Guangzhou, Guangzhou Municipal People's Government on the revision of the decisions of the trial procedures for basic medical insurance for urban workers
(May 14, 2012 at the 15th Guangzhou people's Government Executive Meeting July 30, 2012, the people's Government of 80th Guangzhou announced come into force on the date of promulgation) Executive meeting of the 14th session of 15 decisions of the Municipal Government of Guangzhou City basic medical insurance for urban workers pilot scheme as follows: 60th amended to read "... ... ; Delays in pay, from human resources and Social Security Department or local tax Department, from the date of default of payment, plus five out of 10,000 late fee on a daily basis; refusing to pay overdue insurance, late fees, and by human resources and Social Security Department or local tax Department, in default of payment 1 time more than three times the amount of a fine.
Refusing to pay overdue insurance, late fees, and by human resources and Social Security Department, or local tax Department, apply to a people's Court for compulsory execution. "
This decision shall come into force as of the date of.
The Guangzhou urban basic medical insurance for urban employees published modified according to this decision after a pilot scheme.
Report: trial measures for the basic medical insurance for urban workers, Guangzhou City, 2012 (revised) (July 30, 2008, people's Government of Guangzhou City (2008) 11th announced July 30, 2012, people's Government of Guangzhou City, the 80th release come into force on the date of promulgation of the Guangzhou Municipal People's Government on the modified < trial measures for the urban workers ' basic medical insurance in guangzhou > decision amended)
Chapter I General provisions
First for the protection of the urban workers ' basic medical care, establishing the basic medical insurance system, according to the People's Republic of China labor law and the relevant provisions of national and provincial, combined with the municipality, these measures are formulated.
Second approach applies to the administrative area of the city within the enterprise, individual economic organizations, institutions, government agencies, community groups, private non-enterprise units (hereinafter referred to as the employer) and its employees and retirees (hereafter referred to as insured persons). Article III implementation of territorial management of basic medical insurance.
Across regions, greater mobility of employers and workers, should be relatively concentrated way to participate in the plan area of the basic medical insurance.
Article IV, productivity, level of basic medical insurance and the development level and financial bodies, employers and individual affordability; basic medical insurance premium should be borne by both the employer and employee sides; the basic medical insurance fund combines social pool and personal medical care account and gradually form a multi-level medical security system. Fifth of municipal human resources and Social Security Department in charge of the urban basic medical insurance, responsible for organization and implementation of the measures.
District, county-level cities human resource and Social Security Department responsible for ex officio in medical insurance management and services.
Human resources and Social Security Department of the social insurance agency for Medicare services.
Financial, tax, pricing, health, food and drug administration, business, audit, civil affairs, education, trade unions and other organizations, and shall coordinate the implementation of these measures in accordance with their respective responsibilities.
Chapter II medical insurance premium collection Sixth employing unit shall, in accordance with the provisions of the Department of human resources and social security, social insurance institutions to the specified registration procedures for basic medical insurance.
New employing unit shall be established within 30th of registration procedures for basic medical insurance.
The employer terminate or change of registered particulars of basic medical insurance shall be from the date of termination or change in the 30th, for cancellation or change of the registration to the original registration authorities.
Article seventh employee and the employing unit shall pay on a monthly basic medical insurance premiums. Workers on the base for my annual declaration of personal income tax wage and salary income average number; new workers ' base pay to social security monthly individual income tax declaration, wage and salary income. Personal income tax wage and salary incomes average more than 300% employees ' average monthly wage in the city last year, the portion not included in base pay; less than 60% employees ' average monthly wage in the city last year, above the annual employees ' monthly salaries in the city 60% of the base.
Employer's contribution base for the employee base and.
Employees shall be paid according to their base pay of 2% basic medical insurance premiums, the employer shall be paid according to their base pay of 8% basic medical insurance premiums. Eighth insurance personnel to be retired when actual payment years of basic medical insurance (hereinafter referred to as payment years) over 10 years, retired before they can enjoy basic medical insurance benefits. Period of contributions of less than 10 years, shall be paid a one-time insufficient length (in months) the transitional basic medical insurance (hereinafter referred to as the transition of gold) and pay a one-off is really difficult, and approved by the Municipal Department of human resources and social security can pay by the month.
Transition on the gold standard of payment for year 7 of the employees ' monthly salaries in the city 5%.
Employer shall be insured in the unit's work during the years of not participating in basic medical insurance paid for his one-time transition payment is insufficient payment years section by himself a one-time payment, and collect payment by the employer.
Demobilized or by human resources and social security administrative departments into this city the employees of the employer in the region, their previous work experience, first transferred by the employer recognized that age in a row, and to pay them in accordance with the provisions of the preceding paragraph transition payments.
Nineth employer and 50 years of age, male workers, female workers over the age of 40 when the rescission or termination of labor relations and its workers reached over to rescission or termination of labor relations during the years of not participating in basic medical insurance, the employing unit shall, according to its actual length of one meter in the unit to pay transition payment, calculate the payment years of participating in basic medical insurance. Tenth Article social bid retired of personnel insufficient payment years should paid of transition gold, deduction units meter paid, and meter sent part Hou of remaining part, by following standard enjoy levels Government established of special funds funding: December 1, 2001 Qian pension insurance payment years (containing depending on with pension insurance payment years, with) full 25 years of, by Government special funds full funding paid; full 20 years discontent 25 years of, by Government special funds funding paid 50%, I paid 50%; discontent 20 years of,
The transition all paid by me.
With urban residence, over the age of 50 men and women over 40 years of reemployment of unemployed workers in the new units when they retire and shall be paid by the individual gold special funds established by the people's Governments at all levels in the light of transition funding paid in the preceding paragraph. 11th the employer shall pay the basic medical insurance premiums and transition payments, in accordance with the provisions of the taxation Department expenditures.
Proportion of employees in accordance with the regulations of basic medical insurance premiums paid, deducted from the taxable income from the personal income tax. 12th the employer shall pay the basic medical insurance premiums and transition payments, unified tax is imposed by the Department, over to the social security fund accounts in a timely manner.
Social insurance agencies doing collection work.
Employee basic medical insurance premiums shall be paid, on a monthly basis by the employer withheld from their wages paid.
Pay basic medical insurance premiums and transition payments, once paid, is not refundable.
13th basic medical insurance payment rate adjustment proposed by human resources and social security authorities and the financial sector, upon approval by the provincial and municipal people's Government, published by the municipal government.
14th annual personal income tax on the employer shall faithfully report the wages, number of monthly salaries, social insurance agencies approved pursuant to the provisions of basic health insurance contribution base.
15th an employer legally transfer, separation, merger, closure, insolvency, it shall be debts due to pay basic medical insurance, transition payments, interest and late fees.
Chapter III solidarity fund and an individual medical account
16th paid by employer and employee basic medical insurance premiums and the transition period payments, established by the social insurance agency co-ordinating funds and personal medical accounts, according to the Commission account payment accounted for separately, not crowding out each other.
Employers or individuals to pay transition payment, and financed by the Special Fund set up by the people's Governments at all levels pay the transition of gold, according to the number of retirees who enjoy medical insurance benefits for the month, above the annual employees ' monthly salaries in the city 7 of 75% as a standard, monthly use.
17th year funds consists of the following components:
(A) basic medical insurance premiums paid by employers and the transfer of transition payments according to the provisions included in the personal medical accounts part of the excepted.
(B) solidarity fund balances and interest rates.
(C) the prescribed charge late fees.
(D) Government grants.
(E) legal income.
Article 18th insured persons an individual medical account consists of the following components:
(A) all employees personal.
(B) the transition from basic medical insurance premiums paid by employer and King, as stipulated in the article 19th of this approach into parts.
(C) personal medical account of interest and other lawful sources of income.
Article 19th individual medical accounts into the Base: workers this year's basic medical insurance month base pay, retirees for the employees ' average monthly wage in the city last year.
From the employing unit to pay basic medical insurance premiums and when the transition period payments, monthly into the proportion of personal medical accounts for:
(A) under 35 years of age was 1%.
(B) the age of 35 to 45 years of age 2%.
(C) before retiring aged 45 to 2 8%.
(D) the retiree was 5 1%.
Article 20th individual medical account of principal and interest to cover basic medical expenses may be carried forward for use, not cash or diverted to any other use.
After the death of insured person, personal health account balance into his successor's personal medical accounts heirs not participating in basic medical insurance, personal health account balance can be paid to heirs without heirs, personal medical account balances included in the basic medical insurance fund.
Stored balance at the end of the article 21st individual medical account interest calculation and interest rates, in accordance with the State Council decision on establishing the basic medical insurance system for urban employees of the relevant provisions.
Social insurance agencies shall provide the insured person and related Bank access to personal medical account fund balance of convenience.
Fourth chapter medical insurance payments and settlements 22nd the employer and its employees according to the provisions of the basic medical insurance and payment in full and on time, insured persons can enjoy basic medical insurance treatment next month.
After the termination of the insurance relationship, stop payment next month, stop to enjoy basic medical insurance treatment, but personal health account balance you can continue to use. Employing units and parameter insurance personnel not on time paid medical premium (following referred to owes payment) of, in owes payment times months up, parameter insurance personnel temporarily not enjoy basic medical insurance treatment; in 3 months within fill paid owes paid costs, and interest and late fees of, can fill pay extension payment during should by and manpower Fund paid of medical costs, cumulative parameter insurance personnel payment years and will corresponding amount fill designated into personal medical account; in 3 months Hou fill paid owes paid costs, and interest and late fees of, cumulative parameter insurance personnel payment years and fill allocated personal medical account,
Don't pay basic medical insurance treatment during the insured person for medical costs incurred by the employer is responsible.
Article 23rd medical insurance to pay the medical expenses of insured persons shall meet the basic medical insurance treatment, diagnosis and treatment project scope, standard and scope of medical services and payment provisions of basic health insurance.
Medication, basic medical insurance diagnosis and treatment projects, health care services and payment according to the national, the provincial provisions announced separately.
Municipal human resources and Social Security Department in accordance with the level of economic development and adjust the basic medical insurance treatment projects, medical services, medical facilities and manpower Fund, submitted to the municipal people's Government for approval before implementation.
24th funds prorated payment criteria above, the maximum the following inpatient, outpatient medical costs for a particular project and to specify the fee for basic medical care for chronic diseases.
Personal health accounts to pay basic medical expenses of the following:
(A) out-patient fee for basic medical care for common diseases, emergency treatment.
(B) inpatient, outpatient and specified chronic diseases as well as specific projects in medical costs and fees shall be borne by the individual.
(C) issue prescriptions to the appointed retail drugstores, or purchase non-prescription drug costs.
(D) other costs specified in national and provincial medical insurance policy.
25th clinic specific project scope includes the following:
(A) in the second designated medical institutions under observation at the hospital emergency room for treatment.
(B) in the first and second designated medical institutions or designated community health service institutions to offer home care treatment.
(C) suffering from malignant tumors in the specified designated medical institutions for outpatient chemotherapy, radiotherapy and during secondary treatment, suffering from uremia at designated medical institutions for outpatient dialysis treatment.
(Iv) where the designated medical institutions after Renal Transplantation surgery, continue to specify fixed-point medical institutions of anti-rejection treatment clinic.
(E) the appointed medical institutions of haemophilia in the three-tier comprehensive outpatient treatment.
(F) in accordance with the provisions article 30th additional illness or treatment programs.
Article 26th each hospital stay of insured funds to pay basic medical expenses and manpower standards (hereinafter referred to as standard), according to the following criteria:
(A) workers: level medical institutions to 500 Yuan; second-level medical institutions for 1000; third level medical institutions to 2000 Yuan.
(B) retirees: level medical institutions to 350; secondary medical institutions for 700 Yuan; third level medical institutions to L400.
Persons insured hospital designation of single disease, project standard, formulated by the Municipal Department of human resources and social security, the financial sector separately and published.
27th out particular projects standard of pay basic medical expenses, according to the following criteria:
(A) the standard of pay Emergency Department observation at the hospital, according to the incumbents in the three-level medical institutions pay standards in the hospital, each insurance year 1.
(B) the standard of paid home care by the insured person in a hospital-level medical institutions to pay standard per 90 days 1.
(Iii) other clinics without a specific project funds to pay basic medical expenses and manpower standard.
28th persons insured inpatient and outpatient project-specific standards more than basic medical expenses, paid funds according to the following proportions:
(A) workers: level-90%; level II hospital of 85%; tertiary hospital for 80%.
(B) retirees: level-93%; level II hospital for 89 5%; tertiary hospital for 86%.
Standard of paid home care more than basic medical expenses, funds by the insured person in a hospital-level medical institutions to pay scale.
29th in every social insurance during the year, the basic medical insurance fund insured persons inpatient, outpatient and specified chronic diseases to a particular item of basic medical expenses, on the cumulative ceiling of annual units 4 times times the average wage of workers in the city.
Article 30th overall Fund of hospitalization specified single disease, outpatient or project specific project and specify a range of chronic diseases, standards and practices, the municipal human resources and social security authorities and the financial sector, the health sector shall be formulated and announced to the public.
Insured inpatient and outpatient specific basic starting pay for medical costs of project standards and the proportion of total pay adjustments by the municipal human resources and social security authorities and the financial sector based on medical insurance balance of payments situation, submitted to the municipal people's Government for approval before implementation.
31st under any of the following circumstances, the medical costs incurred by the insured person for medical treatment, medical insurance is not paid:
(A) suicide, self-mutilation (mental illness);
(B) assault, alcohol abuse, drug abuse and injury due to crime or security violations;
(C) traffic accidents, accidents, medical malpractice, clearly part of the liability for medical expenses borne by others;
(D) unauthorized non-designated medical institution or non-designated retail pharmacies to buy drugs and pharmacy;
(E) in foreign countries or Hong Kong, Macau S.A.R., and Taiwan for treatment;
(Vi) belongs to the scope of work-related injury insurance and maternity insurance payment;
(G) not be paid in accordance with the relevant provisions of the case.
32nd insurance medical treatment or drugs and pharmacy, which meet the requirements of the basic medical insurance of medical expenses, settlement in accordance with the following provisions: (A) belonging to the Solidarity Fund paid for by the designated medical institutions or appointed retail drugstores according to standard accounting.
Designated medical institutions, appointed retail drugstores and clearing banks are part of our integrated fund accounting medical costs from insured persons and individual medical savings account deduction of medical expenses, monthly to specify the social insurance agency to declare the settlement. (B) personal health account funding to pay, by the designated medical institution or appointed retail drugstores from the insured person's personal medical accounts button.
Personal medical accounts paid in part by himself pays.
Article 33rd insured persons in the territory of relocation or hospitalized during the study, remote work, and domestic business trip or to visit relatives, travel during emergency medical treatment, local medical institutions belonging to the city funds to pay medical expenses, be reimbursed by the social insurance agencies in complying with the provisions.
Insured persons off-site medical approach by human resources and Social Security Department separately and published.
Article 34th social insurance agency shall, in accordance with municipal human resources and Social Security Department of the relevant standards settled by payment and fixed-point medical institutions of the following costs:
(A) ordinary door (emergency) diagnosis and basic medical expenses part out a specific project, service billing.
(B) the general basic medical costs of diseases, passengers on an annual basis or average bed-day cost of fixed clearing or settlement services means.
(C) specified chronic diseases and some out-patient basic medical costs for specific items, services and monthly maximum payment limit methods of clearing.
(D) Home Basic medical expenses, by service or by date (month) average fixed cost settlement.
(E) medical expenses some items of specified diseases or treatments, years (months) number of fixed or periodic average cost amount settled.
(Vi) other payment methods.
Fifth chapter, medical treatment and health care services management 35th Health Department or the food and Drug Administration issued a valid license to practice medical institutions and retail pharmacy, approved by the military authorities and eligible foreign service military medical institutions, can be submitted to the municipal human resources and Social Security Department application for location based services provide basic medical insurance by the municipal human resources and Social Security Department validated its qualifications.
Meeting the qualifications of appointed, with the social insurance agency signed a service agreement which determined the basic medical insurance for medical institutions, appointed retail drugstores, announced to the public by the municipal human resources and Social Security Department.
Special kinds of diseases, medical subjects basic medical services, and pharmacy, medical institution or retail pharmacy, the municipal human resources and Social Security Department in obtaining medical insurance appointed eligible institutions within and handled by social security departments enter into supplementary agreements.
According to the level of economic and social development, medical savings insurance, medical price adjustments and the actual cost of medical services, timely adjustment and settlement standards of medical institutions.
Article 36th insured person to a medical institution or to the designated retail pharmacies to buy drugs and pharmacy shall produce proof of valid health insurance; in front of the present a valid medical certificate, medical care, drugs and dispensing all the expenses incurred by the insured persons themselves.
Emergency admission or due to coma, confusion, etc cannot be produced on the spot, shall go through the relevant procedures within the 3rd admission.
Due to an insured person in a coma, unable to present, family members or other accompanying persons shall cooperate with the relevant formalities.
37th article Sentinel medical institutions, and Sentinel retail pharmacy should strictly implementation national, and province, and City provides of price policy and standard, implementation basic medical insurance system of about provides, established and basic medical insurance management phase adapted of internal management system, specified institutions and necessary of personnel, is responsible for basic medical insurance service management of specific work, accurate provides parameter insurance personnel medical and medical costs, about information.
Article 38th municipal departments concerned in accordance with their respective functions and to strengthen the designated medical institutions and the management of appointed retail drugstores provide insured medical services.
The sixth chapter medical insurance for urban workers
39th article this city in implemented basic medical insurance of based Shang, established major disease medical grants system, implemented civil servants medical grants approach and injury, and birth medical management approach, established town workers added medical insurance system, encourages employing units and personal established mutual medical guarantees system, participate in commercial medical insurance, implemented social medical rescue, meet different medical consumption level and different economic bear capacity of employing units and workers of more level medical guarantees needs. 40th article of major diseases on Medicaid.
Insured persons participating in basic medical insurance to participate in major diseases on the basis of Medicaid.
Employers shall per person per month for its insured persons according to the employees ' monthly salaries in the city for the last year of 0 26% pay significant medical benefits.
For the enjoyment of specific government funding or if a transition payment unit paid by insured persons, the Government special funds or employer should be funded major medical benefits paid or in the corresponding period. During the period of receiving unemployment insurance benefits the unemployed participating in basic medical insurance and medical benefits shall be paid according to the required standard major diseases and withholding pay from the unemployment insurance payments.
However, unemployed persons expressly does not agree to withhold payment of the excluded.
41st basic medical costs incurred by insured persons, annual accumulated more than after the payment ceiling on basic medical insurance fund, paid for by the major medical benefits in accordance with the following standards:
(A) in-patient treatment and out-project-specific basic medical expenses, paid by the major medical benefits according to 95% standard.
(B) the specified chronic disease outpatient medical expenses from major medical benefits according to the criteria set forth in the corresponding payment.
During the year under a social insurance, major medical benefits for cumulative insured persons inpatient and outpatient project-specific basic medical costs specified chronic diseases and outpatient medical costs a maximum of 150,000 yuan.
Participating in basic medical insurance should be supplementary health insurance premium paid by retirees from the major medical benefit expenditures.
Major medical benefit payment rate adjustment of the scope and standard of treatment, payment by the municipal human resources and social security authorities and the financial sector based on medical insurance balance of payments situation, submitted to the municipal people's Government for approval before implementation. 42nd to establish supplementary medical insurance system for urban employees.
Employers and their employees in the basic medical insurance and critical illness based on Medicaid, can participate in supplementary health insurance.
Enterprises and other economic organizations, be free to establish supplementary medical insurance, supplementary health insurance schemes should be submitted to the municipal human resources and Social Security Department. Enterprise or from the institution to pay the supplementary medical insurance premiums and expenses for their own supplementary health insurance systems, in annual salary within 4% of the parts on this unit, according to the relevant provisions of the financial expenses financial nuclear repair institutions of supplementary health insurance funds in annual salary is less than 4% parts on this unit, social security costs incurred in operating expenditure or expenditures.
Financial and tax provisions, as stipulated in the tax in calculating the corporate income tax as a tax adjustment.
Other sources of supplementary medical insurance funds paid by the unit reference implementation.
Article 43rd, socio-medical, development and perfection of the system, the departments concerned should take steps to, raise money, solve the medical problems of the urban poor.
Meet this city town residents family minimum life guarantees standard of personnel, no life source of personnel, no labor capacity of personnel, cannot set maintenance, and raised people or statutory maintenance, and raised people no maintenance, and dependency capacity of personnel, and special care and object, according to national, and province, and City medical guarantees of about provides, enjoy corresponding of medical rescue and medical grants, medical funding by corresponding channel solution.
44th after an employer participating in basic medical insurance, should continue to undertake medical examination of workers, women workers ' health, public health, prevention, protection, family health insurance and other basic medical insurance health care responsibilities and obligations.
Article 45th insured illness treatment personal burden, the employer shall adopt other security measures to help solve.
The seventh chapter of medical insurance management and supervision
46th article human resources and social security sector is responsible for implementation medical insurance of legal, and regulations and about provides; organization implementation medical insurance system; research developed medical insurance of policy, and development planning and about standard; guide social insurance handling institutions of work; audit social insurance handling institutions prepared of medical insurance pre, and accounts; supervision check medical premium of levy paid and medical insurance of paid; supervision check Sentinel medical institutions, and Sentinel retail pharmacy implementation basic medical insurance provides of situation.
47th social insurance agency shall have the following responsibilities:
(A) handle the urban basic medical insurance and supplementary medical insurance and other social security services.
(B) the medical insurance payment, management and audit.
(C) health insurance budget and final account, review pay health insurance fees.
(D) the establishment and management of basic medical insurance individual medical accounts.
(E) signed with designated medical institutions, appointed retail drugstores health care agreement.
(Vi) assist human resources and Social Security Department to designated medical institutions, appointed retail drugstores for basic medical insurance policy, regulation and service agreements for guidance, oversight, inspection and examination, assessment is poor or breach of contract, breach of medical institutions, according to the relevant provisions of the health insurance and services agreement, the Parties shall be given.
(VII) insurance announced to the public on a regular basis in the designated medical institutions, of appointed retail drugstores and medical and drug costs in General.
(H) the health insurance budget and statistical analysis of medical expenses of insured.
(IX) providing medical insurance to employers and insured persons inquiries, consulting services.
(10) other functions stipulated in national, provincial and municipal.
48th medical insurance raising unified, unified management and use.
Medical insurance into the social security fund account, separate accounts, carrying out two lines of income and expenditure management, earmarks, no unit or individual shall not be misappropriated.
Social insurance agency requirements settled by the budget shall not be extracted from Medicare.
49th banks interest-bearing provisions for medical insurance, Medicare taxes, for free.
50th Finance Department responsible for medical insurance-related financial and accounting management system development and supervision, responsible for Medicare payments financial account accounting and auditing budget and final account prepared by the social insurance agency and paid on time required to account for health insurance funds and the social insurance agency funding.
51st auditing Department shall administer its Medicare paid, and balances and accounts paid, and the balance of the social security fund supervision through auditing.
Other provisions of the eighth chapter 52nd established basic medical insurance system for urban residents.
This urban minors, non-working urban residents and meet the State retirement age cannot be in receipt of a monthly pension or employer pension town residents crowd into the scope of the basic medical insurance for urban residents.
53rd article about town residents basic medical insurance, and non-this city town household practitioners medical insurance, and added medical insurance, and civil servants medical grants and the University, and medium vocational school, and mechanic school full-time students of medical guarantees, and Sentinel medical institutions and Sentinel retail pharmacy management, specific approach, and medical costs settlement way and the about standard, by city human resources and social security sector with about sector common developed, reported City Government approved Hou implementation.
54th article has this city town household, male years full 60 age, female years full 55 age, cannot by months received basic pension or employing units pension of personnel, participate in town workers basic medical insurance payment years full 10 years of, enjoy retired personnel of basic medical insurance treatment; insufficient 10 years of, can by this approach provides of standard, one-time paid transition gold Hou, enjoy retired personnel of basic medical insurance treatment.
55th with urban household registration, in line with basic endowment insurance payment in the age range of freelancers or non-full-time, part-time or flexible work forms of employment, such as personnel, as well as unemployed persons receiving unemployment insurance on a monthly, according to the relevant provisions of this city to have health insurance.
56th of establishing labour relations with the employer not the urban household registration in China, can be selected by the employer in accordance with the means or non-urban household registration medical insurance of employees to have health insurance.
Socialized management of 57th paid retirees a one-time transition payment and after critical illness benefit, health insurance, by residence area retirees socialized management and service agencies to assist the social insurance institution.
Article 58th of retired personnel, army medical treatment, medical expenses according to the original funding channels.
59th due to epidemics, natural disasters and emergencies caused by factors such as widespread worry, danger, rescue of wounded medical costs, coordinated by the Municipal Government to solve.
Nineth legal liability
60th article employing units violation about financial, and accounting, and statistics of legal, and administrative regulations and national about provides, forged, and variable made, and deliberately destruction about books, and material, or not set books, led medical premium base cannot determine of, in accordance with State social security fee levy paid interim regulations processing; delay payment of, by human resources and social security sector or tax sector since owes paid of day up, by day added received five out of 10,000 of late fees; late refused to paid medical insurance, and late fees of, By human resources and Social Security Department or local tax Department, in default of payment of more than 1 time 3 times the amount of a fine.
Refusing to pay overdue insurance, late fees, and by human resources and Social Security Department, or local tax Department, apply to a people's Court for compulsory execution.
61st article employing units not according to provides handle medical insurance registration, and change registration or cancellation registration, or not according to provides declared should paid of medical premium amounts of, by human resources and social security sector ordered deadline corrected; plot serious of, on its directly is responsible for of competent personnel and directly responsibility personnel can at 1000 Yuan above 5000 Yuan following of fine; plot special serious of, on directly is responsible for of competent personnel and directly responsibility personnel can at 5000 Yuan above 10,000 yuan following of fine.
62nd employer does not require withholding from wages paid medical insurance, released or not complying with the provisions to the workers ' health insurance premiums to pay for the employer, by human resources and Social Security Department or the Inland Revenue Department to give a warning, and may be fined not more than more than 500 Yuan 1000 Yuan.
63rd individuals to defraud Medicare, the social insurance agency is responsible for the recovery in serious, does not constitute a crime, by the public security organs in accordance with the People's Republic of China Public Security Administration Punishment Act constitutes a crime, transferred to judicial organs for criminal responsibility shall be investigated according to law. 64th designated medical institutions have one of the following acts, which by the social insurance agency to recover medical expenses that have been paid, by human resources and Social Security Department in a warning, and may be fined not more than 3000 Yuan and 10,000 yuan.
Directly responsible for their agency heads, managers and persons may be fined not more than 200 Yuan and 500 Yuan; if the case is serious enough to constitute a crime, he transferred to judicial organs for criminal liability:
(A) did not participate in the medical insurance of medical expenses paid by the health insurance fund;
(Ii) shall be borne by the individual medical expenses paid for by the health insurance companies;
(C) do not conform to the current standard of hospital patients in the hospital; or falsifying medical records front man in hospital, the decomposition were hospitalized or deliberately prolong hospital stays; or does not meet the discharge standard of the insured persons discharge; or does not comply with the transfer provisions, improper reuse of large-scale equipment for the insurance officer;
(D) will belong to the basic medical insurance fund paid transfer of medical expenses paid by the insured persons;
(V) does not belong to the transfer of basic medical insurance to pay for medical expenses paid for by the health insurance companies;
(Vi) adopt unfair means to get health insurance.
Acts prohibited by the preceding paragraph, in serious or not corrected by warnings of, human resources and social security departments should cancel their eligibility for designated medical institutions.
65th article Sentinel retail pharmacy has following behavior one of of, by social security handling institutions to its recovered has paid of costs, by human resources and social security sector give warning; while, can at 3000 Yuan above 10,000 yuan following of fine; on pharmacy head, and directly is responsible for of competent personnel and directly responsibility people can at 200 Yuan above 500 Yuan following of fine; plot serious constitute crime of, transferred judicial organ law held criminal:
(A) not complying with the prescription drug, dose dispensed;
(B) not part of the scope of the basic medical insurance payment costs are covered by medical insurance or insurance personal health account funding to pay;
(Iii) prescription drugs into other drugs, items;
(D) acts in violation of basic health insurance regulations.
Acts prohibited by the preceding paragraph in serious or rectification is still not correct, human resources and social security departments should cancel its qualifications of appointed retail drugstores.
66th, social insurance agencies and their staff, one of the following acts, by human resources and Social Security Department ordered corrective action and direct responsible personnel and persons directly responsible by human resources and Social Security Department or the supervisory organs shall be given administrative sanctions constitutes a crime, transferred to the judicial organs shall investigate the criminal liability resulting in loss of health insurance, by human resources and Social Security Department or local tax department responsible for recovery:
(A) relief for employers and employees should pay health insurance premiums;
(B) not required auditing employers and workers pay wage base, and violations of the health insurance regulations, resulting in loss of health insurance;
(C) unauthorized alterations or relaxed standard of basic medical insurance treatment.
Any other conduct prohibited by laws, regulations and rules, shall be subject to administrative or criminal liability.
67th article human resource and social security departments and their staff to perform the supervision as provided herein duty or abuse of power, deception, negligence, directly responsible for the heads of departments, supervisors and persons directly responsible shall be given administrative sanctions constitute a crime, transferred to judicial organs for criminal responsibility shall be investigated according to law.
68th financial, tax, health, food and drug regulation, pricing, audit, business, home, education departments and their staff, such as failure to comply with these rules of the corresponding duty or abuse of power, deception, malfeasance, directly responsible for the heads of departments, supervisors and persons directly responsible shall be given administrative sanctions constitute a crime, transferred to judicial organs for criminal responsibility shall be investigated according to law.
69th human resource and Social Security Department or local tax Department staff in the way 68th, 69th acts listed in section, resulting in loss of health insurance, and units or individuals, the diversion of medical insurance, according to the State Council of the relevant provisions of the interim regulations on the collection and payment of social insurance.
The tenth chapter by-laws
70th article this referred to medical insurance, including basic medical insurance fund, transition payments, major medical benefits, supplementary medical insurance and medical benefits for civil servants.
Society's bid for retirees in these measures refers to the participation of social pension insurance, reached the mandatory retirement age, eligible to retire, to human resource and Social Security Department's bid and approved retired social workers.
Socialized management of retirees in these measures refers to the participation of social old-age insurance, and according to the provisions of the relevant procedures, by district, county-level cities to retire retirees who receive the administrative staff management bodies.
Basic medical expenses mentioned in these measures refers to belong to the basic health insurance coverage for drugs, medical clinics and medical services costs, but not containing a proportion of individuals in accordance with the regulations to pay costs.
Social security mentioned in these measures refers to the year from July 1 to June 30 each year.
71st in the administrative area of the city municipal co-ordination of the basic medical insurance system for urban workers, step by step. Before you implement the city-level overall plan, huadu and Panyu district and county-level cities, and Manpower, and has not yet been included in the present management of the industry, approved by the municipal people's Government, in accordance with the uniform policy, the principle of independence, self management, establishing the basic medical insurance system for urban employees.
Adjustment of its medical insurance schemes and standards of treatment, should be submitted to the municipal people's Government for approval.
Insured persons within the administrative area of the city transferred medical insurance, mutual recognition of basic medical insurance payment years; transfer of medical insurance insured persons, when handling the retirement transition payments under the transfer payable to standard.
72nd these measures shall come into force on September 1, 2008.