Wuhan Workers Maternity Insurance Schemes

Original Language Title: 武汉市职工生育保险办法

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(October 30, 2006 46th meeting consideration of the people's Government of Wuhan municipality on November 10, 2006, Wuhan municipal people's Government announced the 173th come into force on December 10, 2006) first in order to safeguard the legitimate rights and interests of workers, and ensure necessary economic compensation during the birth and medical care, according to the provisions of relevant laws and regulations, combined with the city's actual, these measures are formulated.
    Article II to participate in the city basic medical insurance of all kinds of enterprises and Government departments, institutions, social organizations, private non-enterprise units (hereinafter referred to as the employer) and its employees ' maternity insurance, these measures shall apply. Maternity insurance fund article in principle to implement the city's overall plan.
    Caidian, and Jiangxia, and Dong XI Hu, and Hannan, and Huang Po, Xinzhou district maternity insurance fund temporarily and manpower in this area, a gradual transition to integrated in the city.
    Fourth municipal labor and social security administrative departments of the municipal maternity insurance, social insurance agencies respectively in accordance with their respective responsibilities under the specific host riverbank, jianghan, (Editor's Note: this stone by the left, the right for Joe), Hanyang, and Wuchang, qingshan, Hongshan district, Wuhan economic and technological development zone, Wuhan East Lake high-tech development zone, East Lake ecological tourism scenic zone of maternity insurance.
    Caidian Xinzhou district, and Jiang Xia, and Dong XI Hu, and Hannan, and Huang Po, and labour and social security administrative departments are responsible for the area within the administrative area of maternity insurance, its under the social insurance institution undertaking the maternity insurance matters.
    Finance, health, population and family planning, and tax departments according to their respective duties, and maternity insurance-related work.
    Article fifth maternity insurance fund in accordance with the "fixed income, balanced budget principle of" raise, included in the financial account, the two lines of income and expenditure management.
    Sixth maternity insurance fund paid by employer of maternity insurance, maternity insurance fund interest, late fees and other funds covered by maternity insurance by law. Seventh employing units per month, according to the monthly average wages of staff and workers of 0.7% units the previous year pay maternity insurance premiums for their employees.
    Employees do not have to pay.
    Workers Shang a annual monthly wage below this city Shang a annual workers monthly wage 60% of, according to Shang a annual this city workers months average of 60% calculation; above Shang a annual this city workers monthly wage 300% of, according to Shang a annual this city workers months average of 300% calculation; workers Shang a annual monthly wage cannot determine of, according to Shang a annual this city workers months average calculation.
    Article eighth birth insurance fees when standards need to be adjusted by the municipal labor and social security administration authorities and the financial sector adjustment programme, submitted to the municipal people's Government for approval before implementation. Nineth childbearing insurance premium collected by the local tax authorities are responsible for.
    Social insurance agencies shall establish payment records for employers and employees.
    Maternity insurance premium paid by the employing unit, in accordance with the relevant provisions of the State expenditures.
    Article tenth workers enjoyed maternity insurance benefits, shall conform to the national, provincial and municipal family planning regulations and employer continuously for its contribution for more than 6 months of age.
    11th maternity insurance fund to cover the following expenses: (a) childbirth allowance; (b) nursing care leave benefits; (c) reproductive health care costs; (d) family planning surgical medical expense; (e) other expenses of the national and provincial and municipal regulations.
    12th female worker bears or stream (introduction), in the period following maternity leave to enjoy maternity benefits: (a) normal fertility, maternity leave of 90 days; difficult, added 15th of multiple births, each having 1 babies increased 15th; family planning of childbearing policy, increase the 30th.
    (B) abortion less than 12 weeks of pregnancy, maternity leave for 30th; pregnancy for 12 weeks and 28 weeks of age stream (introduction), maternity leave of 45 days; more than 28 weeks of pregnancy induced labor, maternity leave for 90 days.
    13th male spouses of workers maternity, family planning later policy and receive the certificate of the only-child parents honor and enjoy the 10th care leave benefits. 14th maternity pay criteria, in accordance with the fertility of female employees or the stream (introduction) of the base, for which the employer to pay maternity insurance premiums last month divided by the 30th.
    Men nursing leave allowance payment standards, in accordance with his or her spouse on the birth of a month for which employers pay maternity insurance premiums base divided by the 30th. 15th social insurance agencies in accordance with the standards as provided herein available to employers of workers maternity benefits, care leave benefit, the employer must be used for workers in maternity, maternity leave, carer's leave period should enjoy pay and benefits.
    Paid less than workers ' wages, welfare standards, its balance of trade union organization complement; higher than the standard of workers ' wages and benefits, which balances classified employee organization's employee benefits expenses.
    Fully funded by the financial unit, its staff maternity insurance are borne by the social insurance agency settled separately with the financial sector.
    16th worker bears surgical medical expenses or family planning in accordance with the urban workers ' basic medical insurance drug list, treatment programs and health care services regulations, paid for by maternity insurance fund according to fixed criteria (specific criteria attached).
    Reproductive health care costs including female employees because of pregnancy and maternity medical inspection fee, delivery fee, surgical operations, hospitalization, drug charges, postpartum visit.
    Medical costs including staff, implementation of family planning family planning operation placement (remove) intrauterine devices, subcutaneous implants (out) flow (a) production, sterilisation and multiple-pass surgical incurred medical expenses. 17th article following birth and family planning surgery medical costs, birth insurance fund not paid: (a) not meet national, and province, and city family planning provides of; (ii) not meet birth insurance medical management provides of; (three) not meet basic medical insurance drug directory, and clinic project and medical service facilities standard provides of; (four) in abroad or Hong Kong, and Macau S.A.R. and Taiwan occurred of medical costs; (five) for medical accident occurred of medical costs; (six) involved baby of medical, and nursing, and
    Health care costs, (VII) and provincial and municipal regulations of the State fees shall be borne by the individual. 18th employee maternity, or family planning surgery with complications, in the treatment of complicated,, basic medical insurance, in accordance with this regulation.
    Employee treatment complications, complications of medical costs paid by the health insurance fund according to the prescribed.
    19th employee participation in unemployment birth insurance, during the period of receiving unemployment insurance maternity or family planning family planning provisions of, can enjoy the benefits of reproductive health as provided herein. Article 20th birth insurance medical service, site management.
    Designated medical institutions by the municipal labor and social security administrative departments of health, population and family planning administrative departments.
    Social insurance agencies shall sign service agreements with the appointed medical institutions of maternity insurance, specify the rights and obligations of both parties and to the public, and accept their supervision.
    21st designated medical institutions should be strictly in accordance with the provisions of workers maternity insurance medical service.
    22nd in the diagnosis of pregnancy of employees, and designated by the municipal public health administrative agencies to establish the perinatal care manual and complete after the first check, the employer shall take the employee identity card, the Wuhan City family planning services certificate or a birth certificate and other relevant material to the social insurance agency to get maternity insurance, Wuhan and completed medical form (manual).
    23rd employee outpatient antenatal, childbirth and family planning operations in the hospital shall be appointed medical institution of maternity insurance; approved by the social insurance agency because of a medical emergency or referral for referral, can be used in other medical institution.
    24th employee maternity and family planning surgery medical costs, by the social insurance agency and designated medical institutions for settlement procedures; the city's non-contracted medical institutions and medical institutions in the field of emergency medical costs in the delivery, handled by the social insurance agency and the employer paid, clearing procedures.
    25th, social insurance agencies receive employer, designated medical institutions and settlement applications, should be completed audit work on 20th; do not meet the conditions, and shall inform the applicant in writing.
    No unit or individual shall not provide false materials obtaining maternity insurance benefits.
    Article 26th of workers maternity and family planning surgical medical expense standards adjustments and specific measures for the settlement of the municipal labor and social security Administrative Department in conjunction with the financial and administrative departments of public health. 27th article employing units according to this approach provides should participate in birth insurance and not participate in of, or not by provides paid birth premium of, by labor and social security administrative sector ordered deadline corrected; late still not paid birth premium of, except Fill paid owes paid amounts outside, from owes paid of day up, by day added received 2 ‰ of late fees, and can application Court law forced levy paid.
    Workers shall enjoy maternity insurance benefits during this period, paid by the employer in accordance with the criteria set out in this way.
    28th employer Declaration to the social insurance agency shall pay maternity insurance premium amount, concealed wages or the number of insured, the Administrative Department of labour and social security shall be ordered to correct, and shall be sentenced to between concealed wages more than 1 time 3 times the amount of a fine.
    29th designated medical institutions and their staff members in violation of the regulations, resulting in loss of maternity insurance fund, social insurance institution shall be recovered in serious cases, the labor and social security administration to cancel its Sentinel service of birth insurance. Article 30th obtaining maternity insurance benefits, social insurance institution shall be recovered in serious cases, the Administrative Department of labour and social security in accordance with the relevant laws and regulations will be punished; constitutes a crime, criminal responsibility shall be investigated according to law.

    31st a labor and social security administration, social insurance agencies of personnel who abuse their powers, neglect their duties, resulting in loss of childbearing insurance premium, the social insurance institution shall recover the loss of maternity insurance, and the Administrative Department of labour and social security shall be given administrative sanctions constitutes a crime, criminal responsibility shall be investigated according to law.
    Article 32nd on the labour and social security administrative departments specific administrative acts relating to maternity insurance appeal or related administrative disputes and social insurance agencies may apply for administrative reconsideration or bring an administrative lawsuit in accordance with law.
    Workers due to pregnancy or family planning operation related costs of dispute with the employer, in accordance with the relevant provisions of the labor dispute.
    33rd article this approach by the municipal labor and social security Administrative Department is responsible for the interpretation.

    34th article of the measures come into force on December 10, 2006.
    Report: Wuhan workers ' maternity and surgical medical expenses to pay the standard of family planning, fertility medical costs (a) outpatient antenatal care limit standard of 500 Yuan, in which the norm 185 initial production cost. (Ii) delivery and flow (introduction) produced medical with fixed standard: 1. birth: three level hospital 1500 Yuan, and II level hospital 1200 Yuan, and a level hospital 980 Yuan; 2. help delivery produced: three level hospital 2000 Yuan, and II level hospital 1600 Yuan, and a level hospital 1350 Yuan; 3. profile Palace produced: three level hospital 3000 Yuan, and II level hospital 2400 Yuan, and a level hospital 1980 Yuan; 4. meet family planning provides for maternal and child reasons needed terminated pregnancy of medium-term induction operation: three level hospital 1500 Yuan, and
    Hospital level II hospital 1200, level 1000; 5. hospital abortion: tertiary-level hospital 580 Yuan, second class hospital 480 Yuan, a level-390; 6. outpatient surgical abortion: tertiary-level hospital 180 yuan, level-II hospital level of 150 Yuan, 130 hospitals. Workers meet birth insurance provides of delivery, and flow (introduction) produced costs below fixed standard 90% (containing) Shi, social insurance handling institutions according to actual costs and Sentinel medical institutions for settlement; medical costs above fixed standard 90% below 100% (containing) Shi, by fixed for settlement; medical costs above fixed standard 100% below 150% (containing) of part, personal conceit 30%, medical institutions burden 30%, birth Insurance Fund paid 40%
    ; Medical expenses above fixed standard 150% part personal ego 30%, the remaining part by the appointed medical institutions of social insurance agencies based on the results of the annual appraisal of medical services determines the payout percentage.
    (C) the postpartum visit costs time limit standard for 15 yuan/person, cumulative limit of 30 yuan.
                                                                                                  II, and family planning surgery fee family planning surgery fee limit standard for: (a) placed Palace within birth control device 80 Yuan, out 75 Yuan; (ii) skin Xia buried plant operation 100 Yuan, out 55 Yuan; (three) tubal ligation operation 1500 Yuan; (four) vas deferens ligation operation 500 Yuan; (five) tubal complex pass operation 3000 Yuan; (six) vas deferens complex pass operation 2000 Yuan.