According to the Municipal Healthcare Security Bureau, in order to keep advancing universal enrollment, effectively safeguard the maternity insurance rights of flexible workers, and properly connect maternity allowances with maternity medical benefits, the city recently issued the "Notice on Matters Concerning Flexible Workers' Enjoyment of Maternity Allowance Benefits." It clarifies that starting May 1, 2027, flexible workers will enjoy maternity allowances in sync with their employee basic medical insurance benefits. The policy includes a transitional period, and the eligibility conditions differ between the transitional period and the formal implementation stage. Here is a detailed interpretation.
What is the main purpose of this Notice?
To implement the relevant provisions of the "Medical Security Law of the People's Republic of China" regarding citizens' lawful participation in insurance and their enjoyment of basic medical security and maternity insurance benefits as prescribed, to solidly advance universal enrollment and the goal of ensuring coverage for all who should be covered, and to further standardize the rules for flexible workers' enjoyment of maternity insurance benefits, this Notice is hereby formulated.
What does maternity insurance benefits mainly include?
Maternity insurance benefits consist of two items: maternity allowances and maternity medical expenses. Maternity allowances serve as substitute protection for female employees' wages during maternity leave, used to safeguard the basic livelihood of childbearing women during maternity leave; maternity medical expenses are used to safeguard the basic medical needs of childbearing women during childbirth, mainly including the "maternity insurance basic healthcare service package" and the "zero out-of-pocket" benefit for policy-covered medical expenses of hospitalized childbirth in this city.
For flexible workers participating in the city's employee basic medical insurance, how is the benefit waiting period implemented?
For flexible workers participating in the city's employee basic medical insurance, the benefit waiting period is 6 months. Those who have made continuous and full contributions for 6 months and continue to pay normally shall enjoy employee medical insurance benefits from the following month; if contributions are interrupted during the waiting period, the waiting period shall be recalculated. If in-service employees or urban-rural residents stop enjoying employee medical insurance or resident medical insurance benefits, and within 3 months participate in employee medical insurance as flexible workers and pay normally, the above benefit waiting period rules shall not apply.
What conditions must flexible workers meet to apply for maternity allowances?
The policy is implemented in two stages: a transitional period and formal implementation. During the transitional period (before April 30, 2027), those who participate in insurance and pay contributions as flexible workers in the month of childbirth or miscarriage, and who have accumulated 12 months of contributions to the city's employee basic medical insurance before childbirth or miscarriage, may apply for maternity allowances as prescribed. Being in the employee medical insurance benefit waiting period at the time of childbirth or miscarriage does not affect the application for maternity allowances. Under the new policy's formal implementation (from May 1, 2027), applicants for maternity allowances must simultaneously meet two conditions: (1) normally enjoying employee basic medical insurance benefits at the time of childbirth or miscarriage; (2) having accumulated 12 months of contributions to the city's employee basic medical insurance before childbirth or miscarriage. Those in the employee medical insurance benefit waiting period at the time of childbirth or miscarriage shall not enjoy maternity allowances. Note: During the transitional period, whether one is in the medical insurance waiting period is not considered; as long as one is normally insured in the current month and has accumulated 12 months of contributions before childbirth or miscarriage, the allowance can be applied for. After May 1, 2027, at the time of childbirth, one must already be able to normally use employee medical insurance; childbirth during the waiting period will no longer qualify for maternity allowances.
What are the conditions for flexible workers to enjoy maternity medical expense benefits?
The recently issued "Notice on Further Improving Policies Related to Maternity Medical Expense Protection in This City" has clarified that maternity medical expense benefits are enjoyed in sync with basic medical insurance benefits. Flexible workers who normally enjoy employee medical insurance benefits may enjoy the "zero out-of-pocket" benefit for maternity medical expenses; those who give birth during the medical insurance benefit waiting period shall not enjoy the "zero out-of-pocket" benefit for maternity medical expenses and cannot apply for the settlement of the remaining balance of maternity medical expense subsidies. For prudent connection, a transitional period is set from October 1, 2026 to April 30, 2027. For childbirth during the transitional period, those who participate in insurance and pay contributions as flexible workers in the month of childbirth, and who have accumulated 12 months of contributions to the city's employee medical insurance, may handle the settlement of the remaining balance of maternity medical expense subsidies as prescribed even if they are in the employee medical insurance benefit waiting period at the time of childbirth. From May 1, 2027, flexible workers who are in the employee medical insurance benefit waiting period at the time of childbirth shall neither enjoy the "zero out-of-pocket" benefit for maternity medical expenses nor be able to handle the settlement of the remaining balance of maternity medical expense subsidies.
If already pregnant and participating in employee medical insurance as a flexible worker, can one enjoy maternity insurance-related benefits?
Benefit enjoyment is determined by the time of childbirth in different scenarios: if childbirth occurs before April 30, 2027, and the person participates in insurance and pays contributions as a flexible worker in the month of childbirth, and has accumulated 12 months of contributions to the city's employee medical insurance before childbirth, they may apply for maternity allowances as prescribed. Those whose expected due date is May 2027 or later must, starting from October 2026, continuously and normally participate in insurance and pay contributions as flexible workers, normally enjoy employee medical insurance benefits, and have accumulated 12 months of contributions to the city's employee medical insurance before childbirth, in order to apply for maternity allowances as prescribed. If contribution interruption occurs, and at the time of childbirth one is still in the employee medical insurance benefit waiting period, they shall not enjoy maternity allowances or maternity medical expense-related benefits. Note: Flexible workers should adhere to timely insurance participation and continuous contributions, avoiding coverage interruption, to ensure full enjoyment of basic medical insurance and maternity insurance benefits.
If an in-service employee plans to resign to await childbirth and subsequently participates in insurance as a flexible worker, how are maternity insurance benefits enjoyed?
If an insured person, within 3 months after interruption of employee medical insurance benefits, participates in employee medical insurance as a flexible worker, they are not subject to the 6-month employee medical insurance benefit waiting period rule. If they directly transfer from a unit after resignation to flexible employment insurance participation, or after expiration of unemployment insurance benefit receipt immediately transfer to flexible employment insurance participation, they may normally enjoy maternity medical expense benefits; on this basis, if they have accumulated 12 months of contributions to the city's employee medical insurance before childbirth or miscarriage, they may apply for maternity allowances as prescribed.
For those participating in resident medical insurance who transfer to employee medical insurance as flexible workers, how are maternity insurance benefits implemented?
If an insured person normally participates in resident medical insurance at the time of childbirth or miscarriage, they may enjoy maternity medical expense benefits as prescribed, but resident medical insurance participants do not enjoy maternity allowances. For former resident medical insurance participants who, within 3 months of interruption of medical insurance benefits, participate in employee medical insurance as flexible workers, they are not subject to the benefit waiting period rule. If they already normally enjoy employee medical insurance benefits at the time of childbirth or miscarriage, they may enjoy maternity medical expense-related benefits; if they have accumulated 12 months of contributions to the city's employee medical insurance before childbirth or miscarriage, they may apply for maternity allowances as prescribed.
Friendly reminder: Flexible workers participating in insurance should reasonably plan their insurance participation time, pay on time and in full, and avoid interruptions that affect the enjoyment of maternity-related benefits. For further questions, you may consult online via the "Shanghai Healthcare Security Digital Assistant" or call the healthcare security consultation hotline 12393.
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