What is Maternity Insurance?

Maternity insurance is a social insurance system adopted by the state to provide medical services, maternity benefits, and maternity leave to women and workers who are pregnant and giving birth temporarily when they interrupt their work. Social insurance system that gives necessary financial compensation and medical care. China's maternity insurance benefits mainly include two. One is maternity allowance, and the other is fertility medical treatment. The "Maternity Insurance Measures (Draft for Solicitation of Comments)" of the Ministry of Human Resources and Social Security will be open to the public for comments from November 20, 2012. The opinion draft clearly states that maternity insurance benefits will no longer be restricted to household registration, and units that do not pay maternity insurance will be required to pay maternity expenses.

Maternity insurance is a social insurance system that is provided by the state and society in a timely manner when the labor force temporarily suspends labor due to the birth of children through national legislation. China's maternity insurance benefits mainly include two. One is maternity allowance, and the other is fertility medical treatment. Its purpose is to help working women restore their ability to return to work by providing maternity benefits, medical services and maternity leave.

The maternity insurance is determined by the state through legislation. When a working woman temporarily suspends labor due to childbearing, the state and society will provide necessary material assistance and livelihood security to childbearing workers and women. The state has established maternity insurance systems to provide maternity women with maternity benefits, medical services, and maternity leave benefits to protect their physical health and create good conditions for the feeding and growth of infants. Therefore, maternity insurance is very important for the production and reproduction of social labor. Protective effects.

Article 53 of the "Social Insurance Law" stipulates: "Employees shall participate in maternity insurance, and employers shall pay maternity insurance premiums in accordance with state regulations. Employees shall not pay maternity insurance premiums." Article 54 of the Social Insurance Law provides: "Employment If the unit has paid maternity insurance, its employees enjoy maternity insurance benefits; unemployed spouses of employees enjoy fertility medical treatment in accordance with state regulations. The required funds are paid from the maternity insurance fund. "The above regulations indicate that China's maternity insurance covers all employees The unit and its employees have also expanded to unemployed spouses of the employing unit. However, the coverage of maternity insurance in different regions of China is also different, and the specific coverage is subject to the information published by the local Human Resources and Social Security Bureau.

Measures for the settlement of maternity insurance costs

The method for settlement of maternity insurance expenses refers to the way in which the social insurance agency pays for medical services within the scope of maternity insurance. The settlement methods adopted internationally include: pay by disease, pay by project, pay by person, etc. In practice, Qingdao has worked out a method for settlement of medical expenses for maternity insurance in China. The method adopted is that female employees go to designated hospitals to give birth, and social insurance agencies and fixed hospitals implement fixed settlement. The main steps of this settlement method are:

Maternity allowance, fertility medical expenses, family planning surgery expenses, other expenses stipulated by the state and this city;

(1) Maternity Allowance: The maternity allowance is the salary of female employees during maternity leave, and the maternity allowance is lower than herself

Insured employees can enjoy maternity insurance benefits in accordance with regulations when they meet the following conditions:

1. In line with national, provincial and municipal family planning policies;

2. When giving birth or carrying out a family planning operation, the employer has participated in maternity insurance and paid the maternity insurance premium in full for 12 months.

3. Prenatal inspection fees and production costs, the parties carry a marriage certificate,

(1) The object of enjoying maternity insurance is mainly female employees, so the benefits are relatively narrow. With the social progress and economic development, some regions allow female spouses to take certain leave to take care of their wives after they have given birth, and pay holiday pay. In some regions, male spouses provide economic benefits.

The maternity insurance is to protect the basic rights and interests of female employees, reduce and solve the special difficulties caused by the physiological characteristics of female employees during pregnancy and abortion, so that they can obtain the necessary economic income and medical care during childbirth and abortion, and ensure their timely Get healthy and return to work. Its main functions are as follows:

First, the implementation of maternity insurance is a recognition of women's reproductive value. Women's fertility is the need of social development. They not only inherit the family line, but also for the society.

Maternity insurance law

Employee maternity insurance

In 1986, the Ministry of Health, the Ministry of Labor and Personnel, the All-China Federation of Trade Unions and the All-China Women's Federation jointly issued and issued the Interim Provisions on Women's Health Care. On the basis of a six-year survey and research conducted nationwide, this "rule" has played a significant role in protecting the legitimate rights and interests of female employees after scientific demonstration and reference to laws and regulations in various countries.

In July 1988, the State Council issued the Regulations on Labor Protection for Female Employees, which applies to female employees in all state agencies, organizations, enterprises and institutions in China. Units of the army system can be implemented by reference. Its main contents are detailed regulations on female employees' employment, working hours, maternity leave, protection during pregnancy and other benefits.

The "Trial Measures for the Fertility Insurance of Enterprise Employees" issued by the Ministry of Labor in December 1994 stipulated that this method applies to urban enterprises and their employees. The maternity insurance is organized on the principle of territoriality, and the cost of maternity insurance is coordinated by society.

On March 25, 2019, the Opinions of the General Office of the State Council on Comprehensively Promoting the Combined Implementation of Maternity Insurance and Basic Medical Insurance for Employees was issued. ^[5]

Maternity insurance reimbursement method

There are four contents of maternity insurance: 1. maternity allowance; 2. medical expenses for fertility; 3. medical expenses for family planning surgery; 4. other expenses stipulated by the state and this city.

For medical expenses, the employer shall pay maternity insurance premiums in accordance with state regulations, and employees shall not pay maternity insurance premiums.

Common sense questions about maternity insurance

1. Can maternity insurance be transferred?

Maternity insurance cannot be transferred. At the same time, insurance that cannot be transferred includes unemployment insurance and work injury insurance. However, endowment insurance can be transferred across provinces, medical insurance can be transferred, and housing provident fund can transfer the entire balance of the account at one time. ^[6]

2. If a female employee receives maternity allowance during maternity leave, does the employer need to pay it?

The maternity allowance is the maternity leave salary previously mentioned. In order to be consistent with international terminology, it was changed to maternity allowance. If female employees receive maternity benefits during maternity leave, the employer may not pay them; however, the law also stipulates that if the maternity allowance is lower than the wages of female employees or before the implementation of family planning, the difference shall be made up by the employer.

3. Is the cost of abortion for female employees paid by the maternity insurance fund?

Article 7 of the "Trial Measures for Enterprise Employees' Birth Insurance" stipulates: "After a female employee has given birth or had a miscarriage, she or her company shall hold a family planning certificate issued by the local family planning department, and the birth, death or abortion certificate of the baby shall go to the local social insurance agency. Offices go through the formalities, receive maternity allowances and reimburse medical expenses for maternity. "Therefore, abortion of female employees varies depending on the situation. If a female employee fails to issue a local birth control certificate or abortion certificate according to law, such as an unmarried and pregnant woman who has had a miscarriage, the cost of the abortion cannot be paid by the maternity insurance fund. If the abortion female employee can produce the necessary certificates to receive maternity insurance benefits, the cost of abortion shall be paid by the maternity insurance fund. Female employees are unable to work during abortion, and their economic income will be affected. In accordance with the principle of protecting the health of female employees, the maternity insurance fund shall pay for medical expenses incurred by abortions of female employees.

4. Can the employer terminate the labor contract with the female employee during maternity leave?

Article 9 (1) (3) of the Labor Law stipulates: "In the period of pregnancy, maternity leave, and breastfeeding, a female employee shall not terminate a labor contract with an employee on the grounds that she will be laid off on the verge of bankruptcy." This provision reflects the law. With regard to the protection of women's rights and interests, the rights of female employees during childbirth are protected by the state, and no unit may terminate labor contracts for female employees on the grounds of maternity leave.

5. What should I do if a female employee's labor contract expires during pregnancy, childbirth and breastfeeding?

Article 42 of the Labor Contract Law stipulates that if a female employee is pregnant, giving birth, or breastfeeding, the employer may not terminate the labor contract in accordance with Articles 40 and 41 of this Law. According to Article 45 of the Labor Contract Law, if a female employee's labor contract expires during pregnancy, childbirth and breastfeeding, the labor contract should be extended until the breastfeeding period expires. The unit cannot terminate the labor contract due to the expiry of the labor contract during the pregnancy, childbirth and lactation periods. The labor contract must be terminated before the lactation period expires. This is a special protection for female employees during this period.

6. What are the standards for granting maternity benefits?

Article 56 (2) of the "Social Insurance Law" stipulates: "Maternity allowance is calculated according to the average monthly salary of the employee in the previous year." At present, the maternity allowance payment period in each region is generally consistent with the maternity leave limit, ranging from 90-180 Between days. There are basically four ways to pay maternity allowances in different places: (1) Pay in accordance with the wage standard of female employees before giving birth. (2) Calculated according to the monthly average salary of the previous year. (3) Calculated according to the base number of social insurance premiums paid by employees. (4) Calculated according to the average social wage standard.

Adjustment of maternity insurance policy

Maternity insurance benefits will no longer be restricted to household registration

As the functional department in charge of social security, the Ministry of Human Resources and Social Security plans to define various policy standards for maternity insurance. The Ministry of Human Resources and Social Security and the Legislative Affairs Office of the State Council released the "Maternity Insurance Measures (Consultation Draft)" on the 21st. The method clearly states that maternity insurance will achieve full coverage of all types of workers.

Maternity Insurance Workshop

Specifically, it is various types of employers and their employees, including state agencies, enterprises, institutions, individual economic organizations with employees, and other social organizations. The Ministry of Human Resources and Social Security stated that the expansion of coverage will be conducive to the unification of the maternity insurance system and the fairness of social security.

In addition, the opinion draft also makes clear that if a child who participates in maternity insurance gives birth in a different place, the relevant treatment will be implemented in accordance with the policy standards of the participating place. It specifically involves the scope and standards of settlement of fertility medical expenses, which are formulated by each region according to the local actual situation. ^[7]

Units must bear maternity expenses if they do not pay insurance

While clarifying that the scope of insurance coverage will be expanded, the opinion draft specifically states that as social insurance, units must pay for employees. If not paid, the employee's maternity insurance benefits shall be borne by the unit.

According to the statistics of the Ministry of Human Resources and Social Sciences, as of September 2012, 150 million people were covered by the national maternity insurance. Compared with other types of social security, the population insured is relatively small. In practice, it is not uncommon for a unit not to pay maternity insurance to employees.

In order for this social security benefit to be truly implemented, the consultation draft stipulates that if an employer fails to pay maternity insurance for employees in accordance with the law, causing employees to fail to enjoy maternity insurance benefits, the employer shall pay the relevant treatment costs. At the same time face the penalty of late payment of social security.

The opinion draft also explains the field of maternity insurance benefits. In order to ensure the timely payment of maternity medical expenses and facilitate the insured personnel, it is planned to stipulate the relevant costs, which will be settled directly by the social security agency and the agreed hospital. ^[7]

Reduce the proportion of corporate contributions reduced by half

It is worth noting that the consultation draft also made a major adjustment to the proportion of maternity insurance contributions. The opinion draft clearly states that the contribution rate of maternity insurance generally does not exceed 0.5%, which is half of the current 1%.

The opinion draft clearly states that to participate in maternity insurance, employers pay insurance participation fees, and employees do not need to pay any fees. The insurance premium paid by the employer is calculated based on a certain percentage of the total wages of the employee of the unit, and the payment percentage generally does not exceed 0.5%. The specific payment percentage shall be determined by each locality according to the actual situation. ^[7]