Key Benefits:
(Act dated 27 June 2008 from No. 232 of the Government of the Federated States of the Overseas Territories, dated 1 August 2008) Chapter I General Article 1 establishes this approach in order to guarantee basic medical care for the urban population, in accordance with the relevant provisions of the State and the province. Article 2 (i) Voluntary participation and government assistance; (ii) The treatment of medical guarantees and the level of funding; (iii) Emphasis on the need to ensure hospitalization and access to medical care, as well as on the treatment; (iv) Comparison with the basic health insurance for urban workers and the new rural cooperative medical system. Article 3. The basic health insurance of the urban population is administered on the ground. The following persons (other than those still reserved for the contractor's or home base) who are members of the city's city's city's city's administrative region are allowed to participate in the basic health insurance of the urban population: (i) School students at the primary and secondary levels (including vocational high schools, secondary, technical colleges and special education schools), with young children and other urban residents under 18 years of age; (ii) Older residents who have attained the age of 60 years for men, who have reached 55 years of age and who are not covered by basic health insurance for urban workers (hereinafter referred to as older residents); (iii) Be up to 18 years of age, under the age of 60 years of age, the age of 55 years for men and the absence of occupation, income and other non-profit urban residents without social insurance (hereinafter referred to as other non-employed residents). The relocation of persons from the home to the city after retirement is not covered by this approach. Individual business-owners of the legal age of labour and their employees, flexible employment workers, should be allowed to participate in the basic health insurance for the workers in the town, in accordance with the provisions of the scheme. Article IV provides a unified policy on basic health insurance for the urban population. The city level is integrated in the various districts, the urban areas, the horrendous areas, the space bridges, the various urban areas and the long-term areas (hereinafter referred to as the urban area of 6). The Governments of the various districts (markets) should, in line with this approach, develop implementation opinions on the funding standards for basic health insurance for the urban population, the criteria for access to treatment and the management model. Integration at the municipal level should be integrated in due course. Article 5. The municipal labour security administration is the competent authority of the basic health insurance for the inhabitants of the city and is responsible for the implementation and supervision of the organization responsible for the basic health insurance of the urban population. The Sectoral Labour Guarantees Administration is responsible for overseeing the supervision of district health insurance institutions and for participating organizations of the inhabitants of the Territory. The financial sector is responsible for the mobilization of government grants for basic health insurance for urban residents, the allocation and supervision of funds. The health sector is responsible for assisting in strengthening the monitoring of the implementation of the basic health insurance policies of targeted medical institutions. The education sector is responsible for accessing children and participating in school students. In line with their respective responsibilities, the sectors such as the rehabilitation, public safety, civil affairs, audit, statistics, food drug surveillance, material prices and disability, are coordinated with the basic health insurance of the urban population. Article 6 The Regional Health Insurance Agency is responsible for the collection of basic health insurance fees for the inhabitants of the Territory, the processing of the medical insurance card, participation in the payment records and payment of cash claims. The labour security institutions in the streets (communes) are specifically responsible for the registration, collection and policy promotion of the insured population. Chapter II Fund mobilization Article 7 Sources of the Basic Health Insurance Fund for Urban Residents (hereinafter referred to as the Resident Health Insurance Fund) include: (i) Basic health insurance expenses for residents of towns paid by the insured person; (ii) Government grants at all levels; (iii) Fund interest income; (iv) Social contributions; (v) Fund mobilization from other sources. Article 8 (i) In school students, juveniles and other urban residents under the age of 18 years are raised in accordance with the standard of $100 per person per year. Of these, the individual paid US$ 40 and the Government grants US$ 60; (ii) Older residents are raised in accordance with the standard of 500 per person per year. Of these, individuals paid $20 million, and the Government contributed 300 dollars; (iii) Other non-employed residents are raised in accordance with the standard of 500 per person per year. Of these, $400 was paid by individuals, with Government grants of $10 million; (iv) The hardships such as heavy disability and the minimum living security of the town are fully supported by the financially in accordance with the above-mentioned criteria. The basic health insurance fees for the urban population in each of the districts (market) are not less than $80 per year for each of the underage urban residents, and other non-employed residents and older residents are raised less than 300 per year. The Government grants subsidies to minors, older residents, other non-employed residents on the basis of a standard of no less than $40, 160 and 60 per person per person per person per year, and to those who enjoy the minimum living security of the town are paid in full by the Government in accordance with the mobility criteria. The Government grants, in addition to the above-mentioned portion of the provincial financial support, the city-level finances receive grants in proportion to the number of districts (markets), districts. Of this amount, 50 per cent of the six districts in the city (including high-technical industrial development zones), 20 per cent of the commercial River area, 10 per cent of the Pyaz region and the Zanzi district, while the city is covered by local finance. Government grants are included in the financial budget by year and are directly converted into the SHF's financial pool. Article 9. The cost of the health insurance of the resident is incurred in the establishment of a resident health insurance fund and does not establish an individual account. Article 10. The Residential Health Insurance Fund has two income and expenditure lines that are integrated into the management of the Principality of Finance, with separate accounts and special funds. No unit or person shall be excluded and diverted. Article 11. When the insured person pays a payment for the health insurance of a resident in full for a one-year payment period, the insured person may receive medical insurance treatment in accordance with the annual medical year; the resident health insurance treatment for the medical year has not been paid in full and on time during the payment period. Article 12 The death of the insured person during the contributory period may be made available to the district health insurance agency for the return of the payment for the year. Newborns can pay a full-year health insurance fee after the registration of the household, and receive the health insurance treatment of the population for the next month of payment. A medical year is 1 January to 31 December each year. Article 13 Child institutions and small schools should be in operation of the scheme, with the start of the first pay period of admission and participation of school students. Article 14. In the case of the resident health insurance, the basic health insurance for the workers in the town after employment is paid at the time of retirement, which is less than the minimum wage for the basic medical insurance of the urban worker, may be offset by the amount of contributions paid to the basic medical insurance of the urban worker. Article 15. After the employment of the insured person to participate in the basic health insurance of the worker in the town, the treatment of the resident's health insurance has been terminated from the date of the basic medical treatment of the urban worker. In a medical year, the insured person was converted to another job after attending the basic health insurance for the urban worker, which could continue to benefit from the health insurance treatment of the resident in the medical year. Article 16 is in compliance with the non-insecution or post-insecution payment and shall be subject to the treatment of the health insurance of the next medical year after the payment period shall be filled in part by the individual during the calendar year or the interruption of the payment period. Chapter III Article 17 The municipal labour security administration, in conjunction with the municipal financial sector, adjusts the coverage and publishes it as appropriate, in accordance with the income and expenditure of the resident health insurance fund. Article 18 In a medical year, the insured person has a medical fee incurred in hospitalization or inpatient care for the treatment of illnesses, which is subject to a personal burden. Inpatient and patient conditions for the duration of the disease are calculated separately. Inpatient rates are determined in accordance with the criteria of €200 at the level of medical institutions (including community health services), $400 at the secondary level, and 700 at the third level of medical institutions. In a medical year, the second inpatient rate was reduced by 20 per cent compared to the previous year, from the third inpatient period to no longer implement the payment criteria. The clinic provides for the payment criteria for the sick, with only one in the medical year, and a standard of $20 million. Article 19 Article 20 (i) Medical care at the level of medical institutions (including community health services) is paid by 70 per cent of the resident health insurance fund and 30 per cent for individuals; (ii) Medical care at the secondary level, which is paid by 60 per cent by the resident health insurance fund and 40 per cent by the individual; (iii) Medical care at the third level of medical institutions is paid by 50 per cent of the resident health insurance fund and 50 per cent for individuals. The proportion of payments paid by the resident health insurance fund increased by one percentage point per year from the second medical year to a maximum of 5 percentage points. In a medical year, the insured person incurred a medical fee in line with the coverage of the resident health insurance fund, which was paid by the resident health insurance fund in accordance with 20 per cent criteria. Article 2 provides for an emergency medical fee incurred by school students, juveniles and other persons under the age of 18 years for accidental injuries, with a cumulative increase of more than 200 dollars in the coverage of the resident health insurance fund, 80 per cent paid by the resident health insurance fund and a maximum payment rate of US$ 2000 within a medical year (with a proportion of personal burdens). Article 23 of the Convention on the Elimination of the Worst Forms of Child Labour As a result of the illness, the medical costs incurred by emergency observation are consolidated in the uniform settlement of the hospitalization costs, following the transfer of emergency medical care agencies directly to hospitalization. Article 24 requires referrals to the field (Beijing, Shanghai and Oxford) inpatient treatment, after expert advice from targeted medical institutions, such as tier A, or at the municipal level above-level hospitals. The proportion of medical costs has increased by 10 percentage points to be transferred to hospitalization in the field, and the resident health insurance fund has not been paid without medical expenses incurred by the self-release. Article 25 Article 26 is terminated when the insured person participates in the army, in the form of a higher school, in the case of a home to the city. The following cases of medical expenses incurred by the insured person are not covered by the resident health insurance fund: (i) Damage caused by violations of the relevant legal provisions; (ii) suicide spoilers (other than mental illness) or intrusive alcohol; (iii) Reproductive and related surgery; (iv) Treatment in the form of integrity, mail and correction; (v) Rehabilitation treatment; (vi) A third-party liability compensation; (vii) Other areas that are not in compliance with the coverage of the health insurance of the population. Chapter IV Article 28 covers the scope of health insurance, the coverage of medical treatment projects and services, taking into account the relevant provisions of the basic health insurance for workers in the city. Young children need to increase their coverage and pay standards in accordance with the relevant provisions of the State, the province. Article 29 regulates the settlement of the resident health insurance fund, upholds the principle of “relevant, balance-of-payments and guarantees of basic medical treatment” and adopts a mix of control, targeted settlement and quality appraisals. Specific settlement management approaches are developed by the municipal labour security administration with the municipal finance sector. Article 33 Medical insurance institutions shall carry out their medical insurance card after the insured person's first payment of the residential health insurance fee. The insured person should be given effective documents such as his health insurance card to the targeted medical institution. The scope and management of targeted medical institutions are carried out in the light of the relevant provisions of the basic health insurance for the workers. Responsibilities for patients at risk can be treated in hospitals near non-settlement medical institutions. However, in three days from the date of hospitalization, reports should be made to the district health insurance institutions. The medical treatment should be transferred to the targeted medical institution after the condition of the disease is permitted; the resident health insurance fund shall not be paid without justification for overdue reports or the identification of patients at risk. Article 31 provides for the treatment of the medical treatment provided by the insured person and, after the confirmation of the medical insurance, the medical certificate is given to the medical treatment. In article 32, the custodians shall not forfeiture, reproduce and cost documents, deceive medical treatment, nor transfer their medical documents to others. Article 33 medical institutions should carefully review the medical documents of the insured person and strictly implement the standards of fees approved by the basic health insurance medicine catalogue, therapeutic project, the medical facility standards and the price sector. Unwarranted or altered accounts, information, prescriptions, medical fees documents, etc., are not used forfeiting the resident health insurance fund; no violation of the relevant provisions of the management of the targeted medical institutions is prohibited. Article 34 quantified medical institutions should be strictly enforced through the timely publication of health-care prices, treatment projects, medical care facilities. Article XV of the Labour Guarantees Administration and the Medical Insurance Service should strengthen the supervision of targeted medical institutions, with the active collaboration of inspection units and personnel, such as the provision of medical files, illnesses and related data. The Labour Security Administration has established a residential health insurance surveillance telephone and a complaint sheet to provide incentives for the reporting of influential persons. Article 36 of the Resident Health Insurance Fund implements the Unified Social Insurance Fund, the financial accounting system and the internal audit system. Funding for the cause of the health insurance institutions is addressed by the financial sector from the budget and cannot be extracted from the Fund. Article 37 should establish a sound internal management system, strengthen the income and expenditure management of the resident health insurance fund and receive oversight inspections by the executive branch, such as labour guarantees, finance, audit. Chapter V Legal responsibility Article 338, in violation of article 33 of the scheme, or inadmissibility, is guaranteed by the municipality, the district (commune) labour guarantee that the executive is responsible for refunding the resident health insurance fund for which it is charged, and is charged with a fine of more than three times the amount; in exceptional circumstances, the health insurance agency stops the treatment of the resident health insurance for the year. In violation of article 33 of this approach by targeted medical institutions and their staff, the medical expenses incurred by the municipal, district (market) labour security administration have been recovered and a fine of up to $300,000 for targeted medical institutions. In the light of the gravity of the situation, the health insurance institutions are suspended and settled with them; in exceptional circumstances, they are removed from their qualifications. Article 40 violates article 32 of this approach and article 33, which constitutes a violation of the management of the security sector, which is punishable by law by the public security organs; constitutes an offence punishable by law. Article 40 Medical insurance institutions, street labour security institutions and their staff are one of the following acts, which are being restructured by the Labour Guarantee Executive Order; refusal to reproduce the administrative disposition of the principal holder and the direct responsible person; and the criminal liability of the law: (i) No provision for the medical insurance of the resident; (ii) Not subject to the provision of registration, change or information recognition by the insured person; (iii) Secrete retention and diversion of basic health insurance fees; (iv) Disadvantages resulting in loss of the resident health insurance fund; (v) To use its mandate to bribe bribe and gain private gain; (vi) There is no reason to delay payment or to deny medical expenses. Annex VI In accordance with the income and expenditure of the resident health insurance fund and the level of medical consumption, the municipality adjusts to the standard, the payment criteria, the payment criteria, the payment criteria and the maximum payment limits, as appropriate, to the social public. Article 43 does not have access to a child at the residence of the city's residence and a school student may participate in the health insurance of the resident in the light of the relevant provisions of the scheme. The medical costs of students at the regular tertiary level are still being implemented in accordance with existing provisions. The cost of inpatient medical care for the group's urban residents, such as major epidemics, floods and emergencies, is to be addressed separately by all levels of government. Article 42 The executive branch of the municipal labour security shall, in accordance with this approach, establish rules for implementation with the relevant sectors. 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