Can the cost of caesarean section be reimbursed? How much can the cost of caesarean section be reimbursed?

Doctors generally recommend natural births if possible. If the baby is too big for a natural birth or even a dystocia, a caesarean section is performed. The cost is expensive, and some people want to get it reimbursed. So, can the cost of a caesarean section be reimbursed? How much can the cost of a caesarean section be reimbursed?

Can the cost of caesarean section be reimbursed?

It can be reimbursed, but it is divided into reimbursement by the unit or rural medical insurance. You need to consult the local social security bureau for details.

There is a special maternity insurance in social insurance, and the maternity insurance premium is generally paid by the employer, and the employees do not have to pay the maternity insurance premium. Urban resident medical insurance is also just one of the insurance types in the basic social medical insurance. Urban residents do not have special maternity insurance, but the state has a requirement that the maternity medical expenses of residents participating in urban resident medical insurance can be reimbursed in the resident medical insurance according to the hospitalization benefits. At present, in some cities, the resident medical insurance can reimburse the maternity medical expenses, but in some places it cannot be reimbursed at present.

How much can the cost of caesarean section be reimbursed?

The situation may vary from place to place, but the general amount is as follows:

A fixed subsidy is implemented for the childbirth expenses required of women who meet the fertility policy requirements. The subsidy standard is 600 yuan for a normal birth and 1,200 yuan for a caesarean section.

It is reported that pregnant women can receive a maximum subsidy of 500 yuan for normal delivery, including 100 yuan for prenatal examinations and 400 yuan for normal delivery in hospital. For complications such as cesarean section and uterine rupture, amniotic fluid embolism, postpartum hemorrhage (more than 1,000 ml), cervical and vaginal lacerations, uterine inversion, obstetric shock, obstetric disseminated intravascular coagulation, and amniotic cavity infection syndrome, reimbursement will be made according to the general hospitalization policy of the resident medical insurance, and the amount less than 400 yuan will be supplemented by 400 yuan.

There are two ways to claim reimbursement for urban residents' basic medical insurance:

The first is online settlement. When the insured person receives treatment at a designated medical institution that has implemented online settlement or quotation settlement for hospitalization, he or she only needs to pay the personal portion of the fee at the designated hospital's payment window, and the remaining fee will be settled by the social security center with the designated medical institution in accordance with regulations.

Second, reimbursement of full advance payment. The insured person's hospitalization medical expenses incurred in medical institutions that have not yet implemented online settlement shall be paid by the individual first. After discharge, the insured person shall register at the street and town labor and social security service center and its community labor and social security workstation with the discharge certificate, medical expense invoice and full expense list of the designated hospital, collect reimbursement materials, and submit them to the social insurance agency for review and settlement. The social insurance agency shall complete the settlement within the prescribed time and pay the reimbursed medical expenses in accordance with the regulations.

Reimbursement Procedures for Urban Residents' Basic Medical Insurance

After being discharged from the hospital, the insured patient must submit ① a copy of the first page of the medical record (with the stamp of the hospital's medical insurance department), ② a discharge summary, ③ a receipt for hospitalization expenses, ④ a detailed list of hospitalization medical expenses (one-day list), ⑤ a copy of the medical insurance gold coin payment slip, ⑥ a discharge certificate, and ⑦ a copy of the ID card to the community before the 1st of each month for relevant registration.

Before the 5th of each month, each community shall submit relevant materials and forms to the district medical insurance office.

From the 5th to the 10th of each month, the District Medical Insurance Office reviews relevant receipts and calculates the reimbursement amount.

Report to the Municipal Medical Insurance Center for approval from the 12th to the 15th of each month.

In the early next month, the reimbursement fee will be paid. The insured patients need to bring their ID cards to the district medical insurance office to collect the reimbursement.

Taking Chongqing as an example, according to the latest reimbursement ratio adjustment in Chongqing in 2008, if citizens choose the second-tier insurance, that is, the insurance premium is 200 yuan and the individual pays 60 yuan per year, their medical expense reimbursement ratio will be increased by 10% on the original basis, and the annual medical expense reimbursement limit for each insured citizen will be 60,000 yuan; for citizens who choose the first-tier insurance, their medical expenses will be reimbursed according to the local New Rural Cooperative Medical Scheme reimbursement standards, and the annual reimbursement limit will be increased from more than 10,000 yuan to more than 30,000 yuan.

Urban and rural cooperative medical insurance is divided into a deductible and a ceiling. The deductible is determined according to the level of the hospital, with a minimum of 200 yuan and a maximum of 1,000 yuan. The medical expenses paid by residents when seeing a doctor are below the deductible and are borne by the insured residents themselves.

How to claim reimbursement for caesarean section expenses

1. If a normal delivery is not possible and a caesarean section is required, you can apply for reimbursement if you have medical insurance. However, you must report to the medical insurance department for filing and approval.

2. If your husband's company has maternity insurance, you can also enjoy preferential maternity subsidies when you give birth (not reimbursement from their company, but preferential maternity subsidies from the company that pays maternity insurance premiums).

3. After giving birth, collect all the receipts, provided that you have maternity insurance. Then go to the medical insurance center, get several forms to fill out, provide the corresponding procedures and fill out the forms according to the requirements on the forms. Some forms need to be stamped by the unit and the hospital. At the same time, the hospital must also issue a caesarean section certificate. After all the procedures are prepared, send them to the medical insurance center.