Enterprise Employee Maternity Insurance

Maternity insurance is a social insurance system mandated by law that provides financial assistance to female employees whose ability to work is temporarily interrupted and who lose their regular income due to childbirth.

1. What is the coverage of the "Enterprise Employee Maternity Insurance"?

Employees working in various types of enterprises within the city's administrative area (excluding township and village enterprises), as well as privately-run non-enterprise entities, public institutions managed under enterprise-like models, and those forming labor relationships with them—and who hold permanent household registration, including individuals currently employed with a "Work and Residence Permit."

Units covered by state-funded medical care are not included in the city's maternity insurance scheme. Employees' maternity insurance benefits will continue to be administered according to the current regulations.

2. How are birth benefits handled for individuals who do not have household registration in this city?

For employees without local household registration undergoing family planning procedures, medical expenses are covered by the basic medical insurance fund according to regulations if they participate in basic medical insurance; if they are not enrolled in basic medical insurance, the expenses will be paid by their employer. Meanwhile, medical costs related to childbirth for employees without local household registration are also borne by the employer, with payment standards following the guidelines outlined in the Ministry of Labor’s "Notice on Several Issues Concerning Maternity Benefits for Female Employees."

3. What do maternity insurance benefits cover?

Employees entitled to maternity insurance benefits must comply with the national and municipal family planning policies. These benefits primarily include: maternity allowances, maternity medical expenses, costs associated with family planning procedures, and other expenses as stipulated by the national and municipal authorities.

4. What are fertility medical expenses?

Medical expenses incurred by female employees due to pregnancy and childbirth, including examination fees, delivery fees, surgical fees, hospitalization costs, and medication expenses.

5. What are the medical expenses for family planning procedures?

Medical expenses incurred by female employees for procedures such as the insertion (removal) of intrauterine devices, abortion, induced labor, sterilization, and tubal recanalization performed as part of family planning measures.

6. Who pays for the medical expenses incurred by retirees due to family planning surgeries?

Medical expenses for family planning surgeries performed on retirees are covered by the basic medical insurance fund according to regulations for those enrolled in basic medical insurance, while employees without basic medical insurance coverage will have their costs paid by their employers.

7. How are maternity medical expenses settled?

Medical expenses for natural hospital births, medically intervened deliveries, and cesarean sections are reimbursed according to a fixed-rate standard. For hospital births complicated by severe conditions, payments will be made on a per-item basis.

Medical expenses incurred for childbirth in premium, high-quality, and specialized hospital rooms will be reimbursed according to fixed-rate standards tailored to different types of deliveries.

8. How are medical expenses for family planning procedures settled?

Employee expenses for family planning surgeries incurred at outpatient clinics are covered by the maternity insurance fund up to a prescribed limit. If the actual costs exceed the limit, payment will be made according to the limit; if they fall below the limit, reimbursement will be based on the actual amount spent.

Hospital-based family planning surgery costs are reimbursed up to a specified limit.

9. Does maternity insurance have designated medical institutions?

Employees receiving maternity benefits or undergoing family planning surgeries must utilize medical facilities designated under the city's basic medical insurance regulations. For employees who undergo family planning procedures at reproductive health centers approved by the city's family planning authorities, the maternity insurance fund will cover medical expenses according to the reimbursement limits set for first-level designated medical institutions.

10. What proof should employees present when seeking medical treatment?

When seeking medical care, you should present your "Medical Insurance Handbook," and during inpatient childbirth, you must provide your "Maternity Service Certificate."

11. How can insured employees claim reimbursement for outpatient (emergency) and out-of-town medical expenses related to childbirth or planned birth control procedures covered by maternity medical insurance?

Employees enrolled in social insurance who incur outpatient, emergency, or out-of-town medical expenses related to childbirth or planned birth control procedures should first pay these costs in cash. They must then carefully keep the detailed breakdown of maternity insurance claims, prescriptions, original receipts, and any supporting documents. Once verified, the medical expenses eligible for reimbursement from the maternity insurance fund should be compiled by the employer, who will complete the "Beijing Municipality Maternity Insurance Manual Reimbursement Application and Settlement Summary Form" before submitting it to the medical insurance administration agency in the district or county where the employer is registered for maternity insurance coverage.

12. If an employer fails to enroll employees in insurance on time, can the maternity insurance fund still be reimbursed after retroactive payment?

If the employer fails to participate in maternity insurance as required by the "Regulations on Maternity Insurance for Enterprise Employees, " the related expenses for employees' maternity benefits will be borne by the employer. Once the employer becomes insured, the maternity insurance fund will no longer provide retroactive payments.

13. Are medical expenses incurred from IVF procedures entirely non-reimbursable?

The fertility insurance fund will not cover the costs associated with assisted reproductive technologies such as in vitro fertilization (IVF). However, eligible medical expenses incurred during childbirth can be reimbursed according to regulations.

14. If an employer fails to make contributions after enrolling in social insurance, can the maternity insurance fund still provide benefits after the arrears are paid?

If an employer fails to make timely and full contributions after enrolling in social insurance, the employer must subsequently pay all outstanding maternity insurance premiums, after which the maternity insurance benefits will be retroactively provided.