Shenzhen Academy Of Social Medical Insurance

Original Language Title: 深圳市社会医疗保险办法

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(180th, January 30, 2008, Shenzhen People's Government promulgated as of March 1, 2008) Chapter I General provisions article for Shenzhen City, establishing and perfecting the social medical insurance system, enhance the capacity of the insured against the risk of disease, and to protect their medical needs, according to the relevant regulations of the State, combined with the city's actual, these measures are formulated.
    Article multi level social medical insurance system in the city.
    Government set up the basic medical insurance, supplementary health insurance, maternity health insurance system.
    Set of basic medical insurance medical insurance, hospitalization insurance, migrant workers ' health insurance, four children's inpatient and outpatient medical insurance medical insurance forms.
    Medicaid system Government civil service, encourages and supports the creation of enterprise complementary medical insurance system encourages individuals to participate in the commercial health insurance.
    Article, all employers and their workers and other personnel, the city registered permanent residence, provisions should be in accordance with the means to have health insurance.
    Employers in these measures refers to organs within the administrative area of the city, institutions, social organizations, enterprises, privately-run non-enterprise unit, individual economic organizations.
    Participants in these measures refers to the employer has to have health insurance.
    The insured mentioned in these measures refers to officers who have to have health insurance.
    Migrant workers in these measures refers to employment in the non-urban residence rural residence registration staff.
    Article fourth medical insurance system should be guided by fairness and efficiency combined, right corresponding to obligations, security levels commensurate with the level of development of social productive forces of the principle.
    Fifth of municipal labor and social security administration departments (hereinafter the municipal labor and social security departments), medical insurance, in charge of the work, municipal organization of social insurance handling insurance.
    City development and reform, education, civil affairs, finance, health, price, drug management, and other relevant departments should assist in medical insurance.
    Sixth municipal Committee on supervision of social insurance funds are responsible for the medical insurance laws and regulations, implementation of regulations and supervision payments, use and management of the Fund.
    Seventh municipalities according to the Medicare payments, to the fee standards, funds and individual accounts, salaries are adjusted accordingly. Second chapter parameter insurance range eighth article integrated medical insurance applies Yu following personnel: (a) has this city household of on-the-job personnel; (ii) retired Qian has this city household, city social security institutions by months paid pension insurance treatment of retired personnel; (three) participate in original pension insurance industry and manpower of standing deep units in the by Guangdong Province, and Beijing social security institutions by months paid pension insurance treatment, in retired Qian has participate in I City medical insurance of retired personnel; (four) reached statutory retired age Qian has this city household,
    No by months received pension insurance treatment of retired personnel; (five) reached statutory retired age Hou has this city household, not in domestic other place enjoy medical guarantees of personnel; (six) has this city household, 18 age above not reached statutory retired age, not in school attended, not enjoy unemployment insurance treatment or minimum life guarantees treatment, no employing units of personnel; (seven) Municipal Government provides of other personnel.
    Encourage employer non-residence in this city for its employees to participate in comprehensive health insurance.
    Nineth article hospital medical insurance applies Yu following personnel: (a) non-this city household of town household on-the-job personnel; (ii) by city social security institutions by months paid pension insurance treatment of non-this city household retired personnel; (three) has this city household, received unemployment benefits during of unemployment personnel; (four) has this city household, 18 age above and enjoy minimum life guarantees treatment of personnel; (five) and this city except enterprise yiwai of other employing units established labor relationship of farmers workers; (six) Municipal Government provides of other personnel.
    Not meet the statutory retirement age, residence life, the people, can apply to participate in the medical insurance.
    Encourage enterprises to participate in the medical insurance of migrant workers.
    Article tenth medical insurance of migrant workers apply to establish working relations with enterprises in this city of migrant workers.
    Apply to low-income urban household registration incumbent non-residence in this city to participate in a medical insurance of migrant workers.
    11th children's inpatient and outpatient medical insurance applies to the city through education, home, labor and social security departments approved the establishment of kindergartens, primary, middle school, high school, technical school, secondary, special schools and vocational schools (excluding Junior College) registered children, household, and this is not admission, admission of children under the age of 18 years old, specific measures shall be prescribed separately.
    12th regional supplementary health insurance applies to participate in the comprehensive medical insurance and hospitalization insurance personnel.
    13th reproductive health insurance applies to participate in the comprehensive medical insurance has not yet reached the mandatory retirement age of staff.
    Article 14th personnel in the city participated in medical insurance, shall participate in the city's medical insurance.
    Chapter fund raising and management article 15th medical insurance includes basic medical insurance fund, supplementary medical insurance and maternity insurance fund.
    The basic medical insurance fund formed by pooling Fund and individual accounts, funds by the catastrophic Fund, community clinic funds and composition adjustment funds.
    Article 16th medical insurance funds into a special account of the health insurance fund, the two lines of income and expenditure management, earmarked misappropriated is strictly prohibited.
    Article 17th medical insurance fund with fixed income, balance of payments, the principle of a balanced budget with a small surplus.
    Health insurance fund due to disease outbreaks, severe natural disasters or other exceptional circumstances is not sufficient when used by the financial subsidies.
    Financial, household registration, this non-working residents and migrant workers to participate in appropriate medical insurance subsidy, specific measures separately.
    Sources for the article 18th medical insurance fund: (a) the insurance units and medical insurance premiums payable by the insured; (b) interest on health insurance, (iii) subsidies and (iv) other income. 19th article participate in integrated medical insurance personnel of basic medical premium by following provides paid make: (a) on-the-job personnel to I months payroll for payment base, by payment base of 8% by months paid make, which employing units paid make 6%, personal paid make 2%, I months payroll over this city Shang annual on-the-job workers monthly wage 300% of, by this city Shang annual on-the-job workers months average of 300% for payment base, months payroll below this city Shang annual on-the-job workers monthly wage 60% of, By this city Shang annual on-the-job workers monthly wage 60% for payment base; (ii) retired Qian has this city household, by city social security institutions by months paid pension insurance treatment of retired personnel, to its months basic pension for payment base, by pension insurance fund by payment base of 11.5% by months paid make; (three) participate in original pension insurance industry and manpower of standing deep units in the by Guangdong Province, and Beijing social security institutions by months paid pension insurance treatment, in retired Qian has participate in I City medical insurance of retired personnel, To this city Shang annual on-the-job workers months average for payment base, by original employing units by payment base of 11.5%x12 a months x18 years one-time paid foot; (four) reached statutory retired age Qian has this city household, no by months received pension insurance treatment of retired personnel, payment base by I in this city Shang annual on-the-job workers months average of 60% to 300% Zhijian select implementation, by I by payment base of 11.5% by months paid make; (five) reached statutory retired age Hou has this city household, Not in domestic other place enjoy social medical guarantees of personnel, by I in first participate in this city medical insurance Shi, to this city Shang annual on-the-job workers months average for payment base, by payment base of 11.5%x12 a months x18 years one-time paid foot; (six) has this city household, 18 age above not reached statutory retired age, not in school attended, not enjoy unemployment insurance treatment or minimum life guarantees treatment, no employing units of personnel,
    Base pay by me in last year's average monthly wage of fully employed staff in the city choose between 60% to 300%, of which I am at 8% of the base monthly payment; (VII) other persons according to the relevant provisions of the municipal government. 20th article participate in hospital medical insurance personnel of basic medical premium should by months paid make, payment standard for this city Shang annual on-the-job workers months average of 0.8%, specific approach for: (a) on-the-job personnel by employing units by payment base of 0.6% paid make, personal by payment base of 0.2% paid make; (ii) by city social security institutions by months paid pension insurance treatment of non-this city household retired personnel and the has this city household, and received unemployment benefits during of unemployment personnel, by city social security institutions paid make,
    Masonic costs separately from the basic old-age insurance fund and unemployment insurance fund expenditures, and (iii) other payment channels separately.
    21st District supplementary medical insurance premium payment under the following criteria: (a) personnel serving in comprehensive health insurance, according to the 0.5% of their base pay, (ii) personnel participating in medical insurance, according to the 0.2% of their base pay.
    Workers paid by the employer, other people's contributions and fees respectively according to their payment to pay basic medical insurance premiums and payment methods implementation.
    22nd peasants workers ' medical insurance premium payment under the standard of 12 Yuan per person per month, in which employers pay 8 Yuan, individuals pay 4 Yuan.
    Article 23rd maternity medical insurance medical insurance 0.5% monthly base pay, staff paid by the employer, and others of which I pay.
    Employer should set up a 24th or 30th days after obtaining the business license, register with the municipal social security institutions and insurance procedures.
    Residence in this city without employer insured under my personal insurance formalities to the municipal social security institutions.
    Medical insurance premium by the insured or the insured's Bank on a monthly basis after the collection, transfer, social insurance fund of the social insurance institutions to open bank accounts. 25th the employer and the insured is not required to pay health insurance premiums, not pay.

    This city residence the insured due to change in work, for which no employer paid medical insurance premiums, can I continue to pay.
    For participating in this city more than 1 year of basic medical insurance the insured due to job changes, 1 medical insurance insurance year cumulative disruption of not more than 3 months back pay before and after the break after years of continuous insurance can be combined.
    Annual cumulative disruption in health insurance coverage for more than 3 months to recalculate the insurance period.
    26th an employer may choose to participate in the medical insurance forms, but shall not be changed when you select insurance within 12 months.
    Insured to choose medical insurance forms, their participation in the different forms of medical insurance during the period of basic medical insurance can be converted.
    Comprehensive health insurance and hospitalization insurance where the insured length of supplementary health insurance can be converted.
    Former Labor health insurance the insured life same as the insurance life medical insurance of migrant workers.
    27th the employing units and individuals to pay health insurance premiums in pretax expenses.
    28th medical insurance fund and the insured individual account funds calculated according to relevant regulations of the State interest.
    29th insurance unit and the basic medical insurance premiums paid by insured persons access to basic medical insurance fund, used to cover basic medical insurance treatment; local supplementary medical insurance premiums enter the local supplementary medical insurance fund, used to cover local supplementary medical insurance benefits and other spending programs as provided herein; maternity medical insurance into reproductive health insurance fund to cover reproductive health insurance benefits. 30th article city social security institutions for integrated medical insurance parameter assured established personal account, main for outpatient medical costs, specific proportion following: (a) parameter insurance human not retired personnel of, discontent 45 age of personnel by payment base of 5% meter into personal account, 45 age above of personnel by payment base of 5.6% meter into personal account; (ii) parameter insurance human retired personnel of, by payment base of 8.05% meter into personal account.
    One-time payment of health insurance premiums, which shall be assigned to the individual account of the amount of the monthly to personal accounts, and since the 1st of the next month to pay months monthly calculation of the continuous period of contributions.
    Comprehensive medical insurance the rest of the basic medical insurance premiums into the catastrophic Fund, mainly for the medical expenses as provided herein.
    31st article city social security institutions on hospital medical insurance and farmers workers medical insurance parameter assured established community outpatient and manpower Fund and transfers gold, from each parameter assured of medical premium in the draw 6 Yuan into parameter assured selected social Kang Center where of community outpatient and manpower Fund, for paid outpatient medical costs; draw 1 Yuan as transfers gold, for selected social Kang Center settlement hospital Zhijian of medical with transfers.
    Medical insurance and medical insurance of migrant workers in the basic medical insurance premiums, except into the community clinic funds and adjustment funds other than the rest into the catastrophic Fund.
    Community clinic funds balances, carried over to the next year.
    32nd article this city residence the insured household to move to other parts of the country, as well as non-residence the insured from leaving the city, the city of, upon his own application, ending the city's medical insurance, its personal account balance to the domicile of the social insurance institution; balances cannot be transferred, a one-time reimbursement for myself.
    Death of the insured, his personal account balance is paid to the heirs without heirs, to basic medical insurance funds.
    One-time death of the insured to pay health insurance premiums, medical insurance premium has not been paid by its part to basic medical insurance funds into personal accounts.
    Fourth chapter treatment 33rd insurance insured go through formalities, full payment of health insurance premiums after the 1st of the month to enjoy the medical insurance benefits as provided herein.
    Insurance, insured persons are not full pay or interrupt payment of health insurance premiums, is not paid in full or discontinue the payment of 1st of the next month, insured ceased to enjoy medical insurance paid medical insurance benefits, but can continue to use their individual account balances.
    Article 34th basic Medicare insured in the basic medical insurance drug list, treatment programs and health care services within the scope of the standard covered by basic medical insurance treatment.
    Supplementary medical insurance of an insured person can enjoy these measures local supplementary medical insurance benefits.
    Maternity medical insurance of an insured person under the present system of reproductive health insurance benefits.
    35th medical insurance, medicine, basic medical insurance diagnosis and treatment projects, list of basic standards of health services in accordance with national directory published and the Guangdong provincial labor and Social Security Department.
    Supplementary medical insurance drug list and treatment project scope, special biomaterials and artificial organs range, large medical equipment examination and treatment project scope according to the municipal labor and social security authorities and the Municipal Health Department published directories.
    Special medical materials, artificial organs and included in the scope of the basic medical insurance fund account the maximum payout limits, according to the municipal labor and Social Security Department announced pay ceiling on the scope and implementation.
    36th medical insurance the insured individual accounts for payment of insured out-patient medical expenses, the clinic uses local supplementary medical insurance drug list medicines and treatment project costs, fixed costs to retail pharmacies to buy prescription drugs.
    Personal account accumulated amount reached 1 months city Shang annual on-the-job workers months average of, its over part can for paid in Sentinel medical institutions visits Shi since pay of basic medical costs, and place added medical costs, or in Sentinel retail pharmacy purchase basic medical insurance drug directory and place added medical insurance drug directory range within of non-prescription drug costs, also can for paid health medical, and prevention vaccination costs and its has participate in children hospital and the big disease outpatient medical insurance of children of outpatient medical costs.
    37th insured personal account after use, its fee for outpatient medical, catastrophic medical insurance funds and supplementary medical insurance does not pay, but this way the 38th, except as provided in articles 39, 40, 41.
    38th article integrated medical insurance parameter assured in this city Sentinel social Kang Center occurred of meet basic medical insurance drug directory and place added medical insurance drug directory of outpatient drug costs, 70% by personal account paid, 30% respectively included basic medical insurance big disease and manpower fund accounting range and by place added medical insurance fund paid, but patient outpatient big disease of by medical insurance big disease of about provides implementation.
    39th medical insurance the insured's condition required by the municipal social security institutions agreed by the designated medical institutions approved in the outpatient medical equipment examination and treatment 80% in the basic medical insurance of the cost of catastrophic scope of fund accounting.
    Large medical equipment examination and treatment project management measures shall be formulated separately by the municipal labor and Social Security Department.
    40th article parameter assured for outpatient big disease in the chronic kidney function failure outpatient dialysis, organ transplant Hou outpatient with anti-exclusion drug, malignant tumors outpatient chemotherapy, and intervention treatment, and radiotherapy or radionuclide treatment, by city social security institutions approved, its occurred of basic medical costs of 90% included basic medical insurance big disease and manpower fund accounting range, place added medical costs by place added medical insurance fund by 80% paid.
    Insured illness outpatient transfusion needs to happen at a cost, comprehensive medical insurance insured 90% in the basic medical insurance for catastrophic scope of fund accounting, medical insurance and medical insurance of migrant workers insured catastrophic 70% be included in the basic medical insurance fund account range. 41st article integrated medical insurance parameter assured patient this approach 40th article first paragraph provides yiwai of other outpatient big disease, occurred of basic medical costs and place added medical insurance drug directory of drug, and clinic project of costs, by personal account paid; belongs to outpatient big disease by occurred of corresponding outpatient specialist medical costs, personal account insufficient paid and medical insurance annual within costs over city Shang annual on-the-job workers average 5% above of,
    Over part of the catastrophic 70% be included in the basic medical insurance fund account range or by local supplementary medical insurance fund.
    Out in the preceding paragraph shall be determined separately by the municipal labor and social security departments in disease-disease.
    42nd medical insurance, medical insurance of migrant workers, as well as the employer's medical insurance, medical insurance of migrant workers insured, shall be selected near the city, a Community Center for outpatient medical care fixed-point medical institutions. 43rd article hospital medical insurance, and farmers workers medical insurance parameter assured in selected social Kang Center occurred of outpatient (containing emergency) costs by following provides processing: (a) belongs to basic medical insurance drug directory in the methyl class drug and b class drug of, respectively by community outpatient and manpower Fund by 80% and 60% of proportion paid; (ii) belongs to basic medical insurance directory within clinic project or medical with material of, single price in 120 Yuan following of, by community outpatient and manpower Fund paid 90%; single price in 120 Yuan above of
    , Community clinic funds to pay 120 Yuan; (c) the insured's condition needs to be approved by the settlement the hospital referral to other medical institutions where the out-patient medical expenses, or in a non-emergency medical expenses incurred clearing hospital, community clinic funds in accordance with this article, second 90% provisions to pay claims.
    Community clinic funds in annual payments to each hospital a medical insurance medical insurance insured outpatient (emergency) costs, the total amount shall not exceed a maximum of 800 Yuan.
    Article 44th of insured hospital and drug costs, belonging to the basic scope of medical insurance drug list, retirees at 95%, other people at a ratio of 90% included in the basic medical insurance for catastrophic fund accounting area. Insured in-patient medical expenses, falling within the list of basic medical insurance diagnosis and treatment projects and general medical materials, retirees at 95%, other people at a ratio of 90% included in the basic medical insurance for catastrophic fund accounting area.

    Parameter assured hospital Shi for illness need do basic medical insurance clinic project using special medical with material, and for artificial organ of installation or replacement, and using price in 1000 Yuan above of one-time medical with material, by its domestic universal type price of 90% included basic medical insurance big disease and manpower fund accounting range; no domestic universal type comparable price of, by imports universal type price of 60% included basic medical insurance big disease and manpower fund accounting range.
    Comprehensive health insurance, hospitalization insurance insured bed maximum of 50 Yuan/day, medical insurance of migrant workers insured bed fee not exceeding 35 Yuan/day.
    Article 45th in accordance with hospital at different levels on different pay lines, and following hospital for 100 Yuan at the local level, level-II hospital in the city for 200 Yuan, tertiary-level hospital in the city for 300 yuan, non-hospital in the city is 400 Yuan.
    Fall within the basic medical insurance for catastrophic fund accounting costs of inpatient hospital payment, basic medical insurance for catastrophic Fund not be paid.
    Referral referral to insured hospital treatment in different hospitals, hospital payment calculated respectively.
    46th article each medical insurance annual basic medical insurance and manpower Fund of highest paid limit and parameter assured continuous participate in basic medical insurance of years linked, continuous parameter insurance time discontent half of, and full half discontent 1 years of, and full 1 years discontent 2 years of, and full 2 years discontent 3 years of, and full 3 years above of, highest paid limit respectively for this city Shang annual on-the-job workers average of 0.5 times times, and 1 time times, and twice times, and 3 times times, and 4 times times.
    47th comprehensive health insurance, medical insurance insured inpatient cost included in the basic medical insurance billing medical, hospital pay above, overall pay ceiling on funds following part of the catastrophic Fund paid by basic medical insurance.
    Farmers workers medical insurance parameter assured hospital occurred of included basic medical insurance accounting range of medical costs, in hospital up pay line above, and and manpower Fund highest paid limit following of part, by basic medical insurance big disease and manpower Fund by hospital hospital level paid different of proportion, city a level hospital, and II level hospital, and three level hospital, and city outside hospital of paid proportion respectively for 95%, and 90%, and 80%, and 70%, remaining part by parameter assured paid.
    Medical insurance of migrant workers insured for work out of Office, or travel, the hospital costs incurred due to non-settlement the hospital emergency, according to the standards prescribed in the preceding paragraph shall pay a fee of 90% claims, conditional medical institutions to implement accounting.
    48th participate in comprehensive health insurance for retirees can enjoy a time of supplementary health insurance in retirement benefits of 500 Yuan, and enjoy local supplementary medical insurance benefits 20 Yuan a month, supplemented by a municipal social security institutions from local would be covered by the medical insurance fund and into his personal account and can be used for my health.
    49th article each medical insurance annual place added medical insurance fund of highest paid limit and parameter assured continuous participate in place added medical insurance of time linked, continuous parameter insurance time full half discontent 1 years of, and full 1 years discontent 2 years of, and full 2 years discontent 3 years of, and full 3 years discontent 6 years of, highest paid limit respectively for 50,000 yuan, and 100,000 yuan, and 150,000 yuan, and 200,000 yuan, continuous parameter insurance 6 years above of not set highest paid limit.
    Before the implementation of these measures local supplementary medical insurance may have continuous calculation.
    50th article place added medical insurance parameter assured occurred of following costs, in place added medical insurance fund annual highest paid limit within of, by place added medical insurance fund paid 90%: (a) included basic medical insurance and manpower fund accounting range and over basic medical insurance and manpower Fund highest paid limit of costs; (ii) in hospital during using place added medical insurance drug Directory provides of drug and place added medical insurance clinic project of costs.
    51st to participate in reproductive health insurance insured the family planning policy, prenatal, childbirth, hospital, post-natal visits, family planning surgery basic medical expenses (excluding infant fee) maternity medical insurance fund, the specific measures shall be formulated separately by the municipal labor and Social Security Department.
    52nd insured meet the discharge standards, should be discharged from hospital to hospital, from the date it should be discharged from hospital medical expenses health insurance fund shall not be paid.
    53rd article medical insurance fund not paid parameter assured for following case one of occurred of medical with: (a) except this approach 36th article second paragraph provides case outside since purchased drug of; (ii) for injury, and others responsibility caused hurt of; (three) for I deliberately behavior or violations caused hurt of; (four) for traffic accident, and medical accident caused hurt of; (five) itself to abroad, and Hong Kong, and o, and Taiwan medical of; (six) national, and Guangdong Province, and this city provides of other case.
    Fifth chapter of an insured person for medical treatment, referrals (House), on medical parole, and the 54th medical insurance insured treatment at designated medical institutions in the city.
    Hospital medical insurance insured out-at a selected community center, inpatient and outpatient treatment at designated medical institutions in the city.
    Farmers workers medical insurance parameter assured outpatient should in selected social Kang Center medical, also can in and selected social Kang Center with belongs to a settlement hospital under of other Sentinel social Kang Center outpatient medical; emergency rescue can to city Sentinel medical institutions medical; need hospital of, should in selected social Kang Center of settlement hospital treatment; by provides handle referral procedures Hou, also can to other medical institutions medical.
    55th comprehensive health insurance, health insurance, social insurance institutions, insured patients in the hospital specified diseases be appointed medical institution of the city outside the city, shall be designated by the municipal social security institutions designated medical institutions in the city to issue remote medical references for the offsite medical procedures.
    56th article integrated medical insurance, and hospital medical insurance parameter assured in this city Sentinel medical institutions diagnosis and treatment Shi has following case one of of, can application turned to city outside medical institutions visits: (a) by sick species belongs to city labor guarantees sector announced of referral disease type; (ii) by this city three level hospital or city level specialist hospital check consultation still failed to confirmed of difficult illness; (three) belongs to this city three level hospital or city level specialist hospital currently no equipment or technology diagnosis and treatment of critical patients. 57th article meet city outside referral conditions of integrated medical insurance, and hospital medical insurance parameter assured, application turned to city outside medical institutions visits of, should by following program handle referral (hospital) procedures: (a) by this city received diagnosis of three level hospital or city level specialist hospital of main diagnosis doctor provides records summary, proposed referral reason; (ii) by main diagnosis doctor fill in a type two joint of Shenzhen social medical insurance city outside referral audit application table; (three) by turned out hospital section Director signed views,
    Medical or Medicare Office reviewed and stamped with the seal of the hospital later, belonging to designated medical institutions approved by their own illness, could be transferred to outside medical treatment; disease approved by the social security institutions, belongs to the city, after it has been approved can be transferred to medical institutions for treatment.
    Accepted referral of medical institutions should be transferred out of the health care institution siblings or more nonprofit medical bodies.
    Article 58th medical insurance of migrant workers insured hospital due to illness needs a referral, the original settlement the hospital proof of referral, the implementation of sequential referral or referral to the specialist expertise of medical institutions at the same level in the city, each transferred out of the hospital should be to accept the referral hospital proof of referral.
    59th insured transferred out after treatment, need for referral should be received by the first medical institutions providing proof of referral, and referral of medical institutions should be and out of medical institutions or more nonprofit medical bodies at the same level.
    60th article long-term presence in domestic (not containing Hong Kong, and o, and Taiwan area, to with) other city work of this city household parameter assured should in work to selected three home local medical insurance Sentinel medical institutions as its medical of medical institutions, and to city social security institutions record; retired Hou long-term live in domestic other city of parameter assured should in long-term live to selected three home local medical insurance Sentinel medical institutions as its medical of medical institutions, and to city social security institutions record.
    61st insured domestic offsite emergency hospitalization, personnel record provided in this article 60th medical institutions where basic medical costs and local supplementary medical expenses, for application via insured by the municipal social security institutions to audit actual medical expenses, reimbursements, medical fees, not higher than the standard.
    Insured in the domestic long-distance medical out-patient medical expenses and local supplementary medical expenses, examining the expenses deducted from his personal account.
    Insured in the country occurred in different places in accordance with the regulations, such as maternity medical costs, for application via insured by the municipal social security institutions to audit actual medical expenses, not higher than the city's medical fees and municipal hospital reimbursement standards be reimbursed.
    Insured for work on business, to visit relatives in foreign countries or Hong Kong, Macao and Taiwan areas during emergency in-patient medical expenses incurred, upon his own request, the municipal social security institutions to audit actual medical expenses, not higher than the city's medical fees and municipal hospital reimbursement standards be reimbursed. 62nd article parameter assured not by this approach provides handle related procedures, to city social security institutions city outside Sentinel medical institutions medical occurred of hospital medical costs, meet medical insurance fund paid range of, can application claims, but claims proportion by this approach provides reduced 20%; parameter assured not by this approach provides handle related procedures, to domestic non-Sentinel medical institutions medical occurred of hospital medical costs, meet medical insurance fund paid range of, can application claims,
    40% reduction in reimbursement in accordance with this regulation. The sixth chapter designated medical institutions appointed retail drugstores and 63rd of municipal social security institutions under a unified planning, rational distribution, convenient medical care, taking into account the needs, total control, encourage competition, as well as principles of management, information systems adapted to the capacity, determining the designated medical institutions, appointed retail drugstores.

    City social security institutions should priority select non-profit sex medical institutions as Sentinel medical institutions; non-profit sex medical institutions by city social security institutions select determine for Sentinel medical institutions of, shall not refused to; non-profit sex medical institutions cannot meet medical insurance service need of, by city social security institutions select medical conditions and social reputation better of private medical institutions as Sentinel medical institutions, select management conditions and social reputation better of retail pharmacy as Sentinel retail pharmacy. 64th article hospital, and clinic, and social Kang Center meet following conditions of, can to city social security institutions proposed application, signed Sentinel medical service agreement, became Sentinel medical institutions: (a) has and medical institutions grade corresponding of medical technology equipment and medical personnel; (ii) comply with national, and Guangdong Province, and this city about medical service management of legal, and regulations, and regulations and other provides; (three) strictly implementation national, and Guangdong Province, and this city on non-profit sex medical charges and drug retail price of the provides,
    Charging standard announcement system; (iv) commitment to strict compliance with the relevant policies and regulations of the urban social medical insurance system, set up internal management system in conformity with medical insurance, medical insurance management with a sound organization, leaders in charge of insurance, is equipped with the necessary professional management personnel, as well as computers and other equipment to meet social medical insurance needs.
    Enterprises and institutions within medical institutions in accordance with the conditions set out in the preceding paragraph, the number of employees and the Organization in more than 1000 people, or you can apply to become a designated medical institutions, the unit provided medical services to the insured. 65th article retail pharmacy meet following conditions of, can to city social security institutions proposed application, signed Sentinel medical service agreement, became Sentinel retail pharmacy: (a) has drug business license qualification; (ii) comply with national, and Guangdong Province, and this city about medical service management of legal, and regulations, and regulations and provides; (three) strictly implementation national, and Guangdong Province, and this city provides of drug price policy; (four) can timely supply medical insurance medication; (five) in retail pharmacy business time within,
    Due at least 2 name has practice industry pharmacists qualification or pharmacists (containing Medicine Division) above titles of pharmacy technicians on-the-job service; (six) commitment strictly implementation this city social medical insurance system about policy provides, has specification of internal management system, equipped with necessary of management personnel, equipped with meet social medical insurance need of computer, equipment; (seven) has basic medical insurance drug directory and place added medical insurance drug directory in the 80% above of drug.
    Under the same conditions, chain retail pharmacies and available for 24 hours, do not operate with the exception of pharmaceuticals, medical devices, and other products of retail pharmacies may be the preferred option identified as appointed retail drugstores.
    66th eligibility criteria for designated medical institutions and retail pharmacies, applications should be made to the municipal social security institutions in September each year; the social insurance agency shall, within two months of its integrated assessment, and publicize the assessment results, evaluating top medical institutions and retail pharmacies identified as designated medical institutions and appointed retail drugstores.
    67th of municipal social security institutions signed an agreement with designated medical institutions and appointed retail drugstores and managed according to the agreement. Municipal social security institutions in accordance with the regulations and the provisions of the agreement, to supervise the designated medical institution, appointed retail drugstores and managed according to their contracts once every two years, credit rating, and its results made public.
    Municipal organization of social insurance according to the assessment results to designated medical institutions, appointed retail drugstores and related staff incentives reward funds included in the social insurance institution of the Department's budget.
    Designated medical institutions, appointed retail drugstores for credit rating standards by the municipal labor and social security authorities and the municipal quality and technical supervision departments, and reported to the municipality for approval before implementation.
    68th medical institutions should adhere to the "illness treatment and reasonable check, rational drug use, reasonable treatment, according to the stipulations" principle, in accordance with these regulations and agreement to provide insured medical services.
    69th designated medical institutions shall set up medical and medicine separate accounting and management systems and standardizing medical behavior for profit-making purposes is strictly forbidden behavior of each billing Commission, reduce the insured pays costs as a proportion of total medical costs, reduce the financial burden on insured.
    70th designated medical institutions, appointed retail drugstores should establish special management of medical insurance institutions, establish internal management system in conformity with medical insurance system, self-management and self-discipline.
    71st medical institutions and appointed retail drugstores should strictly implement the relevant Government medical fees and price regulations, and to the public.
    Designated medical institutions should provide outpatient charges to insured persons list or hospital daily fee details.
    72nd designated medical institutions should be retained separately insured prescription, examination and treatment of large medical equipment approval and reporting documents such as, examination and treatment, medical expense list, retained for at least two years, social security institutions, for testing.
    Designated retail pharmacies should be retained separately insured to buy drugs prescription and details, and retained for at least two years, social security institutions, for testing.
    73rd designated medical institutions provide medical services should perform basic medical insurance and supplementary medical insurance drug list, medical projects and health care facility standards regulations.
    Designated medical institutions for the insured person uses other than those specified in the preceding paragraph medicines, medical items, medical services shall obtain the consent of the insured.
    Designated medical institutions and other entities or individuals cooperate or contract treatment items must not be included in the scope of medical insurance billing. 74th designated medical institutions accept insured for medical treatment and the medical expense account, should the insured person identification.
    Related to the insured person refuses to produce proof of identity, no accounting for its medical expenses in medical institutions.
    75th article Sentinel retail pharmacy on parameter assured using medical insurance personal account purchase drug Shi, should review following content: (a) parameter assured using of social security card whether for parameter assured I all; (ii) parameter assured purchase prescription drug Shi whether has Sentinel medical institutions issued of prescription; (three) parameter assured purchase non-prescription drug Shi, its personal account accumulated amount whether reached 1 months city Shang annual on-the-job workers monthly wage.
    Seventh chapter fee settlement 76th designated medical institutions appointed retail drugstores and medical services to the insured medical expenses actually incurred, according to these rules or the agreement, social security institutions, and settlement.
    Municipal social security institutions and designated medical institutions, appointed retail drugstores signed agreement shall be agreed upon settlement.
    Medical insurance and settlement services billing, service units can be taken clearing, disease settlement, according to a poll out fixed lump sum settlement or prepay the total settlement, and so on. 77th article parameter assured in Sentinel medical institutions medical or in Sentinel retail pharmacy purchase drug by occurred of meet basic medical insurance, and place added medical insurance, and birth medical insurance provides of medical costs, according to following provides handle settlement: (a) belongs to basic medical insurance and manpower Fund, and place added medical insurance fund, and birth medical insurance fund paid range of, by sentinel medical institutions truthfully by provides accounting; (ii) belongs to personal account paid range of,
    By the designated medical institutions or appointed retail drugstores from the insured person's individual account in the ring; lack of personal accounts to pay, should be directly charged to the insured person. 78th article parameter assured medical occurred of medical costs has following case one of of, first paid cash, subsequently by about documents and information to city social security institutions proposed application, by city social security institutions by provides audit claims: (a) integrated medical insurance, and hospital medical insurance parameter assured in domestic other city emergency or by approved referral to domestic other city occurred of of hospital medical costs; (ii) long-term presence in domestic other city work of this city household parameter assured or retired Hou live in domestic other city of parameter assured,
    In record of medical institutions visits occurred of medical costs; (three) parameter assured in Sentinel medical institutions for chronic kidney function failure outpatient dialysis, organ transplant Hou outpatient with anti-exclusion drug, and malignant tumors outpatient chemotherapy, and intervention treatment, and radiotherapy or radionuclide treatment occurred of medical costs; (four) farmers workers medical insurance parameter assured for workers out or travel, in non-settlement hospital for emergency rescue occurred of hospital medical costs; (five) parameter assured by hospital agreed, hospital Shi in hospital outside for directory within clinic project occurred of of costs;
    (Vi) took place in other cities of the country in accordance with the regulations, such as maternity medical costs.
    79th article hospital medical insurance and farmers workers medical insurance parameter assured medical occurred of outpatient medical costs has following case one of of, first paid cash, subsequently can by about documents and information to settlement hospital or specified of medical institutions proposed application, by settlement hospital by provides be audit claims: (a) for illness need, by settlement hospital approved referral to non-settlement hospital occurred of outpatient costs; (ii) for workers out or travel in non-settlement hospital occurred of outpatient emergency medical costs;
    (C) the designated medical institutions attending computer failures or for damage of the social security card and other reasons which cannot be accounted for.
    Medical insurance of migrant workers insured medical institutions designated by the settlement approved by the hospital referral to hospital costs incurred, paid cash in advance, you can present the relevant documents and information to a clearing hospital procedures stipulated for audit expenses. 80th article hospital medical insurance parameter assured hospital occurred of medical costs or integrated medical insurance parameter assured outpatient occurred of medical costs, has following case one of of, first paid cash, can by about documents and information to medical of medical institutions by provides handle audit claims: (a) visits of Sentinel medical institutions occurred computer fault or for social security card damaged, reasons cannot accounting of; (ii) by hospital agreed, hospital Shi in hospital outside purchase basic medical insurance directory range within of prescription drug.

    81st article parameter assured should in medical costs occurred of day (hospital from discharged day) up 12 months within submitted following information handle claims procedures: turned out hospital referral proved, and cover has visits hospital seal of outpatient records or hospital records copies, and disease diagnosis proved (outpatient), and discharged diagnosis certificate or discharged summary (hospital), and costs details listing, and original charges receipt, and employing units proved and social security card, information. 82nd article this city household parameter assured retired Hou long-term live in other place of, by I application, its medical insurance personal account balance and the by this approach provides should designated into personal account of amount can into its long-term live to of social security institutions; personal account amount cannot transfer of, by I application, can one-time issued to I, into its received pension of bank account; zhihou its monthly should designated into personal account of amount by months into its received pension of bank account,
    No longer qualify 41st treated in accordance with these measures.
    Paid monthly by social insurance institutions non-residence in this city of old-age insurance benefits retirees elsewhere with long-term residence, upon his own application, its classified as a community clinic and manpower in the health insurance fund of the amount of the monthly access to their bank accounts to receive pension, no longer enjoy the treatment provided for in article 43rd.
    Eighth chapter 83rd of supervision and inspection, social security agencies shall establish a sound financial system of the health insurance fund and the medical insurance fund income and expenditure to the public.
    84th financial and auditing departments in accordance with the health insurance fund payments, transfer and management periodically conducts audits and audit findings to inform the Municipal Commission of supervision of social insurance funds.
    85th health administrative departments at all levels should strengthen supervision and administration of designated medical institutions, will perform appointed medical institutions of Medicare provisions in comprehensive assessment of management by objectives and goal responsibility system linking the President.
    Price Administration Department should strengthen the 86th city designated medical institutions appointed retail drugstores and the implementation of national, Guangdong Province, and city oversight of medical service and drug pricing policies.
    Pharmaceutical supervisory and administrative departments should strengthen the designated medical institutions and appointed retail drugstores and drug quality supervision.
    87th article city social security institutions established medical insurance experts Committee, carried out following work: (a) for city labor guarantees sector according to this approach developed about policy provides medical aspects of technology views; (ii) for city social security institutions for medical insurance supervision check provides technical guidance, on supervision check in the occurred of medical difficult problem provides experts views; (three) for city social security institutions established medical insurance outpatient big disease disease species, provides experts views;
    (D) the insured disputes with designated medical institutions for hospital provides expert advice, comprehensive assessment of the reasonableness of exceptional medical expenses (v) assigned by the social security agencies other health insurance.
    Health insurance included in the social insurance organizations are the work of the Committee of experts of Department budget.
    88th insurance unit pay for health insurance premiums should be announced to the staff every six months.
    Insurance, social insurance institutions, and the insured have the right to query the unit or medical insurance fees, salary and benefits, and so on.
    Municipal social security institutions should facilitate units insured and insured queries.
    89th any unit and individual have the right to prosecute, Sue targeted medical institution, appointed retail drugstores, insurance unit, insured persons, social security institutions, and the illegal or irregular behaviour of staff.
    Report content verification, signature, social security institutions from rewarding funds awarded to prosecutors, specific measures separately.
    90th of municipal social security agency staff and hire medical insurance supervisors designated medical institutions, designated retail pharmacies, insurance, medical insurance insured conduct supervision and inspection.
    Designated medical institutions, designated retail pharmacies cannot be required or to provide all the information, the municipal social security institutions may refuse to pay the corresponding fees.
    Municipal social insurance institutions insurance companies pay for inspections, may request units under inspection and payment of health insurance premiums relating to the employment, payroll, financial statements and other information; records, sound recording, video recording, photography and copy the relevant information, but it should be keep secret for the units under inspection. 91st in designated medical institutions for treatment, the insured should show my social security card.
    The insured lost social security card, and shall promptly report to the municipal social insurance institutions; medical expenses incurred for the period after the loss with a replacement, with relevant certificates and documents of the municipal social security institutions to apply for reimbursement, comprehensive medical insurance insured out-patient medical expenses should be on the basis of the regulations deductions from their personal accounts.
    92nd insured social security card is lost resulting in loss of medical insurance fund, municipal social security institutions may apply to the medical institution or to take recourse against the employer.
    93rd insured and designated medical institutions for dispute arises over the discharge date, may apply to the municipal social protection coordination, social insurance institutions may request expert advice from the Expert Committee on health insurance, within 7 business days from the date of acceptance should be determined by date of discharge.
    94th Nineth chapter legal liability the employer is not required to pay health insurance premiums, in accordance with the interim regulations on the collection and payment of social insurance and the relevant provisions of the regulation on labor security supervision.
    The employer is not required to pay health insurance premiums, insured medical expenses incurred during this period by the employer be paid according to the standards of the regulations affecting insured continuously insured period, resulting in the loss of health insurance benefits and losses in part by the standards prescribed by the employer in accordance with the means to pay.
    95th medical institutions, appointed retail drugstores violated signed agreement with the social security agreement, as stipulated in the agreement; a suspected crime, transferred to the judicial organs according to law.
    96th medical institutions, appointed retail drugstores violating price regulations, medicines prescribed by the regulations or health care management, prices, medicines, after health authorities in accordance with the relevant provisions, shall inform the municipal social security institutions will handle results in a timely manner.
    97th article parameter insurance units for not meet I City medical insurance parameter insurance range of personnel handle medical insurance parameter insurance of, the parameter assured of medical insurance relationship invalid, has paid of medical premium respectively back to parameter insurance units and personal, while, city social security institutions can on parameter insurance units sentenced 5000 Yuan above 10000 Yuan following of fine; on medical insurance and manpower Fund has paid of costs, by city social security institutions recovered; suspected crime of, transferred judicial organ law processing.
    98th units or individuals to obtain medical insurance funds by the municipal labor and social security departments ordered to return, if the circumstances are serious, the municipal labor and social security departments by the amount defrauded more than 1 time fined not more than 3 times; a suspected crime, transferred to the judicial organs according to law.
    99th hinder or obstruct the municipal labor and social security departments, municipal social protection agency staff inspection and investigation, in accordance with the People's Republic of China Law on administrative penalties for public security regulations.
    100th of municipal social security institutions for abuse of power, negligence, malpractice, be disciplined according to law; a suspected crime, transferred to the judicial organs according to law.
    101th Medicare administrative relative person of the municipal labor and social security departments, specific administrative acts of the municipal social security institutions may apply for administrative reconsideration or bring an administrative lawsuit in accordance with law.
    Tenth chapter supplementary articles article 102th Governments approved the establishment of the College in the deep, its registered students may refer to the way to comprehensive health insurance, hospitalization insurance regulations, school uniform insurance formalities, payment of health insurance premiums.
    103th enterprises may not exceed the total wages of staff and workers of 4% extraction Enterprise supplementary medical insurance premiums to cover the enterprise supplementary medical insurance benefits from employee benefit costs would be covered by, and the specific measures shall be formulated separately by the municipal government.
    104th retired personnel and one to six armymen (formerly second grade b or above disabled revolutionary servicemen), safeguard measures shall be formulated separately by the City Government.
    105th indigenous personnel to joint-stock company as the employer of rural urbanization in medical insurance and fees.
    106th insured due to large amount of out-of-Pocket medical expenses, causing living below the subsistence level in the city, unable to afford medical care, may apply to the municipal organization of social insurance to cover medical expenses special payments, specific measures by the municipal labor and social security authorities and the finance, civil affairs departments separately.
    107th of municipal labor and social security departments in accordance with this approach to develop medical insurance management approaches. 108th, last year's average monthly wage of fully employed staff is subject to data released by the municipal Statistics Department.
    Referred to in this way, last year's average monthly wage of fully employed staff and by the first half of this year on the city's average monthly wage of fully employed staff calculations, by the second half of last year the city's average monthly wage of fully employed staff calculations.
    109th mentioned in these measures refers to the medical insurance from July 1 to June 30 of the year.
    110th referred to above, the following contains the number of this approach.
          111th these measures shall come into force on March 1, 2008, enacted on May 27, 2003, Shenzhen social medical insurance policy (125th deep house) and of the interim measures for labor workers ' medical insurance in Shenzhen from the date of implementation of the measures annulled.