Treatment Certificate"), and does not have a "Birth Certificate" or "Family Planning Service Certificate", a certificate from the street family planning department of both the husband and wife is required.

2. For out-of-town childbirth (the application and filing procedures for out-of-town childbirth have been completed at the Municipal Medical Insurance Center), you need to provide the "Guangzhou Enterprise Employee Maternity Insurance Out-of-town Childbirth Application Form" or the "Maternity Insurance Designated Hospital Selection Application Form".

3. If a "Medical Certificate" has been obtained and emergency abortion or delivery is performed in a non-designated hospital: ① The original and a copy of the "Medical Certificate". ② A written report issued by the insured person or his/her family.

4. Maternity insurance medical expenses for various special circumstances recognized by the Municipal Medical Insurance Center: ① A written report issued by the insured or his/her family. ② Information required by the Municipal Medical Insurance Center based on various circumstances.