(Adopted by the 25th ordinary meeting of the Government of 30 September 2013, No. 8 of the Shanghai People's Government Order No. 8 of 14 October 2013, which came into force on 1 December 2013)

Chapter I General

Article 1

In order to guarantee basic medical needs for workers, this approach has been developed in accordance with the Social Insurance Act of the People's Republic of China and the Programme for the Implementation of the Decision of the State Department on the Establishment of a Basic Health Insurance System for Urban Employers.

Article 2

This approach applies to enterprises, business units, State agencies, social groups, non-commercial units and individual businessmen with employment (hereinafter referred to as “personal units”) and their basic health insurance and related management activities.

Employees referred to in this approach, including in-service, retired and other insured persons.

Article 3

The criteria set out in this approach for emergency medical self-sufficiency refer to the medical expenses incurred by the staff member in the emergency medical treatment of the medical facility within one year, which are paid by the personal medical accounts of the employee after the year, the local health insurance fund (hereinafter referred to as “the Supplementary Fund”), and the personal self-sufficiency of the employee.

The standard of payment for the Integrated Fund referred to in this approach refers to the medical expenses incurred by the employee in the hospitalization of the targeted medical institution or the observation of the IGO, which, in accordance with this approach, are paid by the Integrated Fund.

The proportion of payments made by the Integrated Fund and the Supplementary Fund referred to in this approach refers to the medical costs incurred by the staff in the targeted medical institutions for medical treatment within one year, which are paid by the Integrated Fund or the Fund.

The most significant amount of the Fund, as described in this approach, refers to the medical expenses incurred by the staff in the targeted medical facility within one year and to the maximum amount paid under this scheme by the Integrated Fund.

Article IV (Management)

The National Human Resources Security Agency is the administrative authority for the basic health insurance in the city, responsible for the uniform management of the basic health insurance in the city. The Regional, District Health Insurance Office (hereinafter referred to as “zonal, district medical offices”) is responsible for the management of basic health insurance within the Territory.

Sectors such as urban development reform, hygienic birth, finance, audit, food medicine regulation, and civil affairs are coordinated with the management of basic health insurance according to their respective responsibilities.

The Social Insurance Service of the city is responsible for the collection of basic health insurance fees.

The Urban Health Insurance Service Management Centre (hereinafter referred to as the “Central Medical Insurance Centre”) is the Medical Insurance Service of this city, which is responsible for the settlement of medical expenses, the allocation and management of the basic health insurance personal accounts (hereinafter referred to as “the personal medical accounts”).

Article 5

The proportion of payments for basic health insurance, the standard of self-sufficiency, the standard of payment for the Integrated Fund, the proportion of payments made by the Integrated Fund and the Fund, the maximum payment thresholds for the integrated fund, should be adjusted in accordance with the level of basic health insurance to the level of economic and social development in the city, the maintenance of a reasonable gradient treatment of basic health insurance and the efficiency of the use of medical resources. Specific adaptation programmes are published by the Urban Human Resources Security Bureau, in conjunction with the relevant sector studies, arguments and reports of the consent of the Government of the city.

Chapter II Registration and payment

Article 6

In accordance with the provisions of the Ministry's Human Resources Security Service, a basic health insurance registration process is handled by the designated social insurance agencies. Among these, the newly established user units should be processed within 30 days of the date of the establishment.

The owner's unit shall terminate or change the registration of the basic health insurance subject to the law and shall, within 30 days of the date of the occurrence of the relevant circumstances, write-off or modification of the registration procedure to the original registration body.

When dealing with the procedures set out in paragraph 2 of this article, the Social Insurance Agency shall be subject to review at the request of the National Human Resources Social Security Agency and, in accordance with the provisions, promptly communicate the registration, registration or write-off of the user unit to the Centre.

Article 7

The average monthly salary of the current employee was the average of the pay base. The average monthly salary for the previous year exceeds the average monthly salary of 30 per cent for active workers in the current city, with overstatements not taking into account the contributions base; less than 60 per cent of the average monthly salary for active workers in the previous year, and 60 per cent of the average monthly salary for active workers in the current city.

Individuals of active workers should pay basic health insurance expenses in accordance with their contribution base of 2 per cent. Individuals of retirees do not pay basic medical insurance fees.

Article 8

The number of contributions from the user unit is based on the number of contributions paid by the employee of the unit.

The user unit shall pay the basic medical insurance fee in accordance with the percentage of its contribution base of 9 per cent, and pay the local health insurance fee in accordance with the rate of 2 per cent of its contribution.

Article 9

The medical insurance fees paid by the user unit are charged on the basis of the channels provided by the financial sector.

Article 10

The calculations of the amount of contributions paid by the user unit and in-service workers, the procedures for payment and the handling of the dispute are implemented in accordance with the relevant provisions of the management of the social insurance.

Chapter III Basic health insurance funds and the Supplementary Fund

Article 11 (Basic Health Insurance Fund)

The basic health insurance fund consists of an integrated fund and a personal medical account.

The basic health insurance payments paid by the user unit are included in the integrated fund, in addition to taking into account the individual medical accounts in accordance with article 13 of this scheme.

Article 12

The Medical Insurance Centre should establish a personal medical account for the worker after the person's unit handles the procedures for the registration of the basic health insurance and pays the medical insurance fees in accordance with the provisions.

Article 13

The basic health insurance payments paid by the in-service workers are fully taken into account in their personal medical accounts.

About 30 per cent of the basic health insurance fees paid by the user unit is included in the personal medical accounts.

The basic health insurance fees paid by the user unit are taken into account in the personal medical accounts and are distinguished according to the age.

The age of the employee is divided as follows:

(i) The age of 34;

(ii) The age of 35 to 44 years;

(iii) Be of 45 years of age.

The age group of retirees is divided as follows:

(i) Retirement to the age of 74;

(ii) Age of 75.

The basic health insurance fees paid by the user unit are taken into account in the specific standards of the individual medical account and their adjustments, which are made public by the Urban Human Resources Security Bureau after studying, demonstrating and reporting to the Government of the city.

Article 14.

Employers should pay unpaid basic medical insurance fees or interrupt the enjoyment of basic old-age insurance treatment and cease to account for funds in accordance with article 13 of this scheme.

Article 15

The funds of the individual medical accounts are owned by individuals and can be transferred across the year and inherited by law.

Individual medical accounts are financed by funds and calendar year balances.

The end-of-year funding of the individual medical account is based on the relevant provisions and is included in the personal medical accounts.

Article 16

Employers can access the credit and expenditure of funds in their personal medical accounts, and municipal health insurance centres should facilitate the search for workers.

Article 17

An additional health insurance fee paid by a person's unit is included in the additional fund.

Chapter IV

Article 18

The targeted medical institutions referred to in this approach refer to medical institutions granted to establish basic health insurance settlement relations with the approval of the health-care sector for the acquisition of authorization for the operation and the approval of the Ministry's Human Resources Agency.

The targeted retail shops described in this approach refer to the granting of retail enterprises for the establishment of basic health insurance settlement-related medicines, with the approval of the Food Medicine Regulatory Service to obtain operational qualifications and the approval of the Urban Human Security Agency.

Article 19

Targeted medical institutions, customized retail pharmacies should provide services to workers and apply for medical expenses in accordance with basic health insurance medical treatment projects, medical facilities and the scope of medicines and payment standards.

Article 20

The basic health insurance treatment projects in the city, the scope of medical care facilities and the use of medicines, and the payment standards, are developed by the Urban Human Resources Security Bureau in accordance with national provisions.

Article 21

Employers may be medically available to the targeted medical institutions within the scope of this city.

Employers may be equipped with medicines in targeted medical institutions or may be equipped with medicines according to the regulations.

The place of employment of workers or residence in the city of Orientale province, as well as in the city of Orientale province, can be accessed to local medical institutions.

Article 2 (Security Insurance Certificate)

Employers should present their health insurance certificates when they are equipped with medicines for medical care at the targeted medical institutions in the city.

The identification of a medical institution or a pharmacies should be carried out for the medical insurance certificate of the employee.

Any individual shall not be able to use, forfeiture, transgender and borrow medical certificates.

Chapter V

Article 23 (Peral conditions for workers' access to basic health insurance)

Employees' units and their employees pay health insurance fees according to the provisions, workers have access to basic health insurance treatment since the last month of payment of health insurance payments, and workers cannot receive basic health insurance treatment.

In accordance with the relevant provisions, the user unit applied for the payment of a medical insurance fee, and during the approved period, the employee did not stop the enjoyment of basic health insurance treatment.

Employees who have not paid medical insurance fees and their employees should be paid, and workers may continue to receive basic health insurance treatment after paying their health insurance payments in full.

The length of the payment of health insurance expenses by the user unit and its employees (considered to as the contributory period) exceeds 15 years, and after the retirement of the employee, the basic health insurance treatment can be enjoyed. Depending on the calculation of the pay-for-year period, the Social Security Bureau of the Entreprenemental Resources is provided separately.

After the retirement age, after the retirement process, a worker may receive a pension, the basic health insurance payments paid by a person's unit are taken into account in part of his personal medical accounts, in accordance with the standards for the last month of his or her work, and the payment of his medical expenses is carried out in accordance with the basic health insurance provisions of the retired person.

Until this approach is implemented, retired persons who enjoy basic health insurance treatment under the relevant provisions are not subject to the limitations set out in this article.

Article 24

In the course of one year, the staff member's personal medical accounts were charged with the payment of funds in addition to article 26 of the scheme, and article 27 of this scheme. Inadequate portions are paid by individuals to a standard of self-sufficiency, exceeding a portion of the payments made under the following provisions (excluding the costs incurred in the distribution of pharmacies at targeted retail shops):

(i) A person under 44 years of age who receives emergency medical treatment at the level of medical institutions, which is paid by an additional fund of 65 per cent; an emergency medical clinic at the secondary level is paid by an additional fund of 60 per cent; and 50 per cent by an additional fund in three medical institutions.

(ii) Persons over 45 years of age, with an emergency medical treatment at the level of 75 per cent paid by the Fund; emergency medical treatment at the secondary medical institution, 70 per cent by the additional fund; and 60 per cent by the Supplementary Fund, at the third level of medical institutions. Of these, by 31 December 1955 and by 31 December 2000, more than the medical costs for the medical portion of the MTS standard, 75 per cent for the medical institutions at the level, 75 per cent for the grant, and 70 per cent for the second and third medical institutions.

The medical costs incurred by the in-service workers in the face of the standard portion of their self-sufficiency, as well as medical expenses incurred in the remaining portions of the payments made by the Supplementary Fund in accordance with the provisions of the present scrutiny, the personal medical accounts have been funded as a result of the annual balances and remain underfunded and are paid by the active staff.

The cost incurred by the active worker to the retail pharmacies at the targeted point could be paid by the personal medical accounts' balances.

Article 25

In the year of the retirement pension, the medical emergency is charged to cover the expenses incurred in connection with the treatment of medical treatment or the pharmacies, in addition to article 26 of the scheme, article 28 of which the individual medical account is paid for the year. Inadequate portions are paid by individuals to a standard of self-sufficiency, exceeding a portion of the payments made in accordance with the following provisions (excluding the costs incurred in the pharmacies in the targeted retail stores):

(i) Persons under 69, with emergency medical treatment at the primary level, are paid by an additional fund of 80 per cent; emergency medical treatment at the secondary medical facility is paid by 75 per cent; emergency medical treatment at the third level is paid by an additional fund of 70 per cent. Of these, by 31 December 1955, by 31 December 2000, by 31 December 2000 and after 1 January 2001, the number of persons involved in the retirement process was higher than the medical costs of the standard portion of the emergency medical treatment, at the primary level, by 85 per cent of the grant; at the secondary medical institution, 80 per cent of the grant was paid by the additional funds; and 75 per cent of the emergency medical clinic at the third level.

(ii) Persons over 70 years of age, with an emergency medical clinic at the primary level, paying 85 per cent of the additional fund; emergency medical treatment at the secondary level is 80 per cent of the additional funds; and 75 per cent of the additional funds are paid at the level of the three medical institutions.

In addition to article 26 of the scheme and article 28 of the scheme, the individual medical accounts of the person were charged with paying funds for one year by 31 December 2000. Inadequate portions are paid by individuals to a standard of self-sufficiency, exceeding a portion of which is paid in accordance with the following provisions (excluding the costs incurred in the pharmacies of the targeted retail store): (b) In the secondary medical facility, an additional 90 per cent grant was paid;

The medical costs incurred by retirees in relation to the standard portion of the self-critical paragraph, as well as the medical expenses incurred in the remaining portions of the payments made under this article, are funded by the individual medical accounts for the calendar year and are still underfunded by the previous year's balances and are still underfunded, with the self-sufficiency of retirees.

The costs incurred by retired persons to the pharmacies at the targeted point may be paid by the personal medical accounts for the calendar year.

Article 26

Employers are diagnosed with severe urtures (chemical treatment, intrusive treatment, radiological treatment, peer treatment, intervention treatment, medical treatment, secondary treatment), in part in psychiatric treatment (psychiatry of Disadvantages, moderate depression, stereopathy, forced disorder, mental stunting, psychological stunting disorders, oral mental disorders) (hereinafter referred to as “therapeutics”), and 85% of the Fund are paid to retirees. The remaining portion is paid by its personal medical accounts for the previous year's balances, which are still underfunded by the worker.

The medical costs incurred by the employee's family beds are paid by the Integrated Fund by 80 per cent, while the remaining portion is paid by the personal medical accounts' balances for calendar years and is still underfunded by the employee.

Article 27

The medical costs incurred by the In-Central Employees in hospitalization or by the IGO were established. The payment rate is €1,500.

The medical costs incurred by the in-service worker in hospitalization or by the IGO are accumulated over the portion of the payment standard and are paid by the Integrated Fund by 85 per cent.

The medical costs incurred by the in-service worker and the medical costs of the remaining portion of the after-payment by the Integrated Fund remain underfunded by the personal medical accounts for the calendar year.

Article 28 (Percentage of retirees, medical costs of emergency observation rooms)

The medical costs incurred by retired persons in hospitalization or by the IRS Observatory are subject to the standard of payment. The payment rate was €700 by 31 December 2000; after 1 January 2001, the payment rate was 1,200.

The medical costs incurred during the year's hospitalization or observation of the Acquisition Unit have resulted in a cumulative excess of the payment standard, with 92 per cent being paid by the Integrated Fund.

The medical costs incurred by retirees and the remaining portions of the medical expenses incurred after the integrated funds are paid by the individual medical accounts for the previous year's balances, which remain underfunded by retirees.

Article 29

The maximum payment limit for the Integrated Fund amounted to $3.4 million. In the first year, the medical costs incurred by the employee in hospitalization, the observation of the IGO are higher than the medical expenses incurred, as well as the medical expenses for the medical treatment of the sick or the family beds, which are paid by the Integrated Fund in accordance with article 26 of this scheme, article 27, article 28, and the proportion of payments under article 28 of this scheme.

The Fund pays the medical expenses above the maximum limit, which is paid by an additional fund of 80 per cent and the rest is self-sufficient.

Article 31 (Support of medical expenses for some special diseases)

The medical costs incurred by the employee in connection with the Epidemiological Diseases in compliance with the requirements of the basic health insurance are met with the medical expenses incurred by the ITS Observatory.

Employers are paid by the maternity insurance fund or the work injury insurance fund, in accordance with the relevant provisions of the State and the city, owing to maternity and medical expenses incurred by work injury and occupational illness.

Article 31 (Day of non-payment)

The following medical costs are not included in the coverage of the basic health insurance fund:

(i) It should be paid from the work injury insurance fund;

(ii) It should be burdened by third parties;

(iii) The burden of public health should be borne by public health;

(iv) Medical care outside the country.

Medical costs should be borne by third parties in accordance with the law, and third parties are not paid or unable to determine third parties and are paid by the basic health insurance fund. After payment by the basic health insurance fund, the right to seek compensation to third parties, as required.

Chapter VI

Article 32 (Central accounts and accounts for medical expenses)

The medical expenses incurred by workers in connection with medical treatment or the distribution of medicines are in compliance with the basic health insurance requirements, and the medical certificate of the employee is governed by the following provisions:

(i) Unpaid by the Integrated Fund and the Supplementary Fund, the targeted medical institutions should be accounted for as a matter of fact;

(ii) Payments made under the personal medical accounts, the customary medical institution or the customary retail pharmacies should be deducted from the personal medical accounts of the employee, and the personal medical accounts are underfunded and should be charged to the worker.

The medical expenses incurred by the targeted medical institutions, the pharmacies, or the pharmacies that are not in compliance with the basic health insurance requirements should be charged to the worker.

Article 33 (A declaration of medical costs)

The medical expenses incurred from the personal medical accounts of the employee, are settled on a monthly basis to the designated district and district medical offices.

The targeted medical institutions are reimbursed for the medical expenses incurred by the Integrated Fund and the Supplementary Fund, which are settled on a monthly basis to designated districts, district medical offices.

Employers' medical expenses incurred pursuant to article 21, paragraph 3, of this scheme may be paid through the Integrated Fund, the Supplementary Fund or the Personal Medical Account funds, which are settled by their medical certificates to designated areas, district medical insurance.

Article 34

The medical expenses incurred by district, district medical insurance for the settlement of the application shall be held in the first instance within 10 working days of the date of receipt of the application, and the first instance shall be sent to the National Human Resources Security Service.

The National Human Resources Security Agency shall, within 10 working days of the date of receipt of the first instance opinion of district, district medical service, make decisions for granting payment, suspension or non-payment of payments. After a suspension of the payment decision, the Urban Human Resources Security Agency shall, within 90 days, make a decision to grant payment or not to pay and inform the relevant units.

In accordance with the medical costs approved by the Urban Human Resources Security Agency, the Urban Medical Insurance Centre shall, within seven working days of the date of approval, be funded from the fund's expenditure; the medical expenses incurred without payment are approved by the Urban Human Resources Security Agency, are borne by the targeted medical institution, the terminal retail pharmacies or the employee's self-payment.

Article XV (Modalities for medical costs)

The National Human Resources Security Service can address medical costs with targeted medical institutions, including through a total pre-payment settlement, the settlement of service projects, the settlement of service modules, and the provision of medical costs beyond the settlement standards.

Article XVI (Option of prohibitions in the cost settlement)

Targeted medical institutions, customized retail stores or individuals shall not resolve medical costs by falsification or conversion of accounts, information, referrals, medical fees documents, etc.

Chapter VII Legal responsibility

Article 37 (Regional inspection)

Monitoring of compliance with the provisions of the basic health insurance for targeted medical institutions, targeted retail pharmacies and insured persons is carried out in accordance with the relevant provisions of the Basic Health Insurance Management Scheme of the Shanghai City.

Article 338 (Constitutional medical institutions, customized retail pharmacies, legal responsibility for violations committed by insured persons)

Depending on the relevant provisions of the State and the city, the targeted medical establishments and the insured person violate the provisions of the scheme.

Article 39

The human resources social security administration and the municipal health care centre staff are one of the following acts, which are rectified by the POHR; causing losses to the Medical Insurance Fund, the user unit or the individual, which is liable under the law, and alerts, lapses or seizures by the competent and other direct responsibilities that are directly responsible; more circumstances, giving downgradation or removal; and, in serious circumstances, granting dismissal:

(i) Failure to perform the statutory duties of social insurance;

(ii) Unregistered the health insurance fund into the financial exclusive;

(iii) Certified or refused to pay medical treatment on time;

(iv) Disadvantaged or simulated medical insurance data such as payment records, access to health insurance records and personal rights records;

(v) Other violations of social security laws, regulations and regulations.

Chapter VIII

Article 40 (Management and oversight of the Medical Insurance Fund)

The management and oversight activities of the Integrated Fund and the Supplementary Fund are carried out in accordance with the relevant provisions of the National and Beni City Social Insurance Fund. The Integrated Fund and the Additional Fund are incorporated into the Financial Excellencies of the Social Security Fund, which are managed in a unified manner, separately, earmarked and should be subject to the supervision of the Social Insurance Fund, established by the Government of the city, as well as financial, auditing sector oversight.

The budget and accounts of the Integrated Fund and the Supplementary Fund are prepared by the Urban Human Resources Security Bureau, in accordance with the provisions of the Municipal Finance Agency, to report on the implementation of the Government's approval.

Article 40

Individual commercial and industrial workers who are not employed in the city, non-time practitioners who do not participate in the basic health insurance of the employed person, and other flexible employed persons, may set the waiting period for the treatment of health insurance. After the expiry of the period, the insured person enjoys the corresponding basic health insurance treatment as stipulated in this approach.

The specific set-up approach to the waiting period was developed by the Urban Human Resources Security Agency.

Article 42 (Basic health insurance for other personnel)

Foreign practitioners from non-communes participating in the basic health insurance of workers pay basic health insurance fees and receive basic health insurance treatment, in accordance with the relevant provisions of this city.

During the receipt of unemployment insurance payments, the unemployment insurance fund paid basic health insurance payments to it under the provisions and enjoyed the corresponding basic health insurance treatment.

Article 43

Access to the mandatory retirement age, in accordance with the State's provisions for persons who are not subject to retirement proceedings and for the extension of the work period, is carried out in accordance with the basic health insurance provisions of the current employee; after the retirement process, the basic health insurance provisions of the same age pension have been implemented.

Article 44

This approach has been implemented effective 1 December 2013. Publication No. 92 of the Supreme People's Government Order No. 92 of 20 October 2000, in accordance with the amendment of the Government of the Shanghai City of 28 March 2008