(a) female workers who give birth or flow (lead) production shall enjoy maternity leave pay in accordance with the relevant provisions of the state and the province. Maternity leave wages are paid by the employer in accordance with the regulations, and the maternity insurance fund is compensated in the form of maternity allowance. Maternity allowance is calculated and paid according to the average payment wage base of female employees before delivery or abortion 12 months. If the insured person is less than 12 months, the minimum payment wage base of the previous year in this city in the month of birth or abortion shall be taken as the base.
(II) Maternity medical expenses such as prenatal examination fees, examination fees, delivery fees, operation fees, hospitalization fees in general wards, medical expenses for postpartum recovery, basic treatment fees, etc. for female employees after pregnancy shall be paid by the maternity insurance fund according to regulations;
(3) The medical expenses incurred by female employees due to birth complications after pregnancy and within 4 months after delivery shall be paid by the maternity insurance fund. After 4 months of medical expenses, to participate in urban basic medical insurance, according to the relevant provisions of the urban basic medical insurance;
(four) in accordance with the provisions of the state to enjoy maternity leave for more than three months, to give a one-time nutritional subsidy, the cost paid by the maternity insurance fund, the standard is 2% of the average wage of employees in this city last year.
Article 8 If the spouse of a male worker who participates in maternity insurance is unemployed, the expenses for prenatal examination, delivery and abortion that meet the family planning regulations shall be paid at 50% of the standard stipulated in maternity insurance, and he shall not enjoy other maternity insurance benefits.
Article 9 Medical expenses incurred by workers due to family planning operations such as placing (taking out) intrauterine devices, abortion, sterilization and recanalization shall be paid by maternity insurance fund according to regulations. Medical expenses for complications caused by family planning operation shall be paid in the urban basic medical insurance fund according to the relevant provisions if they participate in the urban basic medical insurance.
Article 10 If an employee who participates in maternity insurance is unemployed and meets the requirements of family planning or performs family planning operation during the period of receiving unemployment benefits, his maternity medical expenses, one-time nutrition subsidy and family planning operation expenses shall be paid by the maternity insurance fund.
After the female workers who participated in maternity insurance in the original unit retired, they took out the intrauterine device, abortion and other surgical expenses, which met the family planning regulations and were paid by the maternity insurance fund.
Eleventh female workers or the implementation of family planning surgery should be carried out in the city's maternity insurance designated medical institutions. The qualification identification and management of maternity insurance designated medical institutions shall be implemented with reference to the regulations on the management of designated medical institutions of basic medical insurance. Agencies shall implement agreement management for designated medical institutions of maternity insurance.
The catalogue of maternity insurance drugs and medical services is based on the catalogue of basic medical insurance drugs and medical services, combined with the characteristics of maternity insurance, and published after appropriate increase or decrease.
Agencies and designated medical institutions for maternity insurance shall settle accounts according to the project and disease quota. Specific settlement measures shall be formulated separately by the administrative department of labor security in conjunction with the financial department.
Article 12 The maternity insurance fund shall be levied according to the principle of supporting fixed income and basically balancing income and expenditure, and the specific collection and management shall be implemented in accordance with the provisions of the Provisional Regulations on the Collection and Payment of Social Insurance Fees in the State Council.
Maternity insurance funds shall be managed by special financial accounts and two lines of revenue and expenditure, and shall be subject to the supervision of financial and auditing departments according to law.
Thirteenth employers pay maternity insurance premiums at 0.8% of the salary base of all employees in the previous year; Failing to pay within the time limit, in addition to ordering it to pay within a time limit, an overdue fine of 2‰ of the payable amount shall be charged on a daily basis. Self-employed workers do not pay maternity insurance premiums.
Maternity insurance premiums paid by enterprises, private non-enterprise units and individual economic organizations shall be charged in the cost (expense). Maternity insurance premiums paid by self-supporting institutions shall be paid in social security fees.
Fourteenth maternity insurance funds deposited in the bank shall calculate the interest according to the deposit interest rate stipulated by the People's Bank of China, and the interest obtained shall be included in the maternity insurance fund.
Fifteenth when a unit is divided, merged or transferred, it shall pay off the maternity insurance expenses it should bear in one lump sum in accordance with the relevant provisions of laws and regulations.
Sixteenth medical expenses, maternity allowance and one-time nutrition allowance shall not be paid by the maternity insurance fund in the following circumstances:
Violation of national, provincial and municipal family planning policies;
(2) Termination of pregnancy due to illegal selection of fetal sex, suicide, self-mutilation, fighting, alcoholism, drug abuse and other reasons;
(3) Termination of pregnancy due to ectopic pregnancy, hydatidiform mole and other reasons;
(4) Traffic accidents, medical accidents and drug accidents for which a third party is responsible;
(5) Treating various infertility (pregnancy) and sexual dysfunction;
(six) medical expenses incurred in giving birth or carrying out family planning operations abroad or in Hong Kong, Macao and Taiwan;
(seven) the medical expenses of newborns;
(eight) complications of family planning operation;
(nine) the implementation of family planning surgery in the city's non maternity insurance designated medical institutions (except rescue);
(ten) the insured workers did not produce the "social security card" and maternity insurance medical certificate when seeking medical treatment;
(eleven) other expenses that do not meet the scope and standards of maternity insurance.
Seventeenth units, maternity insurance designated medical institutions or individuals to defraud the maternity insurance fund, the administrative department of labor security is responsible for the recovery and punishment; If a crime is constituted, criminal responsibility shall be investigated according to law.
Article 18 If the staff of an agency violates regulations and causes losses to the maternity insurance fund, the administrative department of labor and social security shall be responsible for recovery, and the responsible person shall be given administrative sanctions according to the seriousness of the case; If a crime is constituted, criminal responsibility shall be investigated according to law.
Nineteenth employees who have doubts about enjoying maternity insurance benefits can directly go to the employer or the agency to inquire. In case of labor disputes between employees and employers due to maternity insurance benefits, they may apply to the Labor Dispute Arbitration Committee for arbitration; Anyone who refuses to accept the arbitration award may bring a lawsuit to the people's court according to law.
Twentieth if a party refuses to accept the administrative decision, it may apply for administrative reconsideration or bring an administrative lawsuit according to law.