State Council Office: Include childbirth medical expenses in the scope of medical insurance payment reform

The General Office of the State Council recently issued the "Opinions on Comprehensively Promoting the Merger and Implementation of Maternity Insurance and Employees' Basic Medical Insurance." The "Opinion" mentioned that childbirth medical expenses will be included in the scope of medical insurance payment method reform, and medical expenses such as hospitalization and delivery will be paid according to the type of disease and prenatal examinations will be paid according to the capitation method.

The "Opinion" clearly states that the maternity insurance fund will be incorporated into the basic medical insurance fund for employees, with unified collection and payment and consistent coordination levels. The new employer's employee basic medical insurance premium rate will be determined based on the sum of the employer's contribution rates for maternity insurance and employee basic medical insurance. Individuals do not pay maternity insurance premiums.

At the same time, based on the expenditure of the basic medical insurance fund for employees and the demand for maternity benefits, a rate determination and adjustment mechanism will be established in accordance with the principle of balance between income and expenditure.

The "Opinion" requires that after the merger of the two insurances, childbirth medical expenses will be included in the scope of medical insurance payment method reform, and medical expenses such as hospitalization and delivery will be paid according to the type of disease and prenatal examinations will be paid according to the capitation method. In principle, childbirth medical expenses are settled directly between medical insurance agencies and designated medical institutions.

The "Opinion" requires that maternity insurance benefits for employees remain unchanged during their childbirth period. Maternity insurance benefits include maternity medical expenses and maternity allowances as stipulated in the Social Insurance Law of the People's Republic of China, and the required funds are paid from the employees' basic medical insurance fund. The payment period of maternity allowance shall be implemented in accordance with the maternity leave period stipulated in the "Special Provisions on Labor Protection for Female Employees" and other laws and regulations.

The "Opinion" requires that all regions should implement the merger of the two insurances before the end of 2019.