Hefei City Workers Maternity Insurance Schemes

Original Language Title: 合肥市职工生育保险办法

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(December 18, 2007 Executive meeting of the people's Government of Hefei city, the 106th on December 31, 2007, the 133th, promulgated by the people's Government of Hefei city as of March 1, 2008) Chapter I General provisions article in order to protect workers ' legitimate rights and interests protection of women workers ' basic living and medical care during childbirth need to promote women's equal access to employment, in accordance with the People's Republic of China Law on protection of women's rights, implementation of interim regulations on the collection and payment of social insurance, the
    Anhui Province on population and family planning regulations, interim provisions on maternity insurance of workers in Anhui Province and other laws, rules, regulations, combined with the city's actual, these measures are formulated.
    The second unit and these measures shall apply to the following persons: (a) workers in urban enterprises in the region and (ii) basic medical insurance in this city of State organs, institutions, social organizations and trade unions, (iii) private non-enterprise units and their employees; (d) visa workers individually in this municipality and its employees.
    Third maternity insurance fund and manpower levels consistent with the basic medical insurance fund and manpower levels, the implementation of classification of city, County and Manpower, a gradual transition to integrated in the city.
    The unity of implementation of maternity insurance fund collection, use, and manage.
    Fourth employee maternity insurance introduction of contracted medical institutions and appointed family planning technical service institutions (hereinafter referred to as designated service of birth insurance) agreements.
    Fifth of municipal and county administrative departments of labor security maternity insurance work within their respective administrative areas, maternity insurance agencies to which they belong (hereinafter referred to as the Agency) concrete contractor maternity insurance business.
    Finance, tax, population and family planning, health, food and drug, prices, and other relevant departments shall, within their respective mandates, assist in birth insurance-related work.
    Chapter Sixth maternity insurance fund in accordance with maternity insurance fund to fixed income, balance principle to raise, included in the financial account, the two lines of income and expenditure management.
    Article seventh maternity insurance fund consists of the following components: (a) the employer pay maternity insurance fee; (b) interest on maternity insurance fund (iii) delayed payment of maternity insurance fees; (iv) other funds included maternity insurance fund by law. Eighth article birth Insurance Fund for following spending: (a) birth allowance; (ii) birth medical costs; (three) family planning surgery medical costs; (four) maternity leave during birth complications and family planning surgery Dang period complications of medical costs; (five) birth Dang period complications of medical costs; (six) parameter insurance of male workers its spouse for agricultural family households and not participate in birth insurance of, in birth Shi male workers enjoy of birth nursing fake subsidies; (seven) legal, and regulations, and
    Rules and regulations should be other relevant expenses incurred by maternity insurance fund. Nineth article birth insurance fund not paid following costs: (a) violation national, and province, and city family planning provides occurred of related costs; (ii) for medical accident occurred of related costs; (three) birth Qian implementation artificial auxiliary reproductive operation of costs; (four) involved baby of medical, and nursing, and health, costs; (five) abroad, and to Hong Kong, and o, and Taiwan area during occurred of related costs; (six) was sentenced is prison implementation during of costs; (seven) not has clinical profile Palace surgery refers to levy and implementation profile Palace produced surgery,
    Reproductive medical expenses beyond birth maternity pay criteria. Article tenth insured employer shall from the date of implementation of this approach in the 30th, to the local tax authorities and the social insurance institution registration procedures for childbirth insurance.
    New employer after the implementation of these measures shall be from the date of establishment of registration procedures for insurance in the 30th.
    Employer lawfully terminates or the name, residence and legal representative of changes in registered items shall be terminated or changed in the 30th after, to the seat of the local authorities and the social insurance agency for cancellation or change of the registration.
    11th 0.4%, full funding of State organs and institutions pay rates for enterprise payment rates for 0.8% other employer may choose one of the above rates.
    When enterprise maternity insurance rates need to be adjusted by the municipal labor and social security administration departments, financial departments, and submitted to the municipal people's Government. 12th the employer contribution base determined according to the employer all employee payroll for the last year.
    Unit base pay shall not be less than the full period payment of basic medical insurance for insured employees (or basic old-age insurance) individuals contribution base.
    13th the employing unit shall monthly pay maternity insurance, maternity insurance shall not be relief.
    Workers (employees) personal non-payment of maternity insurance.
    Chapter III maternity insurance benefits article 14th insured workers enjoyed maternity insurance benefits, subject to the following conditions: (a) the employer in accordance with the first paragraph of this article tenth time, continuous demand, whose insurants from fulfilment of payment obligations in full month to enjoy maternity insurance benefits.
    (B) the insurants birth or family planning operations in accordance with laws and regulations.
    (C) the insurants in the Sentinel service of birth insurance maternity or family planning operation. Employers not complying with the first paragraph of this article tenth insurance registration, for the insured procedures to pay in full when the registration period as provided herein to the maternity insurance are insured during the registration fees and late fees, its coverage of the insurance contributions of employees starting next month to enjoy maternity insurance benefits.
    Pay workers during maternity and family planning costs associated with surgery and treatment, borne by the employer according to the criteria set out in this way. Interrupts payment of the employer's, needed to pay in full the interrupt payment during maternity insurance fees and late fees, its workers since the resumption of the payment of insured months month to enjoy maternity insurance benefits.
    Interrupts payment of insurants during childbearing and family planning operation related costs and benefits assumed by the employer according to the criteria set out in these measures.
    15th article birth insurance medical with paid range according to Anhui Province town workers basic medical insurance and injury insurance drug directory, and Anhui Province town workers basic medical insurance clinic project, and Anhui Province town workers basic medical insurance medical service facilities range and paid standard (following referred to "three a directory") of range determine; beyond provides range of medical costs, birth insurance fund not paid.
    Insured workers using the list in the preceding paragraph of class b drugs and individuals to pay part of the cost of diagnosis and treatment of the costs incurred by the project, from paid maternity insurance fund.
    16th maternity insurance fund be paid for your reproductive health care including pregnancy and childbirth during the necessary inspection fee, delivery fee, surgery, drugs and hospitalization (including basic medical care fees, must the fees, anesthesia fees, management fees and materials fees).
    Maternity insurance fund to pay medical costs including staff, implementation of family planning family planning operation position (out), intrauterine devices, abortion, abortion, sterilization, and rehabilitation the costs incurred by patients.
    Maternity insurance fund to pay for complications, complications cost refers to the birth of maternity complications and complications during birth complications, birth control surgery in the period when fee. 17th article by 0.8% rates paid birth premium of employing units, its parameter insurance female workers birth or pregnancy 7 months above (containing 7 months) induction of, enjoy 3 months of birth allowance; has following case one of of, SEO birth allowance: (a) meet family planning late conditions (full 24 age) of early maternal, increased 1 months of birth allowance; (ii) delivery Shi meet medical refers to levy implementation profile Palace produced surgery of, increased half months of birth allowance; (three) more cell tire birth of, each more birth a baby,
    By half a month of childbirth benefits; (iv) during the period of maternity leave for a one-child parents honor card, increase 1 month maternity allowance.
    18th by 0.8% pay maternity insurance premium rates of employers, insured women workers pregnant for more than 3 months (3 months) for 7 months following miscarriage, abortion, 1.5 months maternity benefits; 3 months following miscarriage, 1 months maternity benefits; the risk of ectopic pregnancy, enjoy a 1 month maternity allowance.
    Except following situation outside, female workers abortion, and induction enjoy birth allowance limited to 1 times: (a) has received reproductive health service card or birth card, for habitual abortion, and pregnant women or fetal physique, reasons not suitable production, and accident accident, led to abortion, and induction of; (ii) has take long-term permanent contraceptive birth control measures and occurred accident pregnancy for abortion, and induction of.
    19th month maternity allowance for my birth or miscarriage, prior 12-month average contribution wage; payment of less than 12 months, according to the calculation of average salary actually paid month.
    20th by 0.4% pay maternity insurance premium rates of employers, their women not entitled to maternity benefits, wages and benefits during maternity leave granted by the employer.
    Article 21st wife of insured male workers for agricultural households, and during the period of maternity leave for a one-child parents honor card, issued to male workers ' reproductive care leave subsidies of 500 Yuan.
    The fourth chapter maternity insurance for medical treatment and treatment claims for 22nd staff confirmed the pregnancy of insured shall within 3 months after my social security card, the reproductive health services card or birth certificate to agency records.
    Husband and wife living apart, to work in her husband's place birth or parent live births and other reasons, the insurants needed fertility in different places should be provided when filing units or certificate from the streets, the community.
    Insurants offsite emergency abortion, emergency childbirth and while childbirth and abortion complications, complications, should telephone agencies, within 1 week for the record.
    Maternity staff conduct one-child parents honor certificate for the period of the maternity leave, during the period of maternity leave should be given to agency records.
    Not in accordance with the provisions of birth record, maternity insurance fund does not pay the related costs. Article 23rd insured local treatment of workers maternity insurance shall take the social security card to Sentinel services birth or family planning surgery.

    Medical expenses in line with the scope of insurance payment of maternity, maternity insurance by designated agencies handling services and settlement; not part of the payment by the hospital to charge individuals.
    Article 24th handling birth record of insured workers in the local bears, may, month of birth, designated by the Agency pursuant to receive maternity benefits. Insurance in the operation of the local family planning workers and meet the men enjoy maternity care leave subsidies, shall, within 1 month after the end of the medical or maternity leave, to the Agency for the subsidy, subsidy audit procedures.
    Approved treatment starting from next month, the agency designated banks receive.
    25th insurants offsite fertility, abortion, any advances in medical costs incurred by individuals.
    When insured employee's birth, emergency abortion record in different places, the Agency shall inform its "three directories", medical expenses, and I settled standards, insured workers ' medical expenses that occur in different places in the "list of three" within and not higher than the city's settlement standards of medical cost, paid for by maternity insurance fund. After the end of medical or maternity leave within 1 month after, workers or their clients shall take the workers ' social security cards, baby first diagnosis of the medical certificate of birth, medical records, discharge summary, medical expenses details and medical expense invoices to the Agency for the treatment and settlement auditing procedures.
    Approved for the treatment of the month, the agency designated banks receive, in which birth a birth allowance monthly.
    Fifth chapter fixed service management article 26th appointed service institutions of workers maternity insurance conditions are met, are willing to take measures of workers maternity insurance location based services and the implementation of the provisions of medical expenses and settlement standards of medical institutions and family planning technical service institutions may apply to the administrative departments of labor security, after confirmation by the administrative departments of labor security, signed an agreement with the Agency. 27th article birth insurance Sentinel service institutions should has following conditions: (a) made medical institutions practice industry license, and maternal and child health technology service practice industry license or family planning technology service institutions practice industry license of medical service institutions and family planning service institutions; (ii) meet medical institutions obstetric construction standard or family planning technology service institutions set standard; (three) strictly implementation national, and province, and city prices sector provides of birth medical service and drug price policy, made
    Service price in Anhui province registration certificate (iv) commitment to this approach and the Hefei city maternity insurance medical services agreement; (v) equipped with compatible with Agency and real time transmission and settlement of computer management information system.
    Sentinel service of birth insurance agencies determined should follow to meet people's needs, while ensuring that quality, quantity control principle.
    28th Agency shall regularly publicize the Sentinel service of birth insurance service of insurants, insurance for employees.
    Article 29th maternity insurance medical cost accounting standards by the administrative departments of labor security in conjunction with the health, population and family planning departments separately.
    Settlement standard for determining medical expenses should be commensurate with the actual cost of medical services, fully seeking the views of medical institutions and medical services price changes to adjust.
    Article 30th point of birth insurance services insurance bodies shall carefully check employee information, witness unification of requirements of the strict implementation of the fertility and family planning operation.
    Specification for fixed service of birth insurance institution shall record expenses insurants, passing data to the Agency in a timely manner, and proactively provided to insured workers the costs of clearing inventories, cost self-check your computer system.
    31st point of birth insurance service institutions should strictly enforce the "three".
    Insured workers needed to use at their own expense medicines, medical items and materials for medical use, institutions must fulfil their obligations of Sentinel service of birth insurance and signed project informed consent document, maternity insurance for medical treatment at their own expense.
    Insured workers do not have clinical indications for cesarean section surgery and requires the implementation of Cesarean surgery, maternity insurance contracted medical institutions must inform their birth childbirth payments above the standard over the I's expense, and signed by the patient or family.
    Insured workers when they are discharged from hospital medical statements subject to the insured employee (or client) to verify and sign.
    32nd point of birth insurance service institutions not to take false treatment, false Diagnostics, induced by hanging-bed hospital, hospital stay, reduced admission standards, virtual open drug and treatment projects, outside the list within the list of drugs into drugs or other items, such as substance abuse, take maternity insurance fund.
    Sixth chapter legal responsibility 33rd article employing units violation this approach provides not participate in birth insurance, or not by provides declared should paid of birth premium amounts of, by labor and social security administrative sector ordered deadline corrected; plot serious of, on directly competent head and other directly responsibility personnel can sentenced 1000 Yuan above 5000 Yuan following of fine; plot special serious of, can sentenced 5000 Yuan above 10000 Yuan following of fine.
    34th article employing units not by this approach perform payment obligations of, by labor and social security administrative sector ordered deadline full paid; late not paid of, except Fill paid owes paid amounts outside, from owes paid of day up, by day added received 2 ‰ of late fees (into birth Insurance Fund), and on directly is responsible for of competent personnel and other directly responsibility personnel sentenced 5000 Yuan above 20000 Yuan following of fine.
    35th the employer or the employees to defraud maternity insurance benefits or defraud a maternity insurance fund, the labor Security Administration Department is ordered to return and impose fined not more than the amount defrauded more than 1 time 3 times constitutes a crime, criminal responsibility shall be investigated according to law.
    36th medical service of birth insurance has the article 31st one, be ordered by the administrative departments of labor security refund, and fined not more than the amount defrauded more than 1 time 3 times in serious, cancel the qualification of its medical services constitutes a crime, criminal responsibility shall be investigated according to law.
    37th labor and social security administration, agency staff abuse, malpractice, negligence, resulting in loss of maternity insurance fund, by the Agency to recover the loss constitutes a crime, criminal responsibility shall be investigated according to law.
    Labour and social security administrative departments or other authorities do not fulfil their oversight responsibilities of location based services bodies, this level shall be ordered to correct serious, in accordance with the personnel and other persons directly in charge of administrative sanctions.
                                  Seventh chapter supplementary articles article 38th these measures shall take effect on March 1, 2008, the municipal people's Government promulgated on July 13, 1996, of the interim measures for maternity insurance of enterprise staff in Hefei (48th of the municipal government) abrogated.