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生育保险和职工医保两险合并实施 “两险”缴费基数为职工医保的缴费基数

2017-08-26 08:15:57   中国青年网

本报讯 (记者 黄乔)日前,《重庆市生育保险和城镇职工基本医疗保险合并实施试点方案》开始实施。市人社局相关负责人进行了相关解读。 据介绍,生育保险和职工医保合并实施,是国家层面推进的一项社会保险制度改革。我市是全国首批12个试点城市之一,按照国家部署,我市的两险合并政策,遵循了以下原则:统一参保登记、统一基金征缴、统一定点医疗机构管理、统一经办和信息系统、统一基金管理、职工生育期间的生育保险待遇不变。

“有了这‘五统一、一不变’,两个保险的参保及待遇基本没有大变化。”市人社局相关负责人介绍,目前,两险的合并实施,仅在随单位参加两险的在职职工中执行。

新参保的单位职工享受两险待遇首先要注意的是,新参保单位缴费次月起,享受职工医保规定的有关待遇;连续缴费满6个月的次月起,享受生育保险规定的有关待遇。同时,职工生育或终止妊娠,在我市生育保险定点机构住院期间,发生的符合规定的生育医疗费超过限额部分,可以使用职工医保个人账户结算。

其次,有欠费情况的参保单位及其职工需要注意以下规定。合并前欠费的:参保单位职工医保费或生育保险费欠费的,合并实施后继续停止享受对应的职工医保或生育保险待遇。

合并后欠费的:从欠费次月起,停止两项保险的待遇;欠费3个月内的,足额补缴后,按规定支付两险待遇;欠费3个月以上不足6个月的,足额补缴后,按规定支付生育保险待遇,职工医保不予支付,欠费期间职工医保待遇由单位支付;欠费超过6个月的,欠缴期间其职工两险待遇由单位支付。

“欠费单位及其职工一定要及时完清欠费,职工才能享受待遇。”该负责人提醒说,此外,只参加了两险中一项的单位,需及时到社保经办机构完善手续。“两险”参保单位费率为8.5%,“两险”缴费基数为职工医保的缴费基数。

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