After the reform of medical service prices in urban public hospitals, the price of some medical services increased, the cost of maternity medical care increased, and the two-child policy was fully implemented. The pressure on expense management has increased.Under the new situation, maximizing and optimizing the use of limited maternity insurance funds and realizing the precise management of maternity insurance costs are of great significance to the overall operation and development of medical institutions. Based on the perspective of a three-level comprehensive medical institution, the article briefly describes the exploration and practice of the fine management of maternity insurance by the hospital medical insurance management department under the trend of the merger of employee medical insurance and maternity insurance, and improves the refinement of maternity insurance costs for the hospital medical insurance management department. Management level puts forward policy recommendations.