Decree of the People’s Government of Guangdong Province
No. 203
The Provisions of Guangdong Province on Maternity Insurance for Employees adopted at the Thirty-second Executive Meeting of the Twelfth Session of the People’s Government of Guangdong Province on September 22, 2014, are hereby promulgated and shall become effective as of January 1, 2015.
Governor
Zhu Xiaodan
November 6, 2014
Chapter I General Provisions
Article 1
These Provisions are formulated for the purposes of ensuring employees to receive basic health care and minimum living allowance during the period of childbearing, proportionating the employer’s burden accrued by its responsibility for the employees’ maternity costs, and promoting fair employment, in accordance with such laws and regulations as the Social Insurance Law of the People’s Republic of China and the Special Provisions on the Protection of Female Employees, and in light of the actual situation of this Province.
Article 2
These Provisions shall apply to such “employers” in this Province as the State organs, enterprises, public institutions, social organizations, private non-enterprise units, foundations, law firms and, accounting firms, as well as individual industrial and commercial households with employees, and to all of the above mentioned employers’ staff and workers (hereinafter referred to as the “employees”), when they participate in the maternity insurance plan.
Article 3
An employer and its employees shall participate in the maternity insurance plan in the employer’s place of registration in accordance with the principle of territorial jurisdiction. Where the employer is a State organ or a mass organization, it shall participate in the maternity insurance plan in its place of location.
Local agencies of the Central Government in this Province, provincial units, and units affiliated to the Army or the Armed Police Force with employees of non-military status shall participate in the maternity insurance plan in the place where their employees participate in the basic medical insurance plan.
Article 4
The social insurance administration departments of the people’s governments at or above the county level shall be responsible for the administration of the maternity insurance within its own administrative region, while other relevant administrative departments shall be responsible for the administration of work relevant to maternity insurance within their respective functions and duties.
Social insurance agencies shall undertake such specific maternity insurance-related affairs as registration of the maternity insurance, maternity insurance premium assessment, individual rights-and-interests record, and payment of the maternity insurance benefits; and they shall be responsible for offering such services as the consultation on and information of maternity insurance.
Article 5
The social insurance premium collection agencies shall be responsible for the collection of the maternity insurance premium.
Article 6
No taxes or expenses shall be levied on the maternity insurance fund and its profits or on the maternity insurance benefits, as provided by the relevant national laws and regulations.
Article7
The maternity insurance fund shall be put under the social pooling at or above the prefecture level and shall be progressively put under the social pooling at the provincial level.
Chapter II Maternity Insurance Fund
Article 8
The maternity insurance fund shall be raised and used in accordance with the principles of “revenue determined by expenditure” and “balanced expenditure and revenue”.
In the event of underpayment of the maternity insurance fund, the local people’s government at or above the county level shall make up for the difference.
Article 9
The maternity insurance fund consists of the following items:
(1) Maternity insurance premium;
(2) Interest generated from the maternity insurance fund;
(3) Overdue payment charge;
(4) Financial subsidy; and
(5) Other funds incorporated into the maternity insurance fund in accordance with law.
Article 10
The maternity insurance premium shall be paid by the employer on a monthly basis. Individual employees are not obligated to pay the premium.
The employer pays the maternity insurance premium at the amount of not exceeding 1% of its total payroll in the previous month. The payment ratio shall be proposed based on the estimation of the actual local situation by the local social insurance administration department in the pooling district, and shall be implemented upon approval of the local people’s government in the pooling district and filed with the provincial social insurance administration department.
Where an employer’s payroll in the previous month exceeds the amount of the number of its employees multiplying three (3) times of the on-post employees’ average monthly salary in the previous year in the cities at the prefectural level or above, its due maternity insurance premium shall be calculated in accordance with 3 times of the on-post employees’ average monthly salary in the previous year in the prefecture-level cities multiplying the number of its employees.
Where the employer has no record of payroll in the previous month, its maternity insurance premium shall be calculated in accordance with its total payroll salary in the current month.
Article 11
The maternity insurance fund shall be deposited into the designated financial account of social security funds, which shall be subject to budget management as an independent and separate account in order to ensure that the fund is not to be misappropriated for other purposes than the specified purpose.
The interest of the maternity insurance fund deposited in the bank shall refer to the interest calculation rules of basic medical insurance funds for the urban employees.
Chapter III Maternity Insurance Benefits
Article 12
Where the employer has paid the maternity insurance premium on time and in full amount, its employees shall be entitled to the maternity insurance benefits; and their unemployed spouses’ maternity medical expenses shall be covered by the maternity insurance fund.
The maternity insurance benefits include the maternity medical expenses and maternity allowance.
Article 13
The maternity medical expenses enjoyed by the employee include the following items:
(1) The maternity medical expenses, namely, female employees’ medical costs incurred during the pregnancy and child birth period arising from the pregnancy and child birth, including the fees on prenatal examination stipulated by the State and this Province, expenses on termination of pregnancy, baby delivering, operation, hospitalization and medicine as well as the costs of diagnosing and treating the pregnancy complications and neopathy;
(2) The medical expenses of family planning, including employees’ costs on placing or removing the intra-uterine device and conducting the ligation or recanalization operation of fallopian tube or seminal duct, abortion or induction of labor; and
(3) Other expenses as provided by the laws, regulations and rules.
The benefits of maternity medical expenses enjoyed by an employee’s unemployed spouse shall refer to the local standard of maternity medical benefits of basic medical insurance for urban residents in the pooling district where the employee resides.
The maternity medical expenses covered by the maternity insurance fund shall conform to the catalogue of maternity insurance medicines and treatment items of the basic medical insurance and meet the facilities standards of medical service, as stipulated by the State and the Province. The maternity medical costs not covered by the maternity insurance fund shall be included into the coverage of the basic medical insurance funds in accordance with the provisions.
Article 14
The maternity insurance fund shall not cover the following expenses:
(1) Expenses that ought to be borne by a medical institution resulting from a medical accident;
(2) Expenses that ought to be borne by public health or family planning technical services;
(3) Expenses that ought to be paid by the basic medical insurance fund or work-related injury insurance fund;
(4) Medical expenses that occur in foreign countries or in Hong Kong SAR, Macao SAR and Chinese Taipei; and
(5) Other medical expenses that shall not be covered by the maternity insurance fund in accordance with laws, regulations and rules.
Article 15
The maternity allowance to which an employee is entitled shall be calculated and paid in accordance with the average monthly salary of all employees working with the same employer in the previous year divided by 30 and then multiplying the stipulated days of leave, at the time of the employee’s reproduction or family planning operation.
The average monthly salary of an employee in the previous year shall be determined in accordance with the total monthly payroll of all the insured employees working with the same employer approved by the social insurance agency divided by the total number of insured employees each month.
Where the employer has no record of the employees’ average monthly salary in the previous year, its maternity allowance shall be calculated in accordance with the employees’ average monthly salary this year.
Article 16
The number of leave days when employees are entitled to the maternity allowance shall be calculated in accordance with the following provisions:
(1) Days for female employees’ maternity leave: ninety-eight (98) days for natural birth; thirty (30) days plus for dystocia by; fifteen (15) days plus for each extra baby in the event of multiple births by; fifteen (15) days for abortion in a pregnancy less than four (4) months; forty-two (42) days for abortion in a pregnancy for four (4) months or above; and
(2) Days for the family planning operation leave: one (1) day for taking out the intrauterine device; two (2) days for placing the intrauterine device; twenty-one (21) days for implementing the tubal ligation; seven (7) days for implementing the seminal duct ligation; fourteen (14) days for implementing the recanalization operation of fallopian tube or seminal duct, and adding-up leave days for those receiving the two birth control operations at the same time.
During the leave that does not conform to the previous provisions, including the extended period of maternity or nursing leave to which an employee is entitled in accordance with laws and regulations on family planning, the employer shall pay the said employee salary in accordance with the provisions, and the employee shall not be granted the maternity allowance.
Where there are local provisions in the pooling district on the addition of payment items and the extension of time periods for the maternity allowance, such provisions shall prevail.
Article 17
During the maternity leave or family planning operation leave that employees take in accordance with these Provisions, their maternity allowance shall be advanced by their employer on a monthly basis in accordance with their original salary standards, and then the employer shall be compensated by the social insurance agencies through fund allocation in accordance with these provisions. If the condition permits, the local social insurance agencies in a pooling district may also entrust the financial institutions with direct payment of the maternity allowance to the employees.
Where an employee has received the maternity allowance, he or she shall be deemed as being paid by the employer the same amount of salary. Where the standard of maternity allowance is higher than that of the employee’s original salary, the employer shall pay the balance of maternity allowance to the employee concerned; where the standard of the maternity allowance is lower than that of the original salary, the employer shall make up for the difference.
An employee shall be exempted from paying personal income tax for the maternity allowance received in accordance with law.
The standard of an employee’s original salary mentioned in this Article refers to his or her average monthly salary during the previous twelve (12) months before the employee takes the maternity leave or the family planning operation leave in accordance with law. Where the employee has worked for less than twelve (12) months before the leave, his or her average monthly salary shall be calculated pro rata according to the actual working months.
Article 18
Where an employee has participated in the maternity insurance plan before being laid off, the maternity medical expenses arising during the period of receiving his unemployment insurance benefits, if conforming to these Provisions, shall be covered by the maternity insurance fund.
Article 19
The maternity medical expenses arising after an employee reaches the statutory retirement age shall be covered by the maternity insurance fund, if such expenses conform to these Provision.
Article 20
Where an employee’s unemployed spouse has received benefits from such sources as the basic medical insurance for urban and rural residents, the basic medical insurance for urban residents, the maternity benefits of new rural cooperative medical system, or the benefits stipulated in Article 18 of these Provisions, they shall be no longer entitled to the coverage of maternity medical expenses.
Chapter IV Administration and Supervision of the Maternity Insurance
Article 21
The social insurance administration department in each of the pooling districts is responsible for designating medical institutions covered by the maternity insurance plan within the scope of the designated medical institutions covered by the employees’ basic medical insurance plan. The social insurance agencies shall sign a service agreement with the designated medical institutions for the maternity insurance, and publicize the list of all the designated medical institutions for maternity insurance that have signed the service agreements.
Article 22
Where an employee participating in the maternity insurance plan for over one year cumulatively is to give birth, she shall choose in advance a designated medical institution for prenatal examination and child birth within the scope of the designated medical institutions announced by the social insurance agencies in the pooling district, and applies for confirmation of acceptance with the chosen medical institution. Where the application material is complete and eligible, the medical institution concerned shall handle the confirmation formalities promptly and submit relevant material and the response to confirmation application within 7 days to the local social insurance agency in the pooling district.
Where an employee has the need to change the medical institution for prenatal examination and child birth due to such special reasons as the restricted medical conditions or change of residence, she shall take the original medical institution’s confirmation and relevant documents specifying reasons for such a change to go through the change formalities with the local social insurance agency in the pooling district.
Article 23
An employee applying for confirmation of acceptance by a designated medical institution shall provide the following materials:
(1) The application form for confirmation of acceptance;
(2) Doctor’s diagnosis of the pregnancy;
(3) Such certificates as the social security card that prove participation in the relevant insurance plan;
(4) The identity documents of the insurance beneficiary;
(5) The certification that proves conformity to the relevant provisions of family planning.
The personnel specified in Articles 18 and 19 of these Provisions and their unemployed spouses shall submit the application materials as stipulated by the relevant local provisions in the pooling district in order to apply for acceptance confirmation with a medical institution.
Article 24
Where an employee participating in the maternity insurance plan for over one year cumulatively has completed the acceptance confirmation formalities with and intends to have child bearing in a designated medical institution, her maternity medical expenses shall be settled directly by the social insurance agency in the pooling district with the designated medical institution.
The employee mentioned in the preceding paragraph during the hospitalization for the purpose of child birth may transfer to other designated medical institutions covered by the basic medical insurance plan in the pooling district due to the need of diagnosis and treatment of pregnancy complications and neopathy; and her medical expenses shall be settled directly by the social insurance agency in the pooling district with the designated medical institution.
Article 25
Where an employee participating in the maternity insurance plan for over one year cumulatively gives birth in a designated medical institution in the pooling district, if, with which she fails to go through the acceptance conformation formalities, or if, which is not the medical institution that renders her confirmation, she shall pay her maternity expenses first, and then within one year after the childbirth, apply for the reimbursement with a local social insurance agency in the pooling district with such documents as the application form of the maternity insurance benefits, the identity documents of the insurance beneficiary, certificates that prove her participation in the relevant insurance plan, the certification of the birth or death of the baby, relevant schedule of medical expenses, receipts and bills, and the certification that proves conformity to the provisions of family planning; and the specific reimbursement standards shall be stipulated by the authorities in the pooling district.
Where an employee participating in the maternity insurance plan for over one year cumulatively, due to the emergency and rescue, gave birth in an non-designated medical institution in the pooling district, or in a medical institution outside the pooling district, she shall pay her maternity expenses first, and then within one year after the child birth, apply for the reimbursement with a local social insurance agency in the pooling district with such documents as provided in the first paragraph of this Article and the proof of diagnosis of the relevant medical institution. The said social insurance agency shall verify the medical expenses concerned and pay the expenses with the maternity insurance fund according to the settlement standard of the designated medical institution at the same level, and shall not pay the part exceeding the standard.
Where an employee participating in the maternity insurance plan for over one year cumulatively, not for the reason of emergency or rescue, gives birth in a non-designated medical institution in the pooling district or in the designated medical institution outside the pooling district, she shall pay her maternity expenses first, and then within one year after the child birth, apply for a lump-sum subsidy for the maternity insurance expenses with a local social insurance agency in the pooling district with such documents as provided in the first paragraph of this Article and the proof of diagnosis of the relevant medical institution; and the specific standard of such subsidy shall be stipulated by the authority in the pooling district.
Article 26
Where an employee participating in the maternity insurance plan for over one year cumulatively receives a family planning operation in the designated medical institution in the pooling district or, due to emergency and rescue, has such operation in an non-designated medical institution in the pooling district or in a designated medical institution outside the pooling district, she shall pay the maternity expenses first, and then within one year after the operation, apply for the reimbursement with a local social insurance agency in the pooling district with such documents as the application form of the maternity insurance benefits, the identity documents of the insurance beneficiary, certificates that prove his or her participation in the relevant insurance plan, the proof of diagnosis of the relevant medical institution, and relevant schedule of medical expenses, receipts and bills. The expenses may be settled directly by the social insurance agency with the designated medical institution if the local conditions allow.
Where an employee participating in the maternity insurance plan for over one year cumulatively, not for the reason of emergency or rescue, receives a family planning operation in an non-designated medical institution in the pooling district or in the designated medical institution outside the pooling district, she shall be reimbursed for the family planning operation expenses by going through the procedures and submitting the material stipulated by the preceding paragraph, subject to the standard stipulated by the authority in pooling district.
Article 27
Where an employee participating in the maternity insurance plan for less than one year cumulatively gives birth or receives a family planning operation, she shall pay the maternity medical expenses by themselves first, and then, within one year after reaching 12 months’ participation in the maternity insurance, she may apply for the reimbursement with the social insurance agency in the pooling district subject to the specific reimbursement standard stipulated by the authority in the pooling district, with the corresponding material stipulated by Article 25 or 26 of these Provisions and the following materials:
(1) Labor contract or proof of the employer’ recruitment, and the labor dispatch agreement if the said employee is hired on the basis of labor dispatch;
(2) Proofs of salary payment during the employment period; and
(3) The employer’s business license, registration certification or agency code certificate.
Article 28
Where an employee’s unemployed spouse gives birth or receives a family planning operation, the relevant maternity medical expenses shall be paid according to the terms stipulated by the authorities in the pooling district.
Article 29
Where an application for paying the maternity medical expenses is submitted in accordance with Articles 25 to 28 of these Provisions, the social insurance agency in the pooling district shall review it in a timely manner. The social insurance agency shall pay the relevant expenses within thirty (30) days after receiving the application if the said application conforms to the terms of payment, or issue a written refusal with specified reasons and grounds if the application does not conform to the terms of payment.
Article 30
Where an employer has advanced maternity allowance for an employee participating in the maternity insurance plan for over one year cumulatively, the employer may apply for allocated reimbursement of such maternity allowance with a social insurance agency in the pooling district within one year starting from the next month of the employee’s child birth or family planning operation.
Where an employer applies for allocated reimbursement for the maternity allowance for the female employees’ maternity leave, it shall submit such documents as the application form of the maternity insurance benefits, the identity documents of the insurance beneficiary, the certification of the birth or death of the baby, the proofs of the employer’s advancement for maternity allowance, and the certification that proves conformity to the provisions of family planning. It shall also submit the diagnosis certification produced by the relevant medical institution in the cases of the dystocia, multiple births or termination of the pregnancy.
Where an employer applies for the allocated reimbursement for maternity allowance for the employees’ family planning leave, it shall submit documents as the application form of the maternity insurance benefits, the identity documents of the insurance beneficiary, the proofs of the employer’s advancement for maternity allowance, and the diagnosis certification produced by the relevant medical institution.
Where there are provisions in the pooling district that the maternity allowance shall be granted directly by a financial institution, such provisions shall prevail.
Article 31
Where an employee participating in the maternity insurance plan for less than one year cumulatively gives birth or receives a family planning operation, the employer may apply for allocated reimbursement of such maternity allowance with a social insurance agency in the pooling district within one year after the employee’s advancement for the employees’ maternity allowance and after the employer has contributed the employee’s maternity insurance premium for 12 months. The employer shall apply for allocated reimbursement of such maternity allowance with the social insurance agency in the pooling district.
Where an employer applies for the allocated reimbursement of maternity allowance in accordance with the provision of the preceding paragraph, it shall submit relevant labor contract, labor dispatch agreement or the recruitment proof, proofs of salary payment during the employment period, its business license, the registration certificate or its agency code certification, in addition to the material stipulated by the second paragraph or the third paragraph of Article 30 of these Provisions.
Article 32
Where an employer fails to advance the maternity allowance during the period of employees’ statutory maternity leave or family planning operation leave, due to such objective reasons as suspension of the business license, ordered close-down and cancellation or without any due cause, the employees may apply for the maternity allowance directly with a social insurance agency in the pooling district within one year after the maternity leave or the family planning operation leave.
Where an employer applies for allocated reimbursement of the maternity allowance in accordance with the provision of the preceding paragraph, it shall submit the documents stipulated by the second paragraph or the third paragraph of Article 30 of these Provisions in addition to the proofs of the employer’s advancement for maternity allowance, the relevant labor contract, labor dispatch agreement or the recruitment proof, and the proofs of the employer’s failure to advance maternity allowance.
Article 33
The social insurance agency shall grant the maternity allowance within 30 days upon application and shall inform the employees concerned of such granting if the said application conforms to the terms of payment, or issue a written refusal with specified reasons and grounds if the application does not conform to the terms of payment.
Article 34
The department or institution responsible for family planning shall issue the family planning certificate in accordance with relevant provisions.
Article 35
Where employees participate in the maternity insurance plan across different pooling districts within the administrative region of this Province, their insurance payment period shall be calculated cumulatively. The social insurance agencies in all pooling districts shall issue payment certificates for the employees in need.
Employees and their unemployed spouses are, in accordance with relevant provisions, entitled to the maternity insurance benefits or medical expenses coverage in the district where they have made their latest contribution to the maternity insurance.
Article 36
All employers and employees concerned shall be honest with the circumstances related to the maternity insurance and be responsible for the authenticity of the material submitted.
Where an employee, employer, medical institution or other relevant entities and personnel conceal the truth, submit false certificates or documents, or participate in the maternity insurance plan by other improper means to defraud the maternity insurance benefits, the social insurance administration department, social insurance agencies and premium collection institutions shall keep a record of the illegal acts of relevant personnel or units and put it into relevant credit information database, and disclose such information through news media or their own portal websites.
Article 37
Social insurance administration departments, the financial departments and auditing institutions shall supervise the income and expenditure, management and investment operation of the maternity insurance fund in accordance with their respective functions and duties.
Social insurance agencies and the premium collection agencies shall promptly verify the information on the maternity insurance claimed and paid by the employers, and supervise the employers to participate in the maternity insurance plan in accordance with law.
Social insurance agencies shall verify relevant application materials for the maternity insurance benefits, and conduct on-site investigation of relevant information if necessary. In the event of any illegal circumstances, the case shall be transferred to the social insurance administration department for prompt handling in accordance with law.
Article 38
An employer shall inform its employees of the maternity insurance contribution payment details on a monthly basis, and accept the supervision of its employees.
Social insurance agencies shall regularly disclose the information on participation in the maternity insurance, and the income, expenditure, balance and profit of the maternity insurance fund, and shall accept the supervision of the public.
Where medical institutions, the departments or institutions in charge of family planning discover any violations against the provisions on maternity insurance, they shall promptly inform asocial insurance agency of the relevant information.
All organizations and individuals have the right to complain about and report any violation of the provisions on maternity insurance to the competent social insurance administration department or other relevant departments and institutions. Such departments and institutions shall deal with such report or complaint in accordance with law in a timely manner.
Chapter V Legal Liability
Article 39
Any employer, who fails to process the registration of maternity insurance for its employees or to pay the maternity insurance premium in full amount in a timely manner, shall be handled in accordance with relevant provisions of the Social Insurance Law of the People’s Republic of China. Where such a failure causes denials of the employees or their unemployed spouses’ entitlement to the benefits of maternity insurance, the employer shall pay relevant costs to them in accordance with these Provisions at the rate determined by the standard of the maternity insurance benefits stipulated in the pooling district.
Where an employer fails to declare the total payroll and consequently causes its employees’ loss of maternity allowance benefits, it shall be responsible for compensation.
Article 40
Any employer, who fails to pay the maternity allowance in full amount to its employees in accordance with the second paragraph of Article 17 of these Provisions, shall be ordered by the social insurance administration department to make corrections within a prescribed time limit, and shall be imposed a fine between 2,000 yuan and 20,000 yuan if no correction is made within the prescribed period time limit.
Article 41
Any person, who participates in the maternity insurance plan through concealing the truth, submitting false certificates or documents or other improper means, shall be ordered by the social insurance administration department to make corrections, and shall be imposed a fine between 2,000 yuan and 20,000 yuan. Where such person involved therein have received the benefits of maternity insurance, the department shall order them to return the amount paid for the their benefits of maternity insurance, and impose a fine more than two (2) times but less than 5 times of the paid amount. Where such person is suspected of committing a crime, he/she shall be referred to the judiciary for investigating the criminal liability in accordance with law.
Article 42
Any person, who defrauds the maternity insurance payment or the maternity insurance benefits through concealing the truth, submitting false certificates or documents or other improper means, shall be handled in accordance with the relevant provisions of the Social Insurance Law of the People Republic of China.
Article 43
Any people’s government, relevant administrative department, social insurance agency or premium collection agency or their staff member, who fails to fulfill their duties or have committed illegal acts in the administration of maternity insurance, shall be handled in accordance with the provisions of such laws and regulations as the Social Insurance Law of the People Republic of China.
Article 44
Where any employer or individual consider that a specific administrative act performed by a social insurance premium collection agency or a social insurance agency constitutes an infringement on his/her maternity insurance benefits, he/she may apply for the administrative reconsideration or initiate an administrative action in accordance with law.
Any dispute between an individual and his/her employer on the maternity insurance benefits and compensation shall be handled in accordance with relevant provisions on the settlement of labor dispute.
Chapter VI Supplementary Provisions
Article 45
The application form for medical intuition acceptance confirmation and the application form for the maternity insurance benefits stipulated by these Provisions shall be publicized on the portal website in unified formats by the social security administrative department in the pooling district for free downloads and use.
Article 46
The provincial social insurance administration department shall formulate the relevant medicine catalogue, treatment items and the medical service facilities standards of this Province in accordance with the provisions on the national basic medical insurance and maternity insurance for the urban employees.
Social insurance administration departments in each of the pooling district shall formulate the measures for management of the medical institutions of maternity insurance and shall be responsible for the qualification examination of designated medical institutions.
The supporting provisions and standards, which these Provisions require the authorities of the pooling districts to formulate, shall be made and filed with the provincial social insurance administration department for record within sixty (60) days as of the date of promulgation of these Provisions, and shall be publicized at the same time.
Article 47
Participation in the maternity insurance plan and their maternity insurance benefits for foreigners and citizens of the Hong Kong SAR, Macao SAR and Chinese Taipei shall be governed by the relevant national provisions.
Article 48
These Provisions shall become effective as of January 1, 2015. The Provisions of Guangdong Province on Maternity Insurance for Employees (Decree of the People’s Government of Guangdong Province No. 123) promulgated by the Guangdong Provincial People’s Government on April 25, 2008 shall be repealed simultaneously.