Implementing Rules For The Regulations On Basic Medical Insurance For Urban Workers In Hainan Province

Original Language Title: 海南省城镇从业人员基本医疗保险条例实施细则

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Implementing rules for the regulations on basic medical insurance for urban workers in Hainan Province

    (August 17, 2009, the fifth session of the Standing Committee of the Hainan Provincial people's Government for the 37th passed on September 2, 2009, Hainan Provincial people's Government promulgated as of January 1, 2009, No. 224) article under the basic medical insurance for urban workers in Hainan Province Ordinance (hereinafter regulations), these rules are formulated. Article in the town within the administrative area employers and their workers in the province, regardless of the form of and access to payment shall be as provided in the regulations to have basic medical insurance to pay basic medical insurance premiums.

    Capable of providing and manpower outside of the social insurance agency of the insured issued by effectively excluding evidence.

    The flexible employment personnel participating in basic medical insurance for the insured procedures in their personal capacity.

    Referred to in article regulations refers to the province of retirees retirement (retire) and monthly basic pension (pension) personnel.

    Fourth section established within the administrative region of this province of foreign organizations representative offices in Hong Kong, Macao and Taiwan areas organizations representative offices and its practitioner employed by the Chinese side, in accordance with the provisions of the Ordinance should be participating in basic medical insurance.

    Employed in the unit within the administrative area of the province of Taiwan, Hong Kong and Macau Chinese citizens among the residents shall, in accordance with the provisions of the Ordinance to have basic medical insurance. Town in the administrative region of this province employers employed persons of foreign nationality not to participate in the regulation of basic medical insurance.

    Otherwise provided for by the State, from its provisions.

    Article fifth insurance registration and payment in accordance with the following provisions:

    (A) the following units at the provincial social insurance agency to handle basic medical insurance registration, local tax authorities in Haikou payment registration:

    1. in Haikou region directly under the Central Government, provincial agencies, public institutions, registration of private non-enterprise units at or above the provincial level of the Home Department, social organization, registered with the industrial and commercial administration departments at or above the provincial level enterprises, recruiting troops in Joan units with no army personnel;

    2. the railway and ocean shipping, trans-regional mobility, production of larger enterprises, voluntary at the provincial social insurance agencies participating in basic medical insurance and with the approval of the province, the social security administration. (B) employers in the Yangpu economic development zone on Yangpu social insurance agency for basic medical insurance registration, payment at the Yangpu economic development zone local taxation authorities for registration.

    Its basic medical insurance funds into provincial-level Yangpu household financial account management.

    (C) any other employer in the host cities, counties, autonomous counties social insurance agency for basic medical insurance registration, registration of payment at the local tax authorities.

    (D) participating in basic medical insurance of flexible employment in the employment of the city or County, autonomous county social insurance agency for basic medical insurance registration, registration of payment at the local tax authorities.

    Sixth insured depending on the period of contributions according to the following regulations:

    (A) before July 1, 2001, calculated in accordance with regulations of the State of a continuous length of service or working life, depending on the period of contributions.

    (B) the cross-flow of personnel and manpower area above the county level, according to the administrative rights to this province, organization, human resource administrative department or by other authorized Department official transfer procedures, as provided in the regulations before participating in basic medical insurance in accordance with the national provisions of seniority or length depending on the period of contributions.

    (C) Veterans participating in basic medical insurance for urban workers, according to state regulations, the military service period treated as a period of contributions.

    Seventh is imprisoned, reeducation-through-labor or expelled people, reeducation-through-labor, prison or not reemployment period payment of basic medical insurance premiums, do not enjoy basic Medicare benefits; being sentenced to prison, reeducation-through-labor or expelled before the actual period of contributions and treated as a period of contributions to be recognized.

    The eighth has participated in two or more basic medical insurance employers, insured, repeated access to the basic medical insurance fund to pay benefits, be recovered by the social insurance agency.

    Nineth employer and its proportion of the basic medical insurance premiums as required employees to pay into personal accounts, with the remainder classified funds.

    Employer tuition during their employee medical costs incurred by the employer paid the funds not be paid. Tenth insured employer at the provincial level, unit to pay basic medical insurance rates for employees of the Unit 7% of monthly salary from January 1, 2010.

    In China from January 1, 2009 to December 31, 2009 according to the Unit 6% of monthly salaries to pay.

    At the provincial level to participate in basic medical insurance the employer paid medical insurance premium rates, by the social security administration of the province, in conjunction with provincial financial departments within the range prescribed in the Ordinance, according to the changes in China in Haikou area annual average wage of fully employed staff and basic medical insurance fund balance adjustment programmes imposed reported to the provincial government for approval.

    In this province, and manpower of the regions participating in basic medical insurance the employer paid medical insurance premium rates, by co-ordinating District Social Security Administration, in conjunction with the Ministry of Finance within the range prescribed in the Ordinance, in China under the pooling area changes in annual average wage of fully employed staff and basic medical insurance fund balance adjustment programmes reported to co-ordinate regional people's Government for approval to implement.

    After the 11th stop cost recovery fees, from the recovery fee payment NCO 24th in a row in the month after the time provided for in article before they can again enjoy basic medical insurance funds to pay benefits, the course of medical costs paid by the employer. 12th the employer and their employees span more than pay, rates for the pay procedures last year integrated region where basic medical insurance for employers and their employees to participate in determining the rates of.

    Base pay formalities shall not be less than last year's integrated region where the average monthly wage of fully employed staff.

    13th after the retirement of insured by the social insurance agency approved the payment years (including the actual period of contributions and treated as a period of contributions).

    Enjoy basic medical insurance treatment approved period of contributions, in units of years, accumulated.

    14th January 1, 2009, previously terminated at the employer not paying medical insurance premiums covered by basic medical insurance treatment of retirees and social health benefits of retirees, from January 1, 2009 according to their cumulative period of contributions and enjoy the basic medical insurance treatment. Before the 15th of May 31, 2009 have never participated in the basic medical insurance for retirees, one-time payment of basic medical insurance compensation fee, payment month under the Ordinance and these rules under the basic medical insurance benefits.

    Pay compensation for years of basic medical insurance accounted for in the period of contributions.

    16th as the location where the tax Department, social security administration and finance departments, has confirmed, it is unable to pay basic medical insurance in China difficult units, in their individual capacity to participate in the basic medical insurance, or after the provincial Government agreed to participate in the basic medical insurance for urban residents.

    17th participating in basic medical insurance at the provincial level, and accounted for in the way of personal account funds for:

    (A) the employer employee basic medical insurance premiums paid by individuals all into my personal account.

    (B) integrated and basic medical insurance premiums paid by the employer into the individual account funds by the social security administration of the province in conjunction with the provincial Finance Department within the range prescribed in the Ordinance, in accordance with the provisions of the Ordinance and propose specific percentage of income and expenditure of the Fund, reported to the Government. The preceding paragraph (b) the provision of funds to personal accounts, under 30 years of age and 30 years of age until the age of 39 years, 40-49 years, 50 years to the statutory retirement age, compulsory retirement age to 69 years old and 70 years of age, authorized money counted towards the quota. Higher age groups insured by the insured individual account funds should be more than low ages.

    Annual personal account fund allocation, formulated by the province, the social security administration in conjunction with the provincial Finance Department, submitted to the provincial people's Government for approval before implementation.

    Area employers to pay other co-ordination, the proportion of basic medical insurance funds to personal accounts by co-ordinating District Social Security Administration, in conjunction with the Ministry of Finance within the range prescribed in the Ordinance, in accordance with the provisions of the Ordinance and propose specific percentage of income and expenditure of the Fund, pooling area people Government.

    18th provincial social security Administrative Department in conjunction with the provincial health Administrative Department of basic medical insurance disease directory, separately identified medical expenses shall be paid from the funds of disease, approval of the needed funds will pay the medical costs of diseases and solidarity fund does not pay for disease.

    19th identified medical expenses shall be paid from the funds of the disease into the scope of funds paid by the designated medical institutions itself.

    Approval of the needed funds will pay for disease, contracted medical institutions in accordance with the relevant provisions of the social security administration, paid inclusion and manpower Fund range. Designated medical institutions refuse to conform to the provisions of the preceding paragraph the diseases included in the scope of the solidarity fund to pay and related costs should be borne by the designated medical institutions.

    Identified for the whole Fund diseases that are not paying medical costs borne by the individual.

    20th suitable outpatient treatment of minorities has added funds to pay for disease, after approval by the social insurance agency, its out-patient medical expenses paid by the social insurance agency Fund for inclusion and manpower range.

    Can be incorporated into the integrated fund clinic treating disease of diseases, by the social security administration of the province, in conjunction with the provincial health Administrative Department, specific criteria by co-ordinating district administrative authorities and the financial sector on the basis of social security co-ordination capacity of the Fund.

    The 21st at the provincial level the social insurance agency personnel participating in basic medical insurance, and enjoy the benefits of funds paid in accordance with the following standards: (A) standard of paying funds. When they enjoy the funds to pay for treatment for the first time, standard of paying employees is 800 Yuan; retirees to 600 Yuan.

    When it was again enjoying the solidarity fund to pay for treatment, no further payment standards.

    (B) Solidarity Fund year aggregate maximum payment limit for 230,000 yuan.

    (C) the standard of paying employees more, the maximum payment limit cost-sharing ratio is: in a primary or secondary medical institutions for treatment, and proportion of the Fund and the individual risk ratio 88% and 12%, respectively; in the three-level medical institution, and proportion of the Fund and the individual risk ratio 85% and 15%, respectively.

    (D) the retirees from the film fund 90%, personal ego 10%.

    Year provincial-level co-ordination of basic medical insurance fund pay standards, annual maximum limit and medical expenses proportion, by the social security administration of the province, in conjunction with provincial financial departments within the range prescribed in the Ordinance, according to the changes in China in Haikou area annual average wage of fully employed staff and basic medical insurance fund balance adjustment programmes, implemented after being approved by the provincial government.

    Other areas of basic medical insurance co-ordination Fund year pay standards, annual maximum limit and medical cost-sharing ratios, by co-ordinating District Social Security Administration, in conjunction with the Ministry of Finance within the range prescribed in the Ordinance, according to practitioners at integrated changes in annual average wage of fully employed staff and basic medical insurance fund balance is proposed to identify and adjust programmes and manpower region people's Government for approval before implementation.

    22nd placing artificial organs, the body material, disposable medical supplies, pool fund quotas paid, specific criteria by the social security administration of the province, in conjunction with finance, development and reform, and health departments and reported to the provincial government for approval. 23rd use of high-tech medical equipment to test, must be in accordance with the indications of funds to pay for disease examination.

    On not meet check refers to levy, check results not is by and manpower Fund paid medical and Sentinel medical institutions decided check of disease or meet check refers to levy but has has clear diagnosis and Sentinel medical institutions decided repeat check of, check costs by sentinel medical institutions paid; not meet check refers to levy, parameter assured requirements check, check results not is by and manpower Fund paid medical of disease or meet check refers to levy but has clear diagnosis Hou and parameter assured requirements repeat check of, check fee all by I conceit.

    24th due to severe intensive care unit (recovery room, ICU, CCU, etc), remission shall be transferred to the general ward after; should be transferred to the general ward and was not transferred, charging by the standards of basic medical insurance in general wards, more than the standard part, funds not be paid.

    25th insured hospital treatment process across the natural year, settled in discharge time.

    26th according to the patient should be discharged from hospital, after notification by the designated medical institutions, without a legitimate reason to refuse discharge, designated medical institutions notice all fees from the date of discharge from hospital I ego; should be discharged and assigned medical institutions without informing patients out of hospital, medical expenses shall be borne by the designated medical institutions. 27th insured dose criteria for discharge from hospital: acute disease shall be not more than 3 days, chronic diseases should not exceed 7 days.

    Exceeding the above standard, excessive costs borne by the appointed medical institutions. 28th contracted medical institutions in providing medical services to the insured, should strictly carry out medical insurance policy, health standards and medical services in provincial price administration departments to develop provisions for the charging of.

    Hospital, designated medical institutions should be daily fee to provide medical services list, accept insured supervision.

    29th designated medical institutions to use drugs, diagnosis and treatment project at his own expense, shall first seek consent of the insured person agree in writing; without the consent or agreed but there was evidence against the insured person's will, the social insurance agency appointed medical institutions of power to reduce settlement costs to compensate the medical expenses of the insured risk.

    Designated medical institutions at their own expense the cost of medicines, medical items, more than this treatment all medical expenses of the insured 15% of, social insurance agencies shall verify the medications found manifestly unfair, reduced settlement costs of contracted medical institutions.

    30th designated medical institutions have one of the following acts, the social insurance agency shall be dealt with in accordance with the provisions of:

    (A) refuse to meets the conditions for funds to pay the insured hospital treatment;

    (B) contrary to reasonable inspection, rational drug use, reasonable treatment;

    (C) the force of insured hospital that does not meet discharge criteria.

    31st appointed medical institutions of social insurance agency for payment total funds used prepaid balance, contracted medical institutions admitted to occurred insured meet the scope of the solidarity fund to pay medical costs exceed the prepaid portion of the total, by co-ordinating and designated medical institutions in accordance with the regulations of the Fund share.

    Total prepaid billing and assessment methods by the social security administration of the province, in conjunction with provincial financial departments separately.

    32nd social security administrative departments shall develop medical insurance medical service quality assessment methods, to protect insured medical benefits.

    Article 33rd drug should open bidding procurement of basic medical insurance.

    Article 34th due to traffic accident expense medical expenses and other law shall be borne by the particular responsibility for medical expenses, funds not be paid.

    35th because of increased medical costs for medical accidents, paid by the designated medical institutions.

    36th lived for more than 6 months outside the seat of the insured's retirees in China and studying for more than 3 months, by social insurance, where the insured institutions after approval procedures, off-site for treatment of medical expenses shall be paid as provided in the regulations. 37th insured need to go off-site for treatment, should be transferred out of the designated medical institution referred recommendations, and approved by the social insurance institution, the medical expenses paid as provided in the regulations. Without approval, the medical expenses all of which I am proud.

    Social insurance agencies according to the actual situation, referral for medical expenses being included in the proposed referral hospital total prepaid standard or recommended referral hospitals bear the appropriate share of referral for medical expenses.

    According to the illness should be referred and designated medical institutions not referral bungle illness, contracted medical institutions shall be liable.

    Travel, vacations, insured due to acute offsite medical health-care costs, as provided in the regulations the means to pay; non-acute care in different places for medical treatment, medical costs are covered by my ego. 38th individual accounts can use social security card management.

    Specific management measures shall be formulated separately by the province, the social security administration.

    Personal account management and manpower by other means, the social security administration and social insurance agencies should also strengthen supervision of personal account management.

    39th social security administrative departments shall establish the social insurance agencies and designated medical institutions to implement public comment system, urged social insurance agencies improve health insurance work, supervise designated medical institutions to improve medical insurance services.

    40th since January 1, 2009, each urban area and social supplementary medical insurance accounts merged into the basic medical insurance fund account.

    41st article referred to in these rules, this level consists of the Yangpu economic development zone.

    42nd article of the specific problems in the application of the implementing rules, by the social security administration is responsible for the interpretation of the province. 43rd article of the implementing rules shall enter into force on January 1, 2009. On September 20, 2001 issued by the provincial people's Government, the basic medical insurance for urban workers in Hainan Province of the implementing rules of the regulations repealed simultaneously.

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