Maternity insurance and employee medical insurance are planned to be combined
Will the payment and treatment change?
Recently, the website issued the "Notice on Further Improving the Implementation of the Merger of Employee Maternity Insurance and Employee Basic Medical Insurance" to solicit public opinions, proposing that Tianjin Employee Maternity Insurance and Employee Basic Medical Insurance are to be combined and implemented.
The "Opinions" make it clear that:
1. Synchronous insurance registration
Employers, their employees, and flexibly employed persons shall participate in the maternity insurance of employees at the same time when participating in the basic medical insurance for employees in our city, and shall go through the registration and change of registration in accordance with the regulations. Among them, the employer shall apply for insurance registration for employees in accordance with the law, and flexible employees shall apply for insurance registration on their own.
2. Unified fund collection
The maternity insurance premiums of employees and the basic medical insurance premiums of employees shall be collected and paid in a unified manner, and the new basic medical insurance rates for employees shall be determined according to the sum of the contribution ratios of the maternity insurance and basic medical insurance for employees.
3. Consolidated fund management
The employee maternity insurance fund shall be merged into the employee basic medical insurance fund, and the income item of the employee maternity insurance fund shall be set up in the income of the employee basic medical insurance fund, and the employee maternity treatment expenditure item shall be set up in the treatment expenditure.
补充:
What is the impact of the merger of maternity insurance into medical insurance?
The General Office of the State Council has promulgated the "Opinions on Comprehensively Promoting the Combined Implementation of Maternity Insurance and Basic Medical Insurance for Employees" (hereinafter referred to as the "Opinions"), according to the "Opinions", the two insurances of maternity insurance and basic medical insurance are implemented together, so as to realize the simultaneous registration of insurance, the combined operation of funds, the consistency of collection and management, the unity of supervision and management, and the integration of handling services.
"Five insurances and one housing fund" to "four insurances and one housing fund", will the treatment of employees be affected? In this regard, Chen Jinfu, deputy director of the National Medical Security Administration, once interpreted.
The "Opinions" clearly pointed out that the maternity insurance benefits of employees during the childbirth period should be ensured. Maternity medical expenses, maternity allowances and other maternity insurance benefits of insured persons shall be implemented in accordance with current laws and regulations, and the required funds shall be paid from the basic medical insurance fund for employees.
"The combined implementation of the two insurances will not affect the maternity insurance benefits of the insured employees in the slightest, but only the handling channels will be changed, and the original maternity insurance coverage, protection items and payment levels have not changed." Chen Jinfu said that the merger of the two insurances is not to cancel the maternity insurance, does not involve the adjustment of the maternity insurance treatment policy, nor does it increase the burden of units and individuals, but only the integration of management and operation, that is, all in-service employees who participate in the basic medical insurance for employees participate in the maternity insurance at the same time, which is conducive to the realization of the maternity insurance should be fully insured.
Chen Jinfu further introduced that maternity insurance benefits include two parts: maternity medical expenses and maternity allowance. Different from the proportional payment of medical insurance benefits, maternity insurance adopts the method of reimbursement within the specified range. At the same time, maternity insurance is paid by the unit, and the individual does not pay. After the implementation of the merger, not only the above policies will remain unchanged, but also through the realization of the simultaneous registration of the two insurances, the combined operation of the fund, the consistency of collection management, the unification of supervision and management, and the integration of handling services, while saving management costs and improving efficiency, it will make it more convenient for the insured to reimburse.
From May 1
Chongqing individuals who pay employee medical insurance can enjoy maternity insurance benefits
The "Notice" clarified that from May 1, Chongqing Municipality will participate in the employee medical insurance in an individual capacity and enjoy the treatment period, and the maternity medical expenses incurred shall be reimbursed in accordance with the standard and scope of the payment of medical expenses of Chongqing employee maternity insurance (excluding maternity allowance), which shall be paid by the employee medical insurance pooling fund.
Original Policy:
https://ylbzj.cq.gov.cn/zwgk_535/zfxxgkml/zcwj_291934/gfxwj/202404/t20240424_13154466.html
The Notice clarifies that:
1. Employees who have paid medical premiums for 6 consecutive months in Chongqing shall enjoy maternity medical treatment from the following month
Insured persons who participate in the employee medical insurance in their individual capacity shall enjoy the corresponding maternity medical treatment (medical expenses for childbirth and its complications, family planning surgery costs, etc.) in Chongqing from the month following the month after paying the employee medical premiums for 6 consecutive months in Chongqing, and the treatment standard is the same as that of the insured employees of the unit.
After the maternity medical expenses incurred in the outpatient clinic exceed the payment limit, the maternity medical expenses that continue to occur in accordance with the reimbursement scope of the maternity insurance shall be included in the scope of the overall payment of the general outpatient clinic, and shall be reimbursed in accordance with the standard of the general outpatient treatment of the employee medical insurance in Chongqing Municipality who participates in the general outpatient treatment of the employee medical insurance in the capacity of an individual.
2. Will I enjoy the treatment after the interruption of medical insurance payment? There are three scenarios
After the payment is interrupted, will I enjoy the benefits? The relevant person in charge of the Chongqing Municipal Medical Insurance Bureau said that it will be dealt with in three situations:
Type 1:
If the payment has been made for 6 consecutive months, and the normal payment is resumed within 3 months after the payment is interrupted and the supplementary payment is handled, the maternity medical expenses incurred in the supplementary payment month shall be reimbursed according to the regulations.
Type 2:
If the payment is interrupted during the insurance period and the normal payment is resumed within 3 months and the full amount is paid, the number of years of the original employee medical insurance payment as an individual shall be counted consecutively. If it exceeds 3 months, it will be recalculated, and the maternity medical expenses incurred after 6 consecutive months of payment will be reimbursed according to regulations.
Type 3:
If the insured person terminates or dissolves the labor contract with the employer or continues to participate in the employee medical insurance in his or her personal capacity within 3 months after the expiration of the unemployment insurance payment, and the employee medical insurance treatment is normal, the number of years of participation in the employee medical insurance payment shall be calculated consecutively; If the insured person participates in the employee medical insurance in his or her personal capacity for more than 3 months, the payment period of the employee medical insurance in his or her individual capacity shall be recalculated from the month of payment, and the maternity medical expenses incurred after the payment for 6 consecutive months shall be reimbursed according to the regulations.
Fourth, the personal identity and employee identity switching, and the treatment connection involves two situations
If the insured person participates in the employee medical insurance in his or her personal capacity, participates in the employee medical insurance with the unit, and participates in the resident medical insurance and switches the insurance relationship, the main circumstances for enjoying the maternity medical expense protection treatment include:
Type 1:
If the insured person has participated in the basic medical insurance (resident medical insurance and employee medical insurance) in Chongqing for more than 2 consecutive years (including 2 years), the payment period of the employee medical insurance shall be calculated continuously after continuing to participate in the employee medical insurance in his or her individual capacity.
Among them, the actual payment period of resident medical insurance is converted into the actual payment period of employee medical insurance at a rate of 12.5%, which is calculated consecutively with the payment period of employee medical insurance as an individual.
That is, either the payment period after the conversion of the resident medical insurance exceeds 6 months, or the payment period after the conversion of the resident medical insurance + the payment period of the employee medical insurance exceeds 6 months.
Type 2:
After the insurance is continued to be insured with the unit as an individual, the employee's medical insurance payment period will be calculated continuously, and the maternity medical expenses incurred after 6 consecutive months of payment will be reimbursed according to the regulations.
In particular, we remind everyone that the maternity medical expenses incurred by the employees who participate in the employee medical insurance in their personal capacity in the designated medical institutions outside the city shall be reimbursed according to the regulations.
From 1 June
Maternity medical treatment has been comprehensively improved
Recently, five departments and other five departments jointly issued the "Notice on Optimizing and Adjusting the Policy on Maternity Medical Treatment" (Cheng Yi Bao Fa [2024] No. 11), which clearly states that from June 1, Chengdu urban employees and urban and rural residents will be comprehensively improved in terms of maternity medical treatment for urban employees and urban and rural residents.
Original Policy:
https://cdyb.chengdu.gov.cn/ylbzj/c128999/2024-05/10/content_0b672849bf0c4e01a6485c4f907be3d7.shtml
The Notice clarifies that:
1. Optimize and adjust the policy of maternity medical treatment for urban employees
1. Prenatal check-up fee
The fixed subsidy standard is: 1,000 yuan for childbirth; 700 yuan for termination of pregnancy after 4 months of pregnancy (16 weeks of pregnancy); If the pregnancy is less than 4 months (16 weeks gestation), the pregnancy will be terminated at 300 yuan.
2. Maternity medical expenses
The medical expenses incurred by insured female employees due to childbirth within the scope of the policy shall be paid according to the following standards: 5,000 yuan for normal delivery; dystocia (including cesarean section) 6,000 yuan; For multiple births, an additional 1,000 yuan will be added for each additional baby.
The medical expenses incurred by insured female employees due to the termination of pregnancy within the scope of the policy shall be paid according to the following standards: 2,000 yuan for termination of pregnancy after 4 months of pregnancy (16 weeks of pregnancy) (1,000 yuan for cesarean section); If the pregnancy is less than 4 months (16 weeks of pregnancy), the pregnancy will be terminated at 500 yuan.
If there is a surviving baby in the termination of pregnancy, the prenatal examination fee and maternity medical expenses shall be implemented according to the birth standard. If the medical expenses within the scope of the policy for childbirth or termination of pregnancy are less than the standard for payment, the medical expenses within the scope of the policy shall be paid according to the facts.
2. Optimize and adjust the policies for maternity medical treatment for urban and rural residents
1. Prenatal check-up fee
The fixed subsidy standard is: 700 yuan for the termination of pregnancy after giving birth or pregnancy for more than 7 months (28 weeks of pregnancy).
2. Maternity medical expenses
The hospitalization medical expenses incurred by the insured persons due to childbirth within the scope of the policy shall be paid according to the following standards: 3,000 yuan for normal delivery; dystocia (including cesarean section) 4,000 yuan; For multiple births, an additional 1,000 yuan will be added for each additional baby.
The hospitalization medical expenses incurred by the insured person due to the termination of pregnancy within the scope of the policy shall be paid according to the following standards: 1,200 yuan for termination of pregnancy after 4 months of pregnancy (16 weeks of pregnancy) (1,000 yuan for cesarean section); If the pregnancy is less than 4 months (16 weeks of pregnancy), the pregnancy will be terminated at 210 yuan.
If the insured person terminates the pregnancy and has a surviving baby, he or she shall enjoy the treatment of prenatal examination fees, and the treatment of maternity medical expenses shall be implemented according to the maternity standard. If the medical expenses incurred by the insured person during childbirth or termination of pregnancy within the policy scope are less than the payment standard, the medical expenses within the scope of the policy shall be paid according to the facts.
Source: Tianjin Medical Insurance Bureau, Chongqing Medical Insurance Bureau, Chengdu Medical Insurance Bureau, 51 Social Security Network, etc