近年来，各地不断完善生育支持政策体系和激励机制，积极推动政策范围内生育医疗费用全额保障，实 现住院生娃基本不花钱。今年9月，湖南岳阳在省内率先正式开展职工生育保险住院医疗费用定额包干 支付试点，遴选市内23家优质助产机构作为首批试点单位，全力推动政策范围内孕产妇"零自付"目标落 地。 11月中旬，二胎妈妈陈炎在岳阳市妇幼保健院顺利诞下一名男婴，在她的住院费用结算单上，明确本次 医疗费总额为4514.5元，其中统筹基金支付4000元，其他基金支付514.5元，个人账户支付金额为零元。 截至11月17日，岳阳市已经有126名孕产妇像她一样，在这家医院享受到了"零自付"的生育服务。 据了解，目前岳阳市共有23家助产机构成为首批试点单位，根据试点办法，岳阳全市参加职工生育保险 的女职工只要自愿与试点的助产机构签订服务协议，就能便捷享受定额包干待遇。在试点助产机构因生 育住院发生的政策范围内医疗费用，将不设起付线，不区分医院级别，实行按病种包干支付，其中顺产 包干标准为4000元，难产含剖宫产为6000元，多胞胎每多一婴增加1000元。 为确保这项惠民政策能够精准、平稳落地，试点助产机构在孕产妇入院后会进行严格的妊娠风 ...

此外，广西实行生育津贴发放至个人试点，切实提升民众获得感。广西落实"有条件的地方可探索 将生育保险生育津贴按程序发给参保女职工"工作部署，支持有条件的地市优化生育津贴支付方式，实 施生育津贴发放至个人。 目前，广西贵港、贺州、崇左3市已率先实现生育津贴直达个人。截至2025年10月底，上述3市已为 3879名参保女职工直接发放生育津贴6139.53万元。南宁将于2026年1月1日起实行生育津贴直接发放至 个人，桂林、梧州、防城港、百色4市正在部署推进相关工作。 中新网南宁11月18日电 （黄艳梅 庞雪娇）广西壮族自治区医疗保障局17日介绍，今年以来，广西 在提升产检保障水平、扩大生育保险覆盖面、优化生育津贴发放方式等方面精准发力，以制度支持提升 生育保障能力。 今年1月至10月，广西职工医保普通门诊统筹待遇享受人次1763.98万人次，同比增长20.56%；待遇 支出16.58亿元，同比增长15.68%。 广西将领取失业保险金人员全部纳入生育保险范围，试点将灵活就业人员纳入生育保险范围，生育 津贴保障范围进一步扩大。今年7月1日起，全区领取失业保险金人员在参加职工基本医疗保险的同时同 步参加生育保险，所需保费 ...

为让更多群体享受到生育保障的阳光，广西还将保障范围向更广阔的人群延伸。今年7月1日起，全 区将领取失业保险金人员全部纳入生育保险保障范围，其保费由失业保险基金代缴，个人无需缴费，并 能同等享受生育津贴。截至10月底，已有382名失业人员领取了总额超822万元的生育津贴。同时，广西 正积极试点将灵活就业人员、新就业形态人员等群体纳入生育保险，北海、贵港、防城港、梧州四市已 开展试点，符合条件的灵活就业人员最高可享受1万元生育津贴。 在降低生育成本方面，广西打通了职工医保与生育保险的衔接渠道。根据有关政策，当生育保险基 金支付的产检费用达到1500元上限后，后续符合规定的产前检查费用可无缝纳入职工基本医疗保险普通 门诊保障范围，在职职工最高可再报销2000元。这一举措让孕产保障更有力。数据显示，2025年1—10 月，全区职工医保普通门诊统筹待遇支出16.58亿元，同比增长15.68%；享受人次达1763.98万人次，同 比增长20.56%。 11月17日，记者从自治区医保局获悉，今年以来，广西在提升生育保障水平上持续精准发力，通过 优化产检报销、扩大生育保险覆盖面、改革津贴发放方式等一系列"组合拳"，切实减轻家 ...

Core Insights - The article discusses the implementation of direct payment of maternity benefits to female employees in 25 provinces in China, addressing concerns about childbirth among young people [1][2] - The National Healthcare Security Administration (NHSA) is actively promoting a direct payment model for maternity benefits, which reduces the risk of delays or withholding by employers [2][4] Group 1: Maternity Benefits Policy - The average maternity allowance for female employees has exceeded 26,000 yuan, and it can be claimed without a marriage certificate [1][2] - As of November 1, 2023, 25 provinces, including Jiangsu and Liaoning, have implemented direct payment of maternity benefits to individuals, covering nearly 90% of the regions [1][2] Group 2: Simplification of Claim Process - The NHSA has simplified the application process for maternity benefits, with most regions no longer requiring a marriage certificate or other non-essential documents [2][4] - In some areas, mothers can experience "seamless application" for maternity benefits through automated systems, reducing the need for in-person visits [3][4] Group 3: Comprehensive Maternity Support - The NHSA is working to establish a comprehensive maternity support system, enhancing coverage for hospitalization and maternity medical expenses [4] - Seven provinces have achieved a model where childbirth incurs minimal costs, and all provinces have included assisted reproductive services in their insurance coverage [4]

Core Points - The National Medical Insurance Administration is accelerating the establishment of a comprehensive maternity insurance system to support childbirth and child-rearing [1][3] - As of the end of October, all 31 provinces and Xinjiang Production and Construction Corps have included assisted reproduction in medical insurance, benefiting over 1 million people [1] - The direct payment of maternity benefits to individuals has been implemented in 25 provinces, enhancing convenience for insured female employees [3][11] Group 1: Maternity Insurance System - The maternity insurance system now includes flexible employment workers, migrant workers, and new employment forms, with a focus on improving prenatal care benefits [1][3] - The average maternity benefit for insured female employees is over 26,000 yuan as of 2024 [13] - Seven provinces have achieved a model where childbirth incurs minimal costs for families [14] Group 2: Direct Payment of Maternity Benefits - The direct payment of maternity benefits to individuals has streamlined the process, reducing the need for additional documentation such as marriage and birth certificates [11][13] - In Xiangtan, the maternity benefit process has been expedited from 20 working days to 7 working days, with 2,500 female employees benefiting from this service in 2025 [7][9] - The direct payment system helps alleviate financial pressure on new parents and prevents employers from delaying or withholding benefits [9][11] Group 3: Childcare and Health Services - The development of a childcare service system has increased the number of childcare spots for children under three years old from 1.8 to over 4 per thousand population [23] - Sichuan's Meishan has established public childcare institutions that integrate medical and educational services for infants [25] - The integration of traditional Chinese medicine into childcare practices is being implemented in various childcare centers [26]

Core Viewpoint - The article emphasizes the increasing efforts by the National Healthcare Security Administration to combat fraud in maternity insurance, highlighting the importance of maintaining the integrity of the maternity insurance fund and protecting the rights of insured individuals [4][5]. Summary by Sections Fraud Cases - The National Healthcare Security Administration has exposed five typical cases of fraud involving both insured units and individuals, including three cases involving companies and two involving individuals [7]. - A notable case involved Hubei Daya City Heshun Human Resources Co., which fraudulently claimed maternity insurance benefits amounting to 2.4916 million yuan by fabricating labor relationships and paying insurance for individuals not covered [8]. Characteristics of Fraud - Recent trends in fraud cases reveal three main characteristics: 1. Commonality in illegal behaviors, such as fabricating information and labor relationships [8]. 2. An increasing trend towards criminal prosecution for fraud, indicating a stricter stance from authorities [8]. 3. Diverse sources for identifying fraud, including complaints, data analysis, and routine checks [8]. Regulatory Challenges - The article discusses inconsistencies in the implementation of maternity insurance policies across regions, which can create opportunities for fraud [10][11]. - Specific issues include differences in payment processes and eligibility criteria, leading to potential exploitation by unscrupulous entities [10][11]. Recommendations for Strengthening Oversight - Experts suggest enhancing awareness of maternity insurance policies and improving regulatory measures to prevent fraud [11][12]. - Recommendations include proactive education, improved monitoring, and adapting policies to current economic and social conditions [12].

Core Viewpoint - The National Healthcare Security Administration (NHSA) is intensifying efforts to combat fraud in maternity insurance, highlighting the importance of maintaining the integrity of the maternity insurance fund and protecting the rights of insured individuals [1] Group 1: Fraud Cases - NHSA has exposed five typical cases of fraud involving both insured units and individuals [2] - Three cases involved insured units, including Hebei Province's He Shun Human Resources Co., Heilongjiang Province's Ba Si Te Trading Co., and Guangxi Zhuang Autonomous Region's Feng Da Food Distribution Center [2] - Two cases involved individuals, specifically a man from Liaoning Province and a participant from Shanghai who forged documents to claim maternity insurance funds [2] Group 2: Notable Case - The case involving He Shun Human Resources Co. attracted significant attention, where the company fraudulently claimed maternity benefits amounting to 2.4916 million yuan by fabricating labor relationships [3] - The actual controller and financial personnel of the company were arrested, and the main perpetrator was sentenced to ten years in prison [3] Group 3: Characteristics of Fraud - Recent trends in maternity insurance fraud include common illegal behaviors such as fabricating participant information and labor relationships [4] - There is an increasing trend of criminal accountability for fraud, with more cases being referred to law enforcement for prosecution [4] - The sources of fraud detection have diversified, including complaints, data analysis, and routine inspections [4] Group 4: Regulatory Challenges - Variations in regional policies and execution inconsistencies in maternity insurance management create opportunities for fraud [5][6] - The lack of uniformity in the implementation of maternity insurance policies leads to regulatory loopholes that can be exploited [7] - There is a need for improved awareness of maternity insurance policies among participants and companies to mitigate fraud risks [8]

2025.10. 16 本文字数：1827，阅读时长大约3分钟 生育保险作为社会保险体系的重要组成部分，对维护参保人合法权益、促进就业公平、均衡用人单位 负担具有重要作用。但个别参保单位和参保人法律意识淡薄，通过虚构、编造参保人信息，虚构劳动 关系等参加生育保险；未依法如实申报生育保险缴费基数；伪造、变造病历、票据等申领材料骗取生 育保险基金，严重扰乱生育保障管理秩序，侵害了公共利益和基金安全，依法依规应予以严肃处理。 近日，国家医疗保障局曝光5起骗取生育保险基金的典型案例，以此提醒广大参保单位和参保人，通 过合法途径参加生育保险，提供真实、准确、完整的申报材料申领生育津贴和生育医疗费，共同维护 生育保险基金安全。 湖北省大冶市禾顺人力资源有限公司骗取生育保险基金案 2025年4月，大冶市人民法院对主犯张某某以诈骗罪判处有期徒刑十年，并处罚金人民币五万元；对 从犯陈某某等5人以诈骗罪分别判处有期徒刑二至三年，缓期执行，并处罚金。 黑龙江省齐齐哈尔市佰丝特商贸有限公司等3家参保单位骗取生育保险基金案 黑龙江省齐齐哈尔市医保局开展大数据监测分析，发现齐齐哈尔市佰丝特商贸有限公司、龙源网红食 品有限公司、云逸人力资 ...

Core Viewpoint - The article emphasizes the importance of maternity insurance as a crucial part of the social insurance system, highlighting issues of fraud and the need for legal compliance among insured units and individuals [1] Group 1: Fraud Cases - Case 1: Hubei Province's He Shun Human Resources Co., Ltd. was found to have fabricated labor relationships to pay for medical insurance for non-insured pregnant women, resulting in a fraud of 2.4916 million yuan [2] - Case 2: Three companies in Heilongjiang Province were identified for falsifying labor contracts and payrolls, with the actual operators being involved in a scheme to profit from maternity insurance claims [3] - Case 3: In Guangxi Province, two companies were found to have reported inflated salary bases to claim maternity benefits, amounting to 70,090.69 yuan [5] - Case 4: In Liaoning Province, an individual conspired to create false employment documents to claim maternity benefits of 18,803.37 yuan [7] - Case 5: A participant in Shanghai was discovered to have submitted forged medical records to claim maternity benefits totaling 62,725.9 yuan [10] Group 2: Legal Actions and Recoveries - In the Hubei case, the main perpetrator received a ten-year prison sentence, and the total amount of fraud was referred to law enforcement for further action [2] - In the Heilongjiang case, 26,020 yuan of misappropriated maternity benefits was recovered, and arrests were made [4] - In the Guangxi case, the misappropriated maternity benefits were also recovered, and the main suspects were sent for prosecution [6] - In the Liaoning case, the fraudulently claimed maternity benefits were recovered, and the case was forwarded to the prosecution [8] - In the Shanghai case, the fraudulent amount was returned to the maternity insurance fund, and administrative penalties were imposed [10]

Summary of Key Points Core Viewpoint - The Sichuan Provincial Human Resources and Social Security Department announced the social insurance contribution base for 2025, setting the upper limit at 22,938 yuan/month and the lower limit at 4,588 yuan/month for three main social insurances: basic pension insurance, unemployment insurance, and work-related injury insurance [1]. Group 1: Contribution Base and Policies - The contribution base for flexible employment personnel and those receiving unemployment insurance during the insurance period will be based on the average wage of all urban employees in the province, set at 7,646 yuan/month for medical, maternity, and long-term care insurance [1]. - The contribution base for work-related injury insurance will also use the average wage of 7,646 yuan/month for determining and adjusting benefits [1]. Group 2: Contribution Rates - For 2025, the contribution rates for basic pension insurance in Sichuan are set at 16% for employers and 8% for employees; unemployment insurance rates are 0.6% for employers and 0.4% for employees; work-related injury insurance is solely employer-funded [2]. - The work-related injury insurance rates vary based on industry risk levels, categorized from one to eight, and are subject to floating management based on the incidence of work-related injuries at each employer [2]. Group 3: Individual Contributions - Individual business owners without employees, part-time workers, and other flexible employment personnel can choose their contribution base within the announced limits, with a unified contribution rate of 20% [3].