Shantou Special Economic Zone, Health Care Provisions

Original Language Title: 汕头经济特区医疗保障规定

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Shantou special economic zone, health care provisions

    (June 13, 2012 13th session of the Standing Committee of the people's Government of the 11th district, Shantou city passed to 140th, published since June 14, 2012, Shantou city people's Government as of July 15, 2012) Chapter I General provisions

    First to protect the medical needs of urban and rural residents, rural health care integration, according to the basic principles of relevant laws and regulations, combined with the Shantou special economic zone (hereinafter referred to as the SAR) in practice, these provisions are formulated.

    Article health care work within the scope of the special zone, these provisions shall apply.

    Health care in these rules refers to basic medical insurance, supplementary health insurance, rural cooperative medical care and special care and Medicaid.

    Article health care insist that the Government-led mechanism, market participation, urban and rural areas, innovation, that correspond to rights and obligations, protection levels commensurate with the level of economic and social development principles.

    Fourth municipal people's Government exercise unified leadership, coordinating health care services.

    People's Governments at all levels should include health care work in the national economy and social development plan to ensure that urban and rural residents equal access to health care treatment.

    Municipal human resources and social security administrative departments in charge of health-care work, and organize the implementation of these provisions.

    The social insurance agency (hereinafter the Agency) the specific contractor medical insurance business.

    Development and reform, finance, health, price, food and drug administration, public security, auditing, civil affairs, education, tax, disabled persons ' Federation, and other departments and units, according to their respective duties to assist the implementation of this provision.

    Chapter II basic medical insurance

    Five basic medical insurance including workers ' basic medical insurance and basic medical insurance for urban and rural residents.

    Basic medical insurance fund in accordance with article in order to call for, the principle of a balanced budget, a balanced budget with a small surplus, the municipal planning, district accounting, risk-sharing mechanisms. Gradually establish a contingency reserve of basic medical insurance system of the SAR, funding included in the municipal, district (County) Government budget.

    Specific measures by the municipal human resources, financial, and social security administrative departments shall be formulated by the Administrative Department.

    Article seventh workers participating in basic medical insurance from employers and employees in accordance with national, provincial and municipal regulations common to pay basic medical insurance premiums.

    No employees self-employed, not employers ' participation in the part-time employee's basic medical insurance in China and other flexible employment personnel's participation in employees ' medical insurance, basic medical insurance premiums paid by individuals in accordance with the regulations.

    Residence in this city, and not part of the employee's basic medical insurance coverage for urban and rural residents, and within the scope of the special zone of various universities, scientific research institutes, secondary vocational and technical schools, technical schools students in full-time residence in this city, may participate in the basic medical insurance for urban and rural residents.

    Basic medical insurance for urban and rural residents individual pay combined with government subsidies.

    Article basic medical insurance coverage:

    (A) the general outpatient clinics and manpower of basic medical expenses;

    (B) out-patient specific kinds of basic medical costs;

    (C) at the door (emergency) clinic died of basic medical expenses;

    (D) Home Basic medical expenses;

    (E) inpatient medical costs;

    (Vi) other health care costs at national, provincial and municipal regulations.

    Except as provided in the preceding paragraph, a workers ' basic medical insurance can be provided for the establishment of personal accounts, to cover the insured for medical care, drugs and other charges.

    Nineth basic medical insurance for urban and rural residents of the insured, insured during employment and participate in employee basic medical insurance, you can choose to take advantage of a basic medical insurance system and enjoy the treatment, but not duplicate insurance and access to treatment.

    Chapter III supplementary medical insurance

    Tenth supplementary medical insurance including civil service medical benefits, supplementary medical insurance and large supplementary medical insurance.

    11th following workers ' basic medical insurance of an insured person can enjoy medical benefits for civil servants:

    (A) civil servants (including civil service personnel management);

    (B) the implementation of civil service management (including reference management) unit in the preparation of service personnel (including retirees);

    (C) the laws, regulations and the civil service enjoy the same medical treatment personnel.

    The insured employer shall at the time of payment of basic medical insurance premiums be insured (including retirees) to pay medical benefits for civil servants.

    12th medical coverage for civil servants:

    (A) personal account; (b) out-patient specific kinds of basic medical costs, (iii) Home Basic medical costs, (iv) basic medical hospitalization expenses.

    Article 13th cannot be included in the civil service medical benefits employers, can be provided for the establishment of enterprise complementary medical insurance system or in other forms, properly reduce the burden of medical expenses of the staff.

    14th large supplementary medical insurance including workers ' high medical costs supplementary insurance and supplementary medical insurance of urban and rural residents.

    Workers ' high costs supplementary insurance for medical expenses by the insured and the share of workers ' basic medical insurance fund, supplementary health insurance premiums by urban and rural residents of urban and rural residents of basic medical insurance fund.

    15th large supplementary medical insurance can be undertaken by a commercial insurance company and participate in the monitoring service.

    Agency responsible for commercial insurance and claims.

    Fourth chapter of urban and rural medical assistance and allowances for Medicaid

    16th residents of urban and rural medical assistance including the urban and rural poor medical assistance and medical and rehabilitation assistance for the disabled.

    Article 17th residents of urban and rural poor medical care range:

    (A) the city granted basic living allowances, disabled persons and low-income families, young people and low-income families more than 60 years (60 years) older people, rural five-guarantee individuals participating in basic medical insurance for urban and rural residents should be paid;

    (Ii) the residence towns, sources, without work, without statutory support or dependency of the object and rural five-guarantee the basic medical insurance individual be paid inpatient, outpatient costs;

    (Iii) other medical aid.

    Scope of article 18th medical rehabilitation aid:

    (A) poor mentally ill medical and rehabilitation assistance;

    (B) poor cataract patients medical assistance;

    (C) children with disabilities emergency rehabilitation assistance;

    (D) poor adaptation AIDS for persons with disabilities assistance;

    (E) non-governmental rehabilitation services funded;

    (Vi) special hardship severe diseases medical assistance of persons with disabilities.

    This city residence, the 19th, and within the scope of the special zone in receipt of a periodic benefit or quantitative benefits following staff on a regular basis, you can enjoy special care and medical treatment:

    (A) one to ten disabled military servicemen, civil servants, including the police, the disabled due to war disabled;

    (B) the martyr's survivors, survivors of the soldiers died while on duty military survivor, died;

    (C) separated from the Red Army personnel;

    (D) Veterans (including old guerrillas, an old traffic warden, senior party member, old forts, old Soviet);

    (E) in spite of returning veterans;

    (Vi) war nuclear decommissioning-related personnel (including persons who are directly involved in the decommissioning of uranium mining).

    Allowances have dual or multiple identities, enjoys a special care and medical treatment according to higher principles.

    Article 20th rural and urban poverty medical aid and allowances of medical subsidies from the governmental finance budget funds, parent paid into the Special Fund, local welfare lottery, social donations and other funds.

    Medical rehabilitation of disabled persons relief funds from the governmental finance budget funds, local welfare lottery, the employment security fund for the disabled, the Home Department to allocate funds, donations and other funds.

    Fifth chapter health-care services and management

    21st fundamental designated medical institutions and healthcare management of appointed retail drugstores, and implementation of Sentinel physicians in the designated medical institutions management system.

    Designated medical institutions and appointed retail drugstores and Sentinel physicians management approach by human resources and social security, in conjunction with relevant departments shall be separately formulated by the Administrative Department.

    22nd district departments responsible for urban and rural poor qualification of MFA target identification and the rural and urban poor residents in Medicaid funds and allowances of Medicaid funds budget, fund raising, and management.

    Municipal disabled persons ' Federation, is responsible for medical and rehabilitation of persons with disabilities assistance qualification and medical rehabilitation of disabled persons Relief Fund budget, fund raising, and management. Article 23rd SAR established medical insurance uniform handling mechanism.

    Insured medical expenses should be paid by the basic medical insurance fund in part by agency settlement directly with designated medical institutions and appointed retail drugstores.

    Article 24th handling agencies shall establish and improve healthcare operates a business, financial, security, and risk management systems, paid on time and in full health care benefits, and the previous year in the third quarter of each year the basic medical insurance fund revenue, expenditure, balance and earnings to the public. 25th article human resource and social security administrative departments in charge on the funds of basic medical insurance payments, supervise and inspect the management and investment operations; problems found, should recommend corrective action in a timely manner, and make a decision according to law or made recommendations to the Department.

    Inspection results should be announced to the public on a regular basis.

    Financial departments, the audit authority shall, in accordance with their respective responsibilities, the basic medical insurance fund revenue and expenditure monitoring implementation, management and investment operations.

    Article 26th established health care information sharing platform, between different medical security system information, medical information, and sharing of medical information.

    Human resources and social security Administrative Department and other relevant departments, agencies and their staff, it should be by law, the employer and the confidentiality of personal information, and shall not in any way divulge.
Article 27th build superior medical and health institutions and medical and health institutions at lower levels of Division of labor and cooperation mechanism, first diagnosis and classification of primary medical care, service model of two-way referral, and the linkage.

    28th medical insurance for any organization or individual has the right to violate laws, regulations, regulatory reports, complaints of acts. Human resources and social security and health administrative departments, the agencies in charge of the financial sector, audit institutions belong to this sector, the scope of responsibilities of this body reports, complaints, they shall be dealt with does not belong to this sector, the terms of reference of this body, shall be notified in writing and hand over power to handle departments, agencies.

    Power to handle departments, agencies should be processed in a timely manner, no excuse.

    29th the employer or individual considers that the relevant administrative departments, organizations, agencies of acts against their own legitimate rights and interests, can apply for administrative reconsideration or bring an administrative suit.

    The sixth chapter legal liability

    30th an employer is not required to participate in workers ' basic medical insurance or not complying with the provisions of Declaration and payment of basic medical insurance premiums, in accordance with the People's Republic of China social security law and other relevant regulations.

    31st article units and personal cheat basic medical insurance treatment or basic medical insurance fund spending of, by human resources and social security administrative competent sector ordered returned cheat of medical insurance, at cheat amount twice times above five times times following of fine; is Sentinel medical institutions, and Sentinel retail pharmacy of, by city human resources and social security administrative competent sector suspended or canceled its Sentinel qualification; constitute crime of, law held criminal.

    Managers directly responsible and other persons directly responsible for vocational qualifications, and revoked its licensing.

    32nd units and individuals defrauding residents of urban and rural poor medical assistance or allowances of Medicaid treatment, recovering illicitly acquired by the home sector constitutes a crime, criminal responsibility shall be investigated according to law.

    Article 33rd relevant administrative departments, units, agencies and their staff in violation of the provisions in health-care services, management, supervision, abuse their powers, neglect their duties, engage in the work, shall be ordered to correct by the competent Department, directly responsible in charge and other direct liable persons shall be given disciplinary actions constitute a crime, criminal responsibility shall be investigated according to law.

    The seventh chapter by-laws

    34th healthcare standards in accordance with the relevant provisions of the provincial and municipal; needs adjustment, adjustment programmes prepared by the Department submitted to the municipal people's Government for approval and Publishing Executive. 35th article of the regulations come into force on July 15, 2012.