Heilongjiang implements "two risks" merger! How does it affect the insured? Will the treatment fall? The authoritative answer is here
Beginning this year, Heilongjiang Province started the merger implementation of Heilongjiang Provincial Maternity Insurance and Basic Medical Insurance in accordance with the "Opinions on Comprehensively Promoting the Combination of Maternity Insurance and Employee Basic Medical Insurance" (hereinafter referred to as "Opinions"). What impact will the merger of the "two risks" have on the insured? Will the maternity insurance-related benefits decline after the merger? Regarding a series of hot issues, the relevant person in charge of Heilongjiang Medical Security Bureau gave an authoritative answer:
1. Is there any change in the maternity insurance group?
In accordance with the spirit of the "Opinions", two insurances, maternity insurance and basic medical insurance, are implemented in combination to achieve simultaneous registration of insurance, merger operation of funds, uniform collection and management, unified supervision and management, and integration of handling services.
The so-called unified insurance registration means that employees who participate in the employee's basic medical insurance participate in maternity insurance at the same time. For in-service personnel of state organs and institutions participating in the basic medical insurance for employees in Heilongjiang Province, as required, they must also participate in maternity insurance. Therefore, the coverage of maternity insurance coverage has been expanded.
2. Will the individual pay maternity insurance premiums after the merger is implemented?
The "Opinions" proposed that the maternity insurance fund be merged into the employee basic medical insurance fund and be collected uniformly. The new basic medical insurance premium rate for the employees of the employing unit shall be determined according to the sum of the contribution rates of the employer's participation in maternity insurance and the employee's basic medical insurance. Maternity insurance is that individuals do not pay, and the unit pays, and this policy is also retained. For example, the original unit rate, employee medical insurance is 7.5%, maternity insurance is 0.5%, individual employee medical insurance rate is 2%, the new employee basic medical insurance rate is combined to 8%, and the individual contribution rate is still 2%.
3. Will the maternity insurance-related benefits decline after the merger?
The implementation of this merger clarifies the "two guarantees". The first guarantee is the guaranteed treatment. The original maternity insurance stipulates that the maternity insurance benefits remain the same, but the handling channels have been changed, and the maternity insurance settings have not been changed Guarantee items and payment levels. Of course, in some regions and cities, the previous maternity insurance benefits are inconsistent with state requirements, and this integration will involve the issue of regulation adjustments.
Maternity insurance involves two aspects of guaranteed treatment. The first is maternity medical expenses, which are reimbursed within a prescribed amount, which is different from the guaranteed treatment of medical insurance, because the medical insurance treatment is paid in proportion, which reflects the A special arrangement. The second is maternity benefits. If there is no maternity insurance, either unit or individual will increase the burden on enterprises or individuals. Therefore, maternity insurance clearly stipulates that the maternity insurance fund shall pay maternity benefits within 98 days of the prescribed legal maternity leave. All these reasonable treatments will not change. With social and economic development, maternity protection will only get better and better.
4. Will the combined implementation of the two insurances increase the difficulty for small and micro enterprises to participate?
It is obviously clear that these small and micro enterprises are covered by insurance. If they have a contract, they can take out employee-type insurance; if they are flexible employees, they can participate in the corresponding social insurance in their personal capacity. If it is an individual who cannot participate in the employee's medical insurance, we have institutional arrangements in the resident's medical insurance, and the government will provide subsidies based on the individual's payment to participate in the resident's medical insurance. This kind of resident medical insurance also stipulates that reimbursement of maternity medical expenses incurred by the insured shall be reimbursed by the medical insurance. Even if they have not participated in employee medical insurance, have not participated in maternity insurance, and have participated in resident medical insurance, they can also reimburse maternity medical expenses in the medical insurance.
Judging from the process of the implementation of the two insurance mergers, not only will it not increase the difficulty of small and micro enterprises participating in maternity insurance, but on the contrary, it will simplify the insurance participation process, eliminate policy barriers, and improve management service capabilities.
(Li Rui, CCTV reporter)