Shenzhen Academy Of Social Medical Insurance

Original Language Title: 深圳市社会医疗保险办法

Read the untranslated law here: http://www.chinalaw.gov.cn/article/fgkd/xfg/dfzfgz/201506/20150600399611.shtml

Shenzhen Academy of social medical insurance

    (August 15, 2013, Shenzhen Municipal People's Government at the fifth 91 Executive meeting September 29, 2013, Shenzhen People's Government order No. 256 issue come into effect on January 1, 2014) Chapter I General provisions article for Shenzhen City, establishing and perfecting the social medical insurance system, guarantee the basic medical needs of the insured, in accordance with the People's Republic of China and the relevant provisions of the Social Security Act, combined with the city's actual, these measures are formulated.

Second city into the levels and forms of social medical insurance system.

Government establishing the basic medical insurance and supplementary medical insurance.

    According to payment and the corresponding treatment of basic medical insurance is divided into one, two and three spans in three forms.

    This article, all employers, workers and other persons should be in accordance with the regulations to participate in social medical insurance.

    Fourth article of the urban social medical insurance system should follow the wide coverage, basic, sustainable, equitable and efficiency combined, rights and obligations, the level of protection commensurate with the level of development of social productive forces of the principle.

Fifth of municipal, social health insurance, Social Security Administration Department in charge of the work, social insurance agency (hereinafter referred to as municipal social security institutions) specifically in the social medical insurance work.

    Municipal authorities, within the scope of their respective duties, responsible for work related to social health insurance.

    Sixth municipal government, according to social medical insurance expenditure and revenue, the payment standard, the allocation of funds and personal accounts, salary and pay standards accordingly.

    Chapter II the insurance and the payment The seventh the employing units and employees should pay the social insurance premiums.

    An employing unit shall be the household employee's basic medical insurance for their basic medical insurance for non-household workers in this city, the second document, choose one of three forms of participation.

Article eighth staff participating in basic medical insurance according to the following provisions:

(A) the household 18 years of non-working age population, primary and middle schools and kindergartens in the city record and his party is participating in the city's social security and non-residence in this city of more than 1 year of age children, full-time regular institutions of higher education in this city (including private schools) or research institutes to participate in full-time students receive a general education in the basic medical insurance in second gear;

(B) before reaching the statutory retirement age has the city residence and non-working residents 18 years of age, may participate in the basic medical insurance for first gear or second gear;

(C) upon reaching the statutory retirement age who live in households in the city and there are no monthly old-age insurance benefits or pensions of officers may apply for participating in basic medical insurance document;

(D), residence, enjoy the benefits of minimum living guarantee of the basic medical insurance for non-working residents to participate in first gear;

(E) residence in this city to four disabled people participating in basic medical insurance document;

(F) the participation of unemployed in receipt of unemployment insurance benefits during the second gear of basic medical insurance;

(G) monthly in the city employees ' pension insurance or pensions of persons according to the provisions of the present article 14th, 15th, and participating in basic medical insurance or second gear;

    (VIII) reaches the statutory retirement age and persons continue to pay pension premiums in this city, you can choose to participate in the basic medical insurance for first gear or second gear. The Nineth grade of the employee's basic medical insurance in my salary the months 8% the standard monthly fee, which the employer to pay the 6%, personal payment 2%.

My monthly annual monthly average wage of fully employed staff on the payroll over the city of 300%, this city last month 300% payment of the average wage of fully employed staff; monthly salaries of less than 60% of the last year's average monthly wage of fully employed staff and, last year, this month 60% payment of the average wage of fully employed staff.

Basic medical insurance for workers to participate in second gear, 0.7%, last year's average monthly wage of fully employed staff, the monthly fee, which the employer to pay the 0.5%, personal payment 0.2%.

Employee's basic medical insurance in third gear, 0.5%, last year's average monthly wage of fully employed staff, the monthly fee, which the employer to pay the 0.4%, personal payment 0.1%.

    Individual employees pay part of the withholding by the employer. The tenth article eighth of this approach (a) provision of staff, by himself or family to 0.7%, last year's average monthly wage of fully employed staff, this monthly fee. Students, supervised by the educational and research institutes in September each year to the municipal social security institutions or kindergartens through the integration of the insurance formalities, a one-time payment in September of that year to next August's basic medical insurance premiums.

    18 years of age, household registration, the non-working residents insured formalities apply to the domicile of the subdistrict office.

11th article eighth of this approach (b) provision of staff, monthly fee by himself in accordance with the following provisions:

(A) participating in basic medical insurance document, last year's average monthly wage of fully employed staff in the city choose between 40% to 300% base, one male age of 60, women 50 years of age, by a 8% payment contribution base; males over the age of 60, women over the age of 50, at 11.5% of the base fee;

(B) participating in basic medical insurance in second gear, and, last year, this month 0.7% payment of the average wage of fully employed staff.

Article eighth of this approach (c) provision of staff, apply for the grade of basic medical insurance, by himself to 11.5%, last year's average monthly wage of fully employed staff, this monthly fee.

    Article eighth of this approach (b), (c) provided by me to the domicile of the person's social insurance agency to apply individual insurance procedures.

    12th article of the way to the eighth paragraph (d) and (e) provision of staff, respectively, by the Home Department, CDPF sectors through the integration of the insurance formalities and payment of health insurance premiums for it, and the specific measures shall be separately formulated by the municipal government.

    The 13th article of the article eighth section (vi) persons as stipulated by the municipal social security institutions in the city of 0.7% in the previous year's average monthly wage of fully employed staff for their monthly fee, expenses paid from the unemployment insurance fund.

14th article of the way to the eighth paragraph (VII) provision of personnel, the basic medical insurance payment period and the actual period of contributions to achieve the following provisions, you can stop payment and continue to enjoy basic health insurance benefits:

(A) in 2014 for the monthly old-age insurance benefits procedures who accumulated payment age limit of 15 years, which, actually, this period of contributions for 10 years;

(Ii) in 2015 for the monthly old-age insurance benefits procedures who accumulated payment age limit of 16 years, actual payment years in this city for 11 years;

(C) 2016 monthly old-age insurance benefits procedures who, 17 years ' cumulative period of contributions, of which actual payment age limit of 12 years in the city;

(Iv) 2017 monthly old-age insurance benefits procedures who accumulated payment age limit of 18 years, including actual period of contributions for 13 years in this city;

(V) 2018 monthly old-age insurance benefits procedures who accumulated payment age limit of 19 years, of which actual payment age limit of 14 years in this city;

(Vi) 2019 monthly old-age insurance benefits procedures who accumulated 20 years ' period of contributions, the city's actual payment age limit of 15 years;

(VII) 2020 monthly old-age insurance benefits procedures who accumulated payment age limit of 21 years, the city's actual payment age limit of 15 years;

(VIII) 2021 monthly old-age insurance benefits procedures who accumulated payment age limit of 22 years, the city's actual payment age limit of 15 years;

(IX) 2022 monthly old-age insurance benefits procedures who accumulated payment age limit of 23 years, the city's actual payment age limit of 15 years;

(J) 2023 monthly old-age insurance benefits procedures who accumulated period of contributions for 24 years, the city's actual payment age limit of 15 years;

(11) in 2024 and beyond for the monthly old-age insurance benefits procedures who accumulated payment age limit of 25 years, actual payment age limit of 15 years in the city. Article eighth of this approach (VII) provision of staff, less than duration of payment prescribed in the preceding paragraph, may be I continue to pay until after the prescribed number, stopped payment and continue to enjoy basic medical care insurance benefits.

Opt for the basic medical insurance, according to the basic pension or retirement 11.5% monthly fee; choose to attend a second gear of basic medical insurance, according to the city of 0.7% in the previous year's average monthly wage of fully employed staff are paid a monthly fee.

    Article eighth of this approach in part (a) of persons to participate in medical insurance period is not included in this article's actual contribution and cumulative calculation of the period of contributions; according to the state-mandated health insurance relationship transfer and renewal measures, external medical insurance payment, transfer the cumulative toll of years of life into this section.

15th article of the way article 14th stop payment and continue to enjoy basic medical insurance treatment of personnel participating in basic medical insurance, basic medical insurance for a 15 years enjoying a treatment, less than 15 years of basic medical insurance treatment of second gear. Preceding paragraph, personnel participating in basic medical insurance of less than 15 years may apply by himself to continue participating in basic medical insurance to 15 covered by basic medical insurance after a treatment. After examination and approval by the municipal social security institutions, whose medical insurance no longer changes.

    Continue to pay staff interrupt the payment period, without access to health insurance benefits. 16th article of the way to the eighth paragraph (VIII) provision of staff, according to the relevant provisions of the staff pay and enjoy the treatment.

    Participating in basic medical insurance contribution base established in accordance with its pension contribution base; contribution base below the city 60% of the last year's average monthly wage of fully employed staff and 60%, last year's average monthly wage of fully employed staff, the contribution base. 17th personnel participating in basic medical insurance while participating in supplementary health insurance.

Personnel participating in basic medical insurance according to the 0.2% of the base monthly fee; personnel participating in basic medical insurance in second gear, the contribution base 0.1% monthly fee; personnel participating in basic medical insurance in third gear according to the 0.05% of the base monthly fee.

    Incumbent local supplementary medical insurance premiums paid by the employer on a monthly basis, others according to their basic medical insurance payment channels and payment methods implementation.

    18th in accordance with State regulations in other areas to participate in urban workers ' medical insurance, medical insurance for urban residents, or of new-style rural cooperative medical care, social health insurance, not at the same time to participate in this city, shall not be the enjoyment of social medical insurance benefits. 19th the employer and individual payment officer shall, in accordance with relevant provisions of the social insurance registration, registration, annual review, modification and cancellation procedures.
Municipal market supervision and administration, civil affairs departments, agencies, and authorities shall promptly inform the municipal social security institutions the employer set up, change and termination; city public security authorities shall promptly inform the municipal social security institutions insured household registration, transfer, cancellation, etc.

    Article 20th social medical insurance premium by the insured or the insured's Bank on a monthly basis after the collection, transfer, social insurance fund of the social insurance institutions to open bank accounts.

21st insurance unit in this way for employees to participate in forms of basic medical insurance, medical insurance year shall not be changed.

Different forms of insurance years of basic medical insurance the consolidation.  

    Original medical insurance insured years equated to one of basic medical insurance insurance life original medical insurance insured period assimilated to a second gear of basic medical insurance insurance life original peasant laborer medical insurance insurance life insurance with the basic medical insurance for three years.

    Chapter funds management

22nd the insurance unit and the basic medical insurance premiums paid by insured persons access to basic medical insurance fund.

The basic medical insurance fund formed by pooling Fund and individual accounts, funds by the catastrophic Fund, community clinic funds and composition adjustment funds. Insurance and supplementary medical insurance premiums payable by the insured to enter local supplementary medical insurance fund.

    Supplementary medical insurance does not have a personal account.

    23rd insured medical expenses belong to basic medical insurance drug list, treatment programs and health care services within the scope of the standard (hereinafter referred to as the basic medical costs) paid by the basic medical insurance fund in accordance with this regulation; belongs to the scope of supplementary medical insurance payment (hereinafter referred to as local supplementary medical expenses) by local supplementary medical insurance payable under these regulations.

    24th two lines of income and expenditure management of medical insurance fund, included in the financial accounts of the health insurance fund, separate accounts, earmarking may not be diverted and transfers.

25th medical insurance fund management fixed income, balance of payments, the principle of balance slightly. Health insurance fund due to disease outbreaks, severe natural disasters or other exceptional circumstances is not sufficient use or due to any other reasons to pay is low, the financial subsidies.

    Finance for eligible children in the city, students and household non-working residents to have health insurance, the City provided with appropriate subsidies.

26th medical insurance fund sources for the article:

(A) health insurance premiums and interest thereon;

(B) the medical insurance premium surcharge;

(C) the lawful operation of the health insurance fund benefits;

(D) Government subsidies;

    (E) other income.

    27th the employer and medical insurance premiums payable by the individual in accordance with law as pre-tax expenditures.

    28th of an insured person's individual account balance calculated according to the relevant regulations of the State interest and the personal accounts.

29th of municipal social security institutions established for the basic medical insurance the insured individual accounts, mainly used to cover medical expenses, as follows:

(A) the insured payment under the 8% of basic medical insurance premiums, according to 5% monthly base pay into personal accounts; one over the age of 45, according to 5.6% monthly base pay into personal accounts;

(B) the insured payment under the 11.5% of basic medical insurance premiums, according to 8.05% of base pay to personal accounts; one-time payment of health insurance premiums, which shall be assigned to the individual account of the amount of the monthly to personal accounts;

(C) the insured stops payment and continue to enjoy a treatment of basic medical insurance, and, last year, the average monthly wage of fully employed staff 60% into the base, press into the base of the 8.05% monthly to personal accounts, fees paid by the catastrophic Fund.

    Basic medical insurance payment into the rest of the funds used to pay the medical expenses as provided herein. 30th city basic medical insurance levy on social security institutions in second gear and three health insurance shall be in the city 0.2% in the previous year's average monthly wage of fully employed staff into community clinic funds 1 transfers into gold, and the rest into catastrophic Fund.

Insured second stop payment and continue to enjoy basic medical insurance treatment, classified as a community clinic funds and the cost of adjustment funds, payments from the catastrophic Fund.

    Community clinic funds used to pay basic medical insurance in second gear and three insured outpatient medical expenses resulting from select CHCs; settlement adjustment funds for selected CHCs hospital transfers between basic medical expenses; catastrophic Fund for the basic medical costs and other expenses as provided herein.

31st except as provided in these procedures may continue to insured persons, in this city, when the insured person reaches the statutory retirement age old-age insurance benefits or pensions received in this city, should be transferred to the pension insurance of basic medical insurance or retirement home, ending the city's medical insurance.

Insured mobility across provinces, autonomous regions and municipalities directly under the employment, the basic medical insurance relationship transfer and renewal in accordance with the relevant provisions of the State.

Insured person in Guangdong Province, trans-regional flow of employment, the basic medical insurance relationship transfer and renewal in accordance with the relevant provisions of the Guangdong Province.

The insured individual accounts cannot be transferred, provides social insurance institutions proved that person may apply to a single account.

Insured person to settle down or loss of nationality, may apply for a single personal account balance and put an end to the city's medical insurance.  

    Death of the insured, personal account balance by his heirs to apply for lump sum and ending health insurance; one-time payment of health insurance premiums has not been included in the personal accounts of some serious illness into basic medical insurance fund.

    Fourth chapter for treatment and referral

32nd basic medical insurance of an insured person in accordance with the following medical care, access to health insurance benefits:

(A) a document of basic medical insurance insured treatment at designated medical institutions in the city;

(B) the second gear of basic medical insurance insured medical clinics in select CHCs, after clearing hospitals agree, you can select CHCs are a clearing hospital under the other designated Community Health Center clinics; hospitals and out-patient treatment at designated medical institutions in the city;

(C) three basic medical insurance insured medical clinics in select CHCs, clearing the hospital may, with the consent and select CHCs are a clearing hospital under the other designated Community Health Center clinics; outpatient treatment at designated medical institutions in the city; settlement select CHCs hospital inpatients;

    (D) in line with the other medical circumstances as provided herein. 33rd basic medical insurance in second gear, third gear of an insured person shall be designated the city a Community Center as an outpatient medical care fixed-point medical institutions.

Employers, selected by the employer without employer, selected by him.

14 second insured under basic medical insurance, you can select a Community Center or a local level II hospital as an outpatient medical care fixed-point medical institutions.

    The insured may change the selected community centres or other designated medical institutions, from the entry into force of the month after the change of community centers or outpatient medical institutions. The 34th second of basic medical insurance insured outpatient referrals, three basic medical insurance insured outpatient and inpatient medical referral, shall be agreed by the original settlement the hospital.

    Referrals should be step by step referral or referral to the specialist expertise of medical institutions at the same level in the city, out of hospitals to referral hospitals should be proof of referral.

35th insured fixed-point medical institutions of the city in this city when visiting a doctor, any of the following circumstances, can be transferred to medical institutions for treatment outside the city:

(A) prevalence species belonging to the city published by the social security administration department referral type of illness;

(B) by the municipal owned tertiary hospital, specialist, or hospital consultation still failed to diagnose difficult cases;

(C) belong to the city-owned tertiary hospital, specialist, or there is no equipment or technologies in diagnosis and treatment of critically ill patients in the hospital.

    Accepted referral of medical institutions should be transferred out of the health care institution siblings or more local health care fixed-point medical institutions of insurance.

The 36th article in accordance with the article 35th, outside, under the circumstance of the transfer of the insured to medical institutions for treatment, according to the following procedure:

(A) fill out the referral form outside the city;

(B) admitted to the clinic hospital doctor or issued by the Director;

(C) the hospital insurance institution and stamped with the seal of the hospital.

Out of designated medical institutions should be reported to the municipal social security institutions and referral information for the record.

    Transfer of the insured to point outside of medical institution in the city, rely on referral request form processing account; transferred to other medical institutions outside the city by himself after the advance payment of medical expenses incurred, to the municipal social security institutions to apply for audit expenses.

    37th insured transferred out after treatment requires referral shall be issued by the municipal medical institutions attending then referral to prove.

38th article of the city residence the insured and reaches the statutory retirement age of insured person residing outside the city, can be selected in their place of permanent residence three local health care fixed-point medical institutions as its treatment of medical institutions, and to the municipal social security institutions for the record.

Train companies insured long-term presence in this city outside the city, where the chosen three local health care fixed-point medical institutions as their doctor medical institutions, and to the municipal social security institutions for the record.

This article provides of personnel belongs to basic medical insurance a document parameter assured of, in record Sentinel medical institutions occurred of medical costs, by its I first paid Hou, to city social security institutions application audit claims; belongs to basic medical insurance II document, and three document parameter assured of, in record Sentinel medical institutions occurred of hospital medical costs, by its I first paid Hou, to city social security institutions application audit claims.

    Go through the formalities of the insured on the records of designated medical institutions for treatment is required after referral, should be determined by the medical institution proof of referral, health care costs according to the provisions of this article apply auditing expenses.

39th basic medical insurance, supplementary medical insurance funds pay for health insurance benefits in the following ways: (A) the insured medical expenses should be covered by basic medical insurance fund and local supplementary medical insurance paid part of the municipal social security institutions and designated medical institutions or appointed retail drugstores settled by agreement;
(B) the range of insured medical expenses is a personal account, by the designated medical institutions or appointed retail drugstores from the insured person's individual account in the ring; lack of personal accounts to pay, shall be paid by the insured in cash;

(C) the insured medical expenses using personal accounts by family members and by the designated medical institutions in the city from providing personal accounts of family members in the buckle;

    (D) medical expenses resulting from non-designated medical institutions in the city, by the insured after the advance payment to the municipal social security institutions to apply for reimbursement, municipal social security institutions in accordance with the means to review, eligible to be paid.

Basic medical insurance for the 40th second gear, three-shift insured outpatient medical expenses for the treatment of the following circumstances, after I had paid in advance with the relevant documents and information to the settlement the hospital or designated medical institutions to apply for review claims:

(A) after clearing hospitals agree to refer to non-settlement of hospital outpatient medical costs;

(B) work out or travel to settle non-hospital emergency outpatient medical expenses incurred;

    (C) treatment of fixed-point medical institutions of computer failures, social security card is damaged or cannot be accounted for during replacement.

41st insured in-patient medical expenses or medical insurance a insured out-patient medical expenses, the following circumstances, after I had paid in advance with the relevant documents and information to the attending medical institution for the audit claims:

(A) agreed by the hospitals, hospital outside the hospital with a medical prescription to purchase basic health insurance or a local list of supplementary health insurance within the scope of medicines;

(B) agreed by the hospitals, hospital outside the hospital for basic medical insurance or local clinics within the list of supplementary medical insurance programs;

    (C) the designated medical institutions attending computer failures or for a social security card is damaged or cannot be accounted for during replacement.

    42nd insured in addition to the measures 40th, 41st require case by advance payment of medical expenses, in line with the provisions of these measures, by virtue of the relevant documents and information to the municipal social security institutions to apply for audit expenses.

    Article 43rd insured pays in advance should be incurred or claimed within 12 months from the date of discharge, late shall not be reimbursed. 44th in designated medical institutions for treatment, the insured person shall produce my social security card.

Designated medical institutions received the insured when visiting a doctor, shall check the insured social security card, and may require the insured person to provide proof of identity.

Designated medical institutions determine social security card held by the insured for his own, response to its medical costs according to the provisions of accounting; to determine social security card holders the insured for his own, and may refuse to provide health insurance for their services.

    Of an insured person when visiting a doctor is not required to show social security card or does not indicate the insured status, require access to health insurance benefits and services, contracted medical institutions, social security institutions, and inadmissible.

    Fifth chapter of medical insurance benefits Article 45th insured to handle the insurance formalities, payment of health insurance premiums from the 1st of the next month to enjoy the medical insurance benefits as provided herein.

Insurance declared before the 20th of each month, each month the insured; monthly reporting insured after the 20th month insurance processing.

Insured, insured person interrupt payment of health insurance premiums, since interrupts payment of the 1st of the next month, stop enjoying medical insurance paid medical insurance, but may continue to use his personal account balance.

For this city household of infant handle parameter insurance procedures of, from application month began payment, and from payment of times months up enjoy medical insurance treatment; in households of day up 30 days within by infant was born proved and mother ID copies handle parameter insurance procedures of, can from its was born of months up payment, and since was born of day up by this approach about provides enjoy medical insurance treatment.

    Article tenth of these measures by the host school, research institutes or kindergarten students through the integration of the insurance formalities, child care, since September of that year to mid-August to enjoy medical insurance benefits.

Article 46th medicine, basic medical insurance diagnosis and treatment projects, services the directory in accordance with national standards and the Guangdong Province promulgated a directory.

Supplementary medical insurance project scope, list of drugs and diagnosis and treatment of large medical equipment examination and treatment, social security administration, according to the scope of the project in conjunction with the City Health Department released directories.

    Special medical materials, artificial organs, unit costs more than 1000 Yuan of disposable medical materials of scope and its inclusion in the basic medical insurance fund accounting scope maximum limit, according to social security administration released pay ceiling on the scope and implementation.

47th a insured individual account of basic medical insurance for payment of insured out-patient medical expenses, local supplementary medical expenses, appointed retail drugstores, designated medical institutions in the city, the doctor's prescription drug costs within the list of health insurance, lack of personal accounts paid in part by out-of-pocket.

Basic medical insurance a document parameter assured continuous parameter insurance full a years, in same medical insurance annual within personal since pay of outpatient basic medical costs and place added medical costs over this city Shang annual on-the-job workers average 5% of, over part by basic medical insurance big disease and manpower Fund or place added medical insurance fund by provides paid 70%, parameter assured years full 70 age above of paid 80%.

The insured enjoy the treatment prescribed in the preceding paragraph does not enjoy the treatment provided for in the 49th.

    This approaches the 50th, 51st, 52nd, 53rd, provides treatment, do not enjoy the treatment prescribed by the second paragraph of this article.

48th medical insurance the insured individual account accumulation more than the city's annual average wage of fully employed staff on 5%, the excess can be used to cover the costs:

(A) I appointed retail drugstores to buy basic health insurance and supplementary medical insurance drug list within the scope of non-prescription drug costs;

(B) himself and had participated in the basic medical insurance for spouse and immediate family members at designated medical institutions for treatment time pay basic medical expenses, local supplementary medical expenses;

(C) himself and has participated in the basic medical insurance for spouses and immediate family's health examination, vaccination costs;

    (D) country, Guangdong Province, and the City provided for other medical expenses.

49th basic medical insurance the insured's point Community Center in the city basic medical expenses and local supplementary medical expenses, 70% by his or her personal account, 30% by the basic medical insurance for catastrophic Fund, supplementary health insurance in accordance with the regulations of the Fund to pay, except for the costs of the following items:

(A) the cost of dental treatment;

(B) rehabilitation physiotherapy costs;

(C) checking of large medical equipment in treatment costs;

    (D) other project costs under the municipal government.

    50th basic medical insurance insured at designated medical institutions in the city clinic doing large-scale medical equipment examination and treatment of basic medical expenses, medical expenses, catastrophic 80% by basic medical insurance fund, supplementary health insurance in accordance with the regulations of the Fund to pay.

51st the insured has any of the following circumstances, enjoy outpatient treatment:

(A) outpatient hemodialysis of chronic renal failure;

(B) the inclusion in the scope of medical insurance to pay for anti-rejection drugs used in organ transplant clinic;

(C) the outpatient chemotherapy and interventional therapy of malignant tumors, radiotherapy or radionuclide therapy;

(D) the Hemophilia specialist outpatient treatment;

(E) specialist outpatient treatment of aplastic anemia;

(F) Eastern Mediterranean anemia, specialist outpatient treatment;

(VII) Benign intracranial tumor specialist outpatient treatment;

    (VIII) other circumstances as approved by the municipal government.

52nd insured apply to enjoy out-patient treatment of serious illness, should apply to the municipal medical institutions commissioned by the social insurance institution finds that, after examination and approval by the municipal social security institutions, disease diagnosis and illness outpatient medical records at designated medical institutions for treatment. Insured insured full time 36 consecutive months, from the date of his application to enjoy large outpatient treatment; insured for less than 36 consecutive months since the date approved by the municipal social security institutions enjoy illness outpatient treatment.

Enjoy basic medical care for outpatient treatment in the insured cost, local supplementary medical expenses, respectively, by the serious illness of basic medical insurance fund, pay local supplementary medical insurance fund in the following proportions:

(A) insured for less than 12 consecutive months, the pay scale of 60%;

(B) continuously insured time 12 months 36 months of age, pay scale of 75%;

    (C) continuously insured time less than 36 months, pay for 90%.

    53rd Senate GOP blood transfusion needs to happen due to the illness of an insurer fee, basic medical insurance insured by the catastrophic Fund 90% of basic medical insurance, basic medical insurance in second gear and three insured persons paid by the basic medical insurance fund for catastrophic 70%.

54th medical insurance in second gear, the insured third gear in the city selected community psychiatric Center outpatient treatment as follows:

(A) belongs to the class in basic medical insurance drug list drugs and class b drugs, respectively, by the community clinic funds paid by 80% and 60%;

(B) the projects fall within the list of basic medical insurance individual diagnosis and treatment or medical materials, clinic funds paid by the community 90%, the maximum payment amount is not more than 120 Yuan.

Insured's condition needs the consent of clearing hospital outpatient medical costs incurred by referral to other medical institutions, or work out, travel to settle non-hospital emergency outpatient medical expenses incurred, from community clinic funds reimbursed according to the provisions of the preceding paragraph to pay the standard 90%; other cases in the non-settlement of hospital outpatient community clinic funds shall not be reimbursed.

    Community clinic funds in a health insurance during the year to pay for basic medical insurance for every second, three insured out-patient medical expenses, the total amount shall not exceed a maximum of 1000 Yuan.

55th basic medical care for insured in-patient fee and local supplementary medical expenses, does not exceed the payment paid by the insured over payment of part of, respectively, by the serious illness of basic medical insurance funds and supplementary health insurance in accordance with the regulations of the Fund to pay. Payment in accordance with the level of hospital settings, following hospital for 100 Yuan at the local level, level-II hospital to 200 Yuan, tertiary-level hospital for 300 yuan; municipal medical institutions in accordance with the provisions referrals or record of 400 Yuan, is not in accordance with the provisions for referral or filing 1000 Yuan. Insured person transferred to a different hospital, calculate pay line.
    56th basic medical care for insured in-patient fee and local supplementary medical expenses above the pay part payment as follows:

(A) the insured person has been receiving a monthly old-age insurance benefits and payment under the 11.5% of basic medical insurance, paid for 95%;

(B) basic medical insurance the insured payment under the 8% medical premium and basic medical insurance the insured was not in the second, monthly old-age insurance benefits, pay scale of 90%; (C) three basic medical insurance insured in accordance with the regulations at the level of the city hospital, level II hospital level III hospital, city hospital for medical treatment, payout percentage, 75%, 85%, and 70%, respectively.

    Work out, travel to settle non-hospital for emergency medical expenses, according to the standards of hospital inpatient payments 90% payments.

57th insured hospital with basic medical insurance diagnosis and treatment projects within the scope of the special medical material and unit price 1000 Yuan of disposable medical materials, installation or replacement of artificial organs, coordinated by the basic medical insurance fund in accordance with the following payment, but the highest released, Social Security Administration Department, payment of an amount not exceeding the popularity of price:

(A) belong to the domestic material, according to the 90% of the actual price paid;

    (B) belongs to the imported materials, according to the 60% of the actual price paid.

Article 58th insured in-patient beds costs from catastrophic medical insurance funds pay fees according to the actual inpatient beds, but shall not exceed the following standards:

(A) one and two spans of basic medical insurance of an insured person, the maximum payment amount is determined by the municipal price control Department, which nonprofit medical bodies in general wards a-room bed in a double room guidance price of the first tranche of the Government;

    (B) three basic medical insurance the insured, the maximum payment amount is determined by the municipal price control Department, which nonprofit medical bodies in general ward b-room Triple room bed charge Government guidance price of the first tranche.

The 59th in the city receiving a monthly pension benefits or pension and continue to enjoy a treatment of an insured person to basic medical insurance, recipients of old-age insurance benefits or pension the month by local supplementary medical insurance paid 500 Yuan medical subsidy and following standard monthly payment of medical benefits, personal accounts:

(A) has not reached the age of 70, 20 Yuan a month;

    (B) reached the age of 70, 40 Yuan a month. 60th basic medical insurance and supplementary medical insurance to set pay limits.

Basic medical insurance fund in accordance with this regulation to pay basic medical costs exceed the limit part, paid for by local supplementary health insurance in the amounts paid.

    Insured at designated medical institutions in the city hospital's medical costs and local supplementary medical expenses where part of this supplementary medical insurance payment limit, supplemented by the local health insurance fund 50%.

61st annual funds of basic medical insurance medical insurance payment limits according to the insured continuously participating in basic medical insurance in accordance with the following standards:

(A) the insurance periods of less than 6 months in a row, last year a 1 time times the average wage of fully employed staff;

(B) continuously insured time less than 6 months less than 12 months, twice the annual average wage of fully employed staff on a double;

(C) continuously insured time 12 months and 24 months of age, annual average wage of staff and workers on duty on a 3 times;

(D) continuously insured time 24 months and 36 months of age, for the city last year 4 times times the average wage of fully employed staff;

(E) continuously insured time of 36 months and 72 months of age, annual average wage of staff and workers on duty on a 5 times;

    (F) continuously insured time over 72 months of age, 6 times the annual average wage of fully employed staff on a double.

62nd annual local supplementary medical insurance medical insurance payment limits, according to continuous time participating in the supplementary health insurance insured according to the following standards:

(A) the insurance periods of less than 6 months in a row, for 10,000 yuan;

(B) continuously insured time less than 6 months less than 12 months, 50,000 yuan;

(C) continuously insured time 12 months and 24 months of age, for 100,000 yuan;

(D) continuously insured time 24 months and 36 months of age, for 150,000 yuan;

(E) continuous time of 36 months and 72 months of age of insured for 200,000 yuan;

    (F) completed more than 72 months of continuous insurance for 1 million Yuan. 63rd insured according to the 52nd, 61st, 62nd calculated continuously insured time means the insured pays health insurance premiums in this city in continuous time.

Insured annual cumulative disruption in health insurance coverage does not exceed 3 months back pay after the break of continuously insured time together over 3 months, recalculation.

Insured a one-time payment of health insurance premiums, since the 1st of the next month to pay monthly insurance monthly calculation of the continuous time.

    Employer provisions in accordance with the means to participate in and to pay the payment of social insurance premiums after, late fees, pay the insured the time consolidation for continuous coverage.

    64th of an insured person in accordance with this approach provide referrals in municipal medical institutions of basic medical expenses and local supplementary medical expenses, for application via insured by the municipal social security institutions to audit actual medical expenses, reimbursements, medical fees, not higher than the standard, which is a personal account of outpatient medical costs, deducted from their personal accounts.

    65th article by this approach provides handle record of a document parameter assured in city outside medical institutions occurred of medical with and II document, and three document parameter assured in city outside medical institutions occurred of hospital medical costs, by parameter assured application, by city social security institutions on actual occurred of medical with for audit, by not above this city medical charges standard be claims, which belongs to personal account paid of outpatient medical costs, from its personal account deductions.

66th insured in accordance with this regulation to handle referrals, filing in the city outside the city designated medical institutions, foreign non-designated medical institutions in the city hospital's medical costs and local supplementary medical expenses, both as a standard 90%, 70% pay as provided herein.

    Insured person not complying with the provisions of referral of this approach, for the record, in a non-designated medical institutions in the city outpatient medical costs, medical insurance is not paid, but the range is a personal account, deductions in the personal account balance.

    67th three basic medical insurance the insured are not settled by these rules for the referral procedures to hospitals outside the city, designated medical institutions in the city hospital medical expenses, paid for by the health insurance fund in accordance with this Regulation shall be standard 90% to pay.

The 68th medical insurance forms for change of insured hospital, its health insurance hospital medical expenses according to admission forms of treatment standards.

    The insured meet the discharge standards, should be discharged from hospital to hospital, from the date it should be out of hospital medical costs incurred by himself the burden of medical insurance fund not be paid.

69th insured medical expenses incurred due to any of the following circumstances, medical insurance is not paid:

(A) these measures are in addition to the 47th, 48th article circumstances since the purchase of medicines;

(B) shall be paid from the work injury insurance and maternity insurance fund;

(C) shall be borne by the third party;

(D) shall be borne by the public health;

(E) to Hong Kong, Macao, Taiwan and abroad for medical treatment;

(F) the provisions of the Central Government, the Guangdong Province and the city not be paid by the Fund.

    Medical costs that shall be borne by the third party, third person did not pay or cannot determine the third person, insured persons according to the relevant regulations of the State, social security institutions, to apply for advance payment.

    70th insured shall source documents to apply for reimbursement of medical expenses, the voucher was reimbursed for social security institutions to not examine claims.

    The sixth chapter designated medical institutions and appointed retail drugstores

71st of municipal social security institutions on the basis of unified planning, rational distribution, convenient medical care, taking into account the needs, total control, encourage competition, as well as principles of management, information systems adapted to the capacity, through integrated assessment, negotiation, sale by tender, plus medical insurance targeted services and location based services project.

Social insurance agencies shall give priority to selecting nonprofit hospitals as designated medical institutions; non-profit medical institutions do not meet health care needs, selection by the municipal social security institutions non-profit medical institutions as designated medical institutions.

    Appointed medical institution of appointed retail drugstores and the selection criteria and procedures shall be open to the public.

72nd hospitals, clinics, community centers applied for designated medical institutions, subject to the following conditions:

(A) has a grade appropriate medical equipment and medical institutions and medical staff;

(B) to comply with Central Government, the Guangdong Province, and city health services management laws, regulations, rules and other regulations;

(C) strict implementation of the Central Government, the Guangdong Province, the city of the provisions on non-profit medical charges and drug prices, premium standard notification system;

(D) commitments in strict compliance with the relevant policies and regulations of the urban social medical insurance system, set up internal management system in conformity with medical insurance, medical insurance management with a sound organization, software and hardware equipment to fulfill the social medical insurance needs.

    Enterprise internal medical institution in accordance with the conditions set out in the preceding paragraph, the number of employees and the Organization in more than 1000 people, or you can apply to become a designated medical institutions, the unit provided medical services to the insured.

73rd retail pharmacies apply to be appointed retail drugstores, subject to the following conditions:

(A) with the drug licensing qualifications;

(B) to comply with Central Government, the Guangdong Province, and City medical services management laws, regulations, rules and regulations;

(C) strict implementation of the Central Government, the Guangdong Province, the City provided drug pricing policy;

(D) the timely supply of Medicare drugs

(E) in the retail pharmacies business hours, job services pharmaceutical technical personnel in accordance with the drug agency's requirements and regulations; (Vi) is committed to the strict implementation of the relevant policies and regulations of the urban social medical insurance system, regulate the internal management system, software and hardware equipment to fulfill the social medical insurance needs.
    74th of municipal social security institutions selected designated medical institutions and appointed retail drugstores should establish and publish a plan.

Eligibility criteria for designated medical institutions and retail pharmacies should be published in the municipal organization of social insurance plan within the specified time apply to a municipal social security institutions;, social insurance institution shall, within 60 days of its integrated assessment, and publicize the assessment results, evaluating top medical institutions and selected retail pharmacies for designated medical institutions and appointed retail drugstores.

Under the same conditions, large, strong technical force, high grade, integrity and good health care bodies may be the preferred option for designated medical institutions.

    Under the same conditions, retail pharmacies, pharmaceutical retail chain enterprises can provide 24-hour service of pharmacies, not for pharmaceutical and medical device product integrity better retail pharmacy, may be the preferred option identified as appointed retail drugstores.

75th of municipal social security institutions signed an agreement with designated medical institutions and appointed retail drugstores and managed according to the agreement.

Municipal organization of social insurance according to the contracted medical institutions and hereunder designated retail pharmacies, a credit rating every two years and publish the results.

    Municipal organization of social insurance based on the evaluation results to designated medical institutions and appointed retail drugstores and related staff incentives reward Department budget funds included in the social insurance institutions.

    76th point appointed retail drugstores and medical institutions should adhere to the "illness treatment and reasonable check, rational drug use, reasonable treatment, according to the stipulations" principle, in accordance with these regulations and agreement to provide insured services.

    Appointed medical institutions of the 77th medicine should be established separate accounting and management systems, standardizing medical behavior for profit is strictly prohibited for the purpose of billing Commission, reduce the insured pays costs as a proportion of total medical costs, reduce the financial burden on insured.

    78th medical institutions, appointed retail drugstores should establish internal management system in conformity with medical insurance and insurance agencies, self-management and self-discipline.

79th designated medical institutions and appointed retail drugstores should strictly implement the relevant Government medical fees and price regulations, and to the public.

    Designated medical institutions should provide outpatient charges to insured persons list or hospital daily fee list and other documents.

80th designated medical institutions should be retained separately insured prescription, examination and treatment of large medical equipment approval and reporting documents such as, examination and treatment, medical expense list, retained for not less than two years.

    Designated retail pharmacies should be retained separately insured to buy drugs prescription and details, and retained for not less than two years.

81st designated medical institutions provide medical services should perform basic medical insurance and supplementary medical insurance drug list, medical projects and health care facility standards regulations.

Designated medical institutions for the insured person uses other than those specified in the preceding paragraph pharmaceutical projects, medical services, medical facilities, shall be informed in advance and with the consent of the grantor.

    Designated medical institutions and other entities or individuals cooperate or contract treatment items must not be included in the scope of medical insurance billing.

82nd medical institutions with doctors who are qualified as herein provided for the insured to provide insured medical services.

    Physician loss caused by violation of the relevant provisions of the health insurance medical insurance fund, municipal social security institutions may refuse to provide health care services, the results announced to the public, inform the designated medical institutions and submitted to the municipal public health Administrative Department according to the proposal.

83rd insured using medical insurance individual account to the designated retail pharmacies to buy medicines, appointed retail drugstores verification shall, in accordance with the following provisions:

(A) the purchase of prescription drugs, verification of the valid prescription issued by a designated medical institutions in the city, and of patient prescription records and social security card match the name;

    (B) purchases of non-prescription drugs, should my social security card and verify valid prescription issued by a designated medical institutions in the city, the city, or its individual account accumulation has reached the city's annual average wage of fully employed staff of 5%.

84th designated medical institutions appointed retail drugstores and medical services to the insured medical expenses actually incurred, according to the regulations and the agreement, social security institutions, and settlement.

Municipal social security institutions and designated medical institutions, appointed retail drugstores signed agreement shall be agreed to settlement and pay standards.

    Health insurance costs to take total control of the composite payment system.

    85th of an insured person in accordance with the provisions transferred to the municipal medical institutions for treatment, which belongs to the article 35th of the present approach (b), (c), medical costs incurred by the municipal social security institutions is not higher than the city after medical fee reimbursement, and transferred out of the hospital and the city settled by agreement approach.

86th of municipal social security institutions and the designated medical institutions agreed to pay standards, as stipulated in the agreement of contracted medical institutions part of the actual costs are less than the agreed payment standard reward costs from catastrophic medical insurance funds in Liechtenstein.

    Community clinic funds balances, balances section award to settlement after the hospital, with the rest carried over to the next year.

    The seventh chapter, supervision and inspection

    87th of municipal social security institutions should establish and improve the financial system of medical insurance fund and the medical insurance fund income and expenditure to the public. 88th of social medical insurance expenditure, management and use of the Fund should be incorporated into the Municipal Commission of supervision of social insurance funds supervision.

    Municipal finance and auditing Department in accordance with the health insurance fund payments, transfer and management periodically conducts audits and audit findings to inform the Municipal Commission of supervision of social insurance funds.

    89th levels of health administrative departments, the public hospital administration contracted medical institutions supervise and administer, designated medical institutions to implement health insurance regulations included in the General objectives of the medical management of content, and goal responsibility system into its owner.

90th, price management departments deal with designated medical institutions appointed retail drugstores and the implementation of national, Guangdong Province, the city's medical service supervision and drug pricing policies.

    Pharmaceutical supervisory and administrative departments to deal with designated medical institutions and appointed retail drugstores and drug quality supervision. 91st of municipal social security institutions set up social insurance medical Advisory Committee of experts.

Social Security Advisory Committee of medical experts to carry out the following tasks:

(A) pursuant to these measures, the social security administration, for departments to formulate relevant policies to provide professional advice on medical insurance;

(B) health insurance supervision and inspection for the municipal social security institutions to provide technical guidance, supervision and inspection of medical problems by offering expert advice;

(C), social insurance institution, for the establishment of health insurance outpatient disease, provide expert advice;

(D) for insured health insurance outpatient illness recognized that the provision of expert advice;

(E) the insured disputes with designated medical institutions for admission provided expert advice to evaluate abnormal medical expenses;

(Vi) other medical insurance work commissioned by the municipal social security institutions.

    Social security medical expert Advisory Committee work included in the social insurance agency budgets.

92nd of municipal social security institutions should be insured health insurance conditions and treatment in the enjoyment of individual rights to social security records regularly sent free insured.

    Insured and the municipal social security institutions agreed to sign social security personal services Web page, fax, e-mail, SMS and other forms of access to records of individuals ' rights, municipal social security institutions without sending.

The 93rd article of any unit and individual have the right to prosecute, Sue targeted medical institution, appointed retail drugstores, insurance unit, insured persons, social security institutions, and the illegal or irregular behaviour of staff.

Report content verification, signature, social security institutions from rewarding funds awarded to prosecutors, award funding for municipal social security institutions of the Department's budget.

    Municipal social security institutions on the reporting units and the confidentiality of personal information.

94th of municipal social security institutions to designated medical institutions, appointed retail drugstores, insured, insured medical insurance acts of supervision and inspection, and employing agencies or health insurance supervisors in the supervision.

Designated medical institutions and appointed retail drugstores do not provide medical insurance information, municipal social security institutions may refuse to pay the corresponding fees.

    For checks, social security institutions may request units under inspection and paying medical insurance premiums relating to the employment, payroll, financial statements and other information, records, recordings, videos, photographs and copy to gather relevant information.

    95th insured loss of social security card, and shall promptly report to the municipal social insurance institutions; insured medical expenses incurred during the bidding for the new card by their first payment, receiving new cards with new cards and medical records and other related information according to the relevant provisions of the measures applied for reimbursement, fill the account or deducted from their personal accounts. 96th insured social security card is lost resulting in loss of medical insurance fund, municipal social security institutions may apply to the medical institution or to take recourse against the employer.

    Insured social security card is lost and the failure to report the result of their social security cards are used, resulting in loss of personal accounts by its own.

    97th insured disagrees with the definition of designated medical institutions discharge date, may apply to the municipal social security institutions found that municipal social insurance agency shall arrange for the social insurance medical experts Advisory Committee of experts, within 10 working days from date of acceptance to determine discharge date. 98th of municipal agencies find social security card with the exception of social security, to avoid medical insurance and insured losses, you can pause the accounting function of the social security card and notify the insured person to explain the situation.  

    Social security card suspended billing during medical expenses paid by the insured person, verified no contraventions of, municipal social insurance institution shall restore the social security card billing and reimbursement of medical costs incurred during the suspension as provided herein. The eighth chapter legal liability
    99th an employer does not apply for social insurance registration, by the municipal social security administration Department of a rectification; fails, the employer should pay social security fees 3 times the amount of the fine, directly responsible to the head of personnel and other persons sentenced to 3000 Yuan fines respectively.

100th an employer does not pay medical insurance premiums as provided herein, workers should know or should know, social insurance institutions, within two years from the date of the complaint or information.

The employer fails to pay medical insurance premiums as provided herein, shall be ordered by the municipal social security Administrative Department within a time limit which should be paid and to pay medical insurance premiums; fails to perform, and in default of payment of the amount of a fine equivalent.

    Employer fails to pay the social insurance premiums for more than two years as provided herein have not been found and complaints, and municipal social security administrative departments are no longer punished.

101th employer pay social insurance premiums, from the date of default of payment by the day plus five out of 10,000 late fee.

    Employer application to pay two years of health insurance or individual payment officers to pay health insurance premiums and municipal social security institutions are inadmissible.

102th employer should participate in social medical insurance and did not participate in, their employee medical costs, the employer's standards for the treatment of payments in accordance with these measures.

    Employers ' participation in social medical insurance and pay the payment of social insurance premiums after, late fees, insured new medical costs paid by the health insurance fund in accordance with the regulations.

103th designated medical institutions, designated retail pharmacies violated signed agreement with the municipal social security institutions, as stipulated in the agreement.

    Designated medical institutions and appointed retail drugstores penalty included in the basic medical insurance fund. 104th insured health insurance provisions have been contravened any of the following circumstances, social insurance institutions to suspend their social security card account 3 months causing loss of medical insurance fund, suspended billing function for 12 months.

Social security card suspended billing period, insured medical expenses in accordance with scope of medical insurance funds, can apply for reimbursement, but health insurance funds to pay half to pay for the treatment.

(A) lent a social security card for use by others;

(B) through drug pills, drugs or selling drugs get basic medical insurance funds;

    (C) medical access to funds to pay drug exceeds many times the normal dose.

    105th article medical institutions, and drug business units, medical insurance service institutions to fraud, and forged proved material or other means cheat medical insurance fund of, by city social security administrative sector ordered returned, and at cheat amount five times times of fine; belongs to medical insurance service institutions of, lifted service agreement; directly is responsible for of competent personnel and other directly responsibility personnel has practice industry qualification of, law revoked its practice industry qualification; suspected crime of, transferred judicial organ law processing.

    106th to fraud, forgery proof social health insurance or other means of treatment by the municipal social security administration processing pursuant to the 104th, ordered to return, and a fine of the amount defrauded five times; a suspected crime, transferred to the judicial organs according to law.

    107th unit or individual in violation of the provisions of credit evaluation system for dishonest behavior into the city.

    108th, social security administrations and municipal social security institutions and their staff at the social medical insurance management, oversight failed to perform their duties or does not properly carry out their duties, shall be subject to administrative liability; a suspected crime, transferred to the judicial organs according to law.   

    109th medical insurance administration, the social security administration, counterpart to the sector, specific administrative acts of the municipal social security institutions may apply for administrative reconsideration or bring an administrative lawsuit in accordance with law.

    The Nineth chapter supplementary articles

    110th enterprises may not exceed the total wages of staff and workers of 4% extraction Enterprise supplementary medical insurance premiums to cover the enterprise supplementary medical insurance benefits, expenses from the employee benefits expenses.

    111th retired personnel and one to six armymen (formerly second grade b or above disabled revolutionary servicemen), safeguard measures shall be formulated separately by the City Government.

    112th, urbanization, these personnel to joint-stock company participated as an employer health insurance and payment. 113th article participate in original pension insurance industry and manpower of standing deep units in the by Guangdong Province, and Beijing social security institutions by months paid pension insurance treatment of retired personnel, in retired Qian has participate in this city social medical insurance of, its basic medical insurance by in this city by months received pension insurance treatment personnel of provides handle; need continues to paid basic medical premium and place added medical premium of, respectively by months to this city Shang annual on-the-job workers months average of 11.5% and 0.2% paid,

    Years payable either by the original employer paid medical insurance premiums payable at once. 114th article reached statutory retired age, and not in this city received pension insurance treatment of parameter assured, should by city social security institutions provides of fingerprint collection way provides its I of fingerprint, and in yihou annual of corresponding month within city social security institutions provides once fingerprint; not on time provides of, city social security institutions since times months up stop paid medical insurance treatment; added provides fingerprint Hou, city social security institutions since provides times months up continues to paid medical insurance treatment.

Stop pay period, insured medical expenses incurred by the first payment, additional fingerprints pursuant to the relevant provisions apply for reimbursement.

Social insurance agencies shall keep fingerprint data of the insured shall not be used for other purposes.

    The insured is unable to provide fingerprints,, social insurance institutions, should be required to provide valid proof of living material.

    115th home care and elderly care medical, cancellation of health insurance after the drug add new expense items such as examination fee, into the scope of social medical insurance fund, according to the relevant provisions of the city.

    116th Social Security Administration Department may in accordance with this approach to develop medical insurance management approaches. 117th, last year's average monthly wage of fully employed staff is subject to data released by the municipal Statistics Department.

    Referred to in this way, last year's average monthly wage of fully employed staff, by the first half of the last two years of the city's average monthly wage of fully employed staff calculations, by the second half of last year the city's average monthly wage of fully employed staff calculations.

118th employer mentioned in these measures refers to organs within the administrative area of the city, institutions, social organizations, enterprises, privately-run non-enterprise unit, individual economic organizations.

Participants in these measures refers to having participated in social health insurance employer.

The insured mentioned in these measures refers to officers who have participated in social medical insurance.

    Household non-working residents of this municipality in these measures, refers to the age of 18 has not reached the statutory retirement age, that is not in school and not in the employment of the employer of the city officials, reaches the statutory retirement age but not in receipt of a monthly old-age insurance benefits the city officials and local personnel in receipt of residents of old-age insurance benefits.

    119th insured workers retired or placed in this city, served in the army during the military time or age in military medical insurance, basic medical insurance, considered the actual period of contributions.

    120th annual for the year mentioned in these measures refers to the medical insurance from July 1 to June 30 the following year.

121th before the implementation of these measures by the city's pension fund to pay health insurance premiums retirees and personnel of the one-time payment of health insurance premiums, its funding sources according to the original regulations.

In this way prior to the introduction of persons receiving monthly medical benefits, paid by the supplementary medical insurance continue to.

    Insured before implementation of the measures approved by the municipal social security institutions identified as outpatient, basic medical expenses and local supplementary medical expenses proportion of account 90% and 80%, respectively.

122th in the city before the implementation of maternity insurance, 18 years of age and has not yet reached the legal retirement age of basic medical insurance and the second gear while participating in reproductive health insurance insured in accordance with the following provisions:

(A) a document of basic medical insurance the insured, according to its basic medical insurance contribution base 0.5% monthly pay maternity medical insurance premiums;

(B) the second gear of basic medical insurance insured, according to its basic medical insurance contribution base 0.2% monthly pay maternity medical insurance premiums.

Incumbents, such as maternity medical insurance premiums paid by the employer, other people's contributions and fees respectively according to their payment to pay basic medical insurance premiums and payment methods implementation.

    Maternity health insurance insured persons of the family planning policy, prenatal, childbirth, hospital, post-natal visits, family planning surgery basic medical expenses (excluding infant fee) still original from reproductive health insurance fund, for antenatal medical expenses to provide family planning certificate date of birth health insurance fund.

    123th unemployed receive unemployment insurance benefits during interrupt handling they receive unemployment insurance compensation formalities participants not later than 30th, deemed to be the insured participate in original medical insurance forms and still enjoy the treatment. 124th article this approach since January 1, 2014 up purposes, on January 30, 2008 developed of Shenzhen social medical insurance approach (Shenzhen City Government makes 180th,) and on issued Shenzhen non-practitioners residents participate in social medical insurance added provides of notification (deep house (2008) No. 210,), and on will Shenzhen children and the students medical insurance into hospital medical insurance of notification (deep house (2010) 126th) abolition from the date of implementation of this approach.