For every office worker, the importance of "five insurances and one fund" is self-evident. For women in the workplace, "maternity insurance" has attracted much attention. Recently, "five insurances and one fund" has ushered in a major change. The original "five insurances and one fund" will become "four insurances and one fund". After the change, maternity insurance and medical insurance will be combined into one.
The general office of the State Council yesterday announced the "opinions on comprehensively promoting the implementation of the merger of maternity insurance and basic medical insurance for employees" (hereinafter referred to as the "opinions"). The maternity insurance fund is incorporated into the basic medical insurance fund for employees, with unified collection and payment and the same level of overall planning. This also means that the implementation of the combination of maternity insurance and basic medical insurance started in 2016 was officially implemented after the pilot.
At a regular policy briefing held by the State Council yesterday, Chen Jinfu, deputy director of the State Medical Security Bureau, said that after the merger of the two insurances, the treatment of maternity insurance will not change at all. Moreover, it will not increase the difficulty of small and micro enterprises to participate in the insurance, on the contrary, it simplifies the insurance process and eliminates policy obstacles. According to the relevant person in charge of the Ministry of human resources and social security, the merger is conducive to improving the mutual aid ability of social insurance funds, better enhancing the maternity insurance security function, and improving the administrative and handling service management efficiency.
Core content
On March 25, the State Affairs Office issued the opinions on comprehensively promoting the merger of maternity insurance and basic medical insurance for employees
1. Unified insurance registration.
The on-the-job employees who participate in the basic medical insurance of employees shall participate in the maternity insurance at the same time.
2. Unified fund collection and management.
According to the sum of the payment proportion of maternity insurance and basic medical insurance for employees, the new basic medical insurance rate for employees of the employer shall be determined, and individuals shall not pay maternity insurance premium.
Unified medical service management.
We will bring medical expenses for childbirth into the scope of medical insurance payment reform, and promote the payment of medical expenses such as hospitalization and childbirth by disease type and prenatal examination by head.
4. Unified management and information service.
The basic medical insurance agency is responsible for the management and the funds are included in the budget at the same level.
5. Ensure that the maternity insurance benefits of employees during childbearing period remain unchanged.
02 main policies
Unified insurance registration
The on-the-job employees who participate in the basic medical insurance of employees shall participate in the maternity insurance at the same time. In the process of implementation, it is necessary to improve the scope of insurance, find out the basic number in combination with the national insurance registration plan, and promote the realization of the full coverage.
Unified fund collection and management
The maternity insurance fund is incorporated into the basic medical insurance fund of employees, which is collected and paid in a unified way with the same level of overall planning. According to the sum of the payment proportion of maternity insurance and basic medical insurance for employees, the new basic medical insurance rate for employees of the employer shall be determined, and individuals shall not pay maternity insurance premium.
At the same time, according to the expenditure of the basic medical insurance fund and the demand for maternity treatment, we should establish the rate determination and adjustment mechanism according to the principle of balance of income and expenditure.
The basic medical insurance fund for employees shall strictly implement the financial system of social insurance fund, and the income of maternity insurance fund shall not be listed separately. The maternity treatment expenditure items shall be set up in the overall fund treatment expenditure of basic medical insurance for employees.
We should explore the establishment and improvement of fund risk early warning mechanism, adhere to the openness of fund operation, strengthen internal control, and strengthen administrative and social supervision to ensure the safe operation of the fund.
Unified medical service management
After the implementation of the two insurances, the unified designated medical service management will be implemented. When medical insurance agencies sign relevant medical service agreements with designated medical institutions, they should add relevant requirements and indicators of reproductive medical services to the contents of the agreements, and make full use of agreement management to strengthen the monitoring of reproductive medical services.
Implement the basic medical insurance, work-related injury insurance, maternity insurance drug directory, basic medical insurance diagnosis and treatment items and medical service facilities.
To promote the behavior standard of reproductive medical service. We will bring medical expenses for childbirth into the scope of medical insurance payment reform, and promote the payment of medical expenses such as hospitalization and childbirth by disease type and prenatal examination by head.
In principle, medical insurance agencies and designated medical institutions should settle medical expenses directly.
We should make full use of the intelligent monitoring system of medical insurance, strengthen the monitoring and auditing, and control the unreasonable growth of medical expenses.
Unified management and information service
After the implementation of the merger of the two insurances, it is necessary to unify the handling management and standardize the handling process. The basic budget of the medical insurance agency shall be included in the unified budget of the medical insurance agency at the same level.
Make full use of the medical insurance information system platform and implement the integrated operation of the information system.
The original medical expense settlement platform of maternity insurance can be temporarily retained and incorporated into the medical insurance settlement platform when conditions are ripe.
Improve the statistical information system to ensure timely, comprehensive and accurate reflection of the operation of the maternity insurance fund, the people enjoying the benefits and the payment of benefits.
Ensure that the maternity insurance benefits of employees remain unchanged during their childbearing period
Maternity insurance benefits include maternity medical expenses and maternity allowance stipulated in the social insurance law of the people's Republic of China, and the required funds are paid from the basic medical insurance fund of employees.
The payment period of maternity allowance shall be implemented in accordance with the period of maternity leave stipulated in the special provisions on labor protection of female workers and other laws and regulations.
Ensuring institutional sustainability
All localities should integrate the two insurance funds to enhance the fund's ability to co-ordinate and help each other; study and judge the impact of the current and future population situation on the expenditure of maternity insurance, and enhance the awareness of risk prevention and the ability of institutional guarantee;
According to the principle of "do your best and do according to your ability", we should proceed from reality, start from the protection of basic rights and interests, reasonably guide expectations; track and analyze the fund operation and expenditure structure after the implementation of the merger, improve the monitoring indicators of maternity insurance; according to the needs of maternity insurance expenditure, establish a dynamic adjustment mechanism of premium rate, prevent risk transfer, and realize the sustainable development of the system.