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(Adopted by Decree No. 265 of 27 November 2007 on the Government of the South Kyoto Republic, which was published as of 1 April 2008) Chapter I General In order to improve the basic social health insurance system in the town, the basic medical needs of the insured persons are guaranteed, and in accordance with the relevant laws, regulations, such as the People's Republic of China Labour Code, the State Department's Decision on the establishment of a basic health insurance system for the workers in the town, this approach is being developed in conjunction with this city. Article 2 Article 3. Government of the urban, district (zone) is responsible for the harmonization and integrated management of basic social health insurance in towns. The municipal labour security administration is responsible for the basic social health insurance in the town. The municipal, district (zone) labour security administration is responsible for the basic social health insurance work in the integrated area, with the Medical Insurance Service (hereinafter referred to as the institution of the Office of the United Nations High Commissioner for Refugees (UNHCR) in specific town social health insurance matters. Sectors and trade union organizations, such as development and reform, finance, civil affairs, health, education, food and drug surveillance, tax, price, audit, public safety, should, within their respective responsibilities, assist the labour security administration in its basic social health insurance work. Article 4 Article 5 Basic social health insurance in towns should be based on the affordability of user units, individuals and government finances, to determine the level of financing and to adhere to the principle that the level of safeguards is adapted to the level of local economic development and to uphold the principles of receipt, balance of payments, savings and coverage. Article 6. The municipal labour security administration, in accordance with the economic development of the city and the operation of the basic health insurance system, will advise the relevant authorities on adjusting the base, payment standards and related treatment for the basic health insurance. Article 7 establishes the Social Health Insurance Monitoring Organization for Towns responsible for social oversight of the implementation of the health insurance policy. The Health Insurance Monitoring Organization consists of representatives of the human person, members of the Government and relevant ministries, trade unions, user units, medical institutions and retail pharmacies, as well as experts. Chapter II Basic health insurance for urban workers Article 8. Basic health insurance for urban workers is compulsory social insurance by the Government. Various types of enterprises, individual economic organizations, non-commercial units of civil service, social groups (hereinafter referred to as the user's unit) and their practitioners (including retired staff, 1 to 6 decommissioned persons) and flexible employment personnel should participate in the basic health insurance for urban workers. National agencies, utilities are involved in the basic health insurance for urban workers, in accordance with the relevant provisions of the State and the province. Article 9 Flexible workers should be allowed to attend the registration process for the basic medical insurance for the workers of the town (zone) at the place of their own household or residence, and to pay the basic medical insurance expenses as required. Article 10 Basic health insurance payments for urban workers are paid jointly by the user unit and the in-service workers. The user unit is paid by 9 per cent of the total salary of the active employee; the active worker pays on the basis of 2 per cent of his or her salary and is paid by the user's unit from the employee's monthly salary. Individuals of retirees do not pay. A 1% of the average salary of the flexibilities in the last year is paid in the city. Article 11. Basic health insurance payments paid by a person's unit, the enterprise is charged from the employee's welfare fee; the State organs, business units and social groups are dealt with by the source of funds; and other user units are implemented in accordance with the relevant national provisions. The basic health insurance fees for flexible employed persons are borne by individuals. Article 12 (i) The Integrated Fund consists of the deduction of basic medical insurance fees paid by the user unit and the flexible employed person to the remainder of the personal accounts and the lauruna, interest, financial subsidies, lump-sum and other income. (ii) Individual accounts include basic medical insurance payments paid by the insured person, part of the integrated fund, one-time start-up funds, interest and other income. The principals and interest in the personal accounts are owned by the individual and may be transferred and inherited. The proportion of the annual average monthly pension of the staff member of the Integrated Fund, according to the personal accounts of the insured person, has been transferred to the personal accounts of the insured person on a monthly basis on the basis of the contributions paid by the in-service worker himself and the retirement (service). The individual accounts of the retired (service) personnel are less than the minimum amount of the accounts, partly filled by the Integrated Fund on a monthly basis. Article 13. For the first time, a person's unit participates in the basic health insurance for the worker in the town and should pay a one-time start-up fund for the insured person, as required. One-time start-up funds are fully transferred to the individual accounts of the insured person. The number of retirees accounting for more than 33 per cent of the current workforce and the payment of one-time basic health insurance funds should be made in the event of the basic medical insurance for the workers. The user unit is involved in pre-insecution, non-worker maiming, and other persons who undergo early retirements as prescribed by the State (other than those who are in advance of special work under the relevant provisions of the State), and the person's unit shall pay a lump-sum basic medical insurance fee to the statutory retirement age, as required. Those who were retired after the insurance were paid for the basic medical insurance expenses of the urban worker for a period of up to 30 years, the woman was less than 25 years, and the flexibilities of employment were paid for a continuing period of up to 10 years and, in the course of the retirement process, the owner or the individual of the insured person should pay the basic health insurance fee for the town worker for a year of a lump sum. Article 14. The basic health insurance of the urban worker may be transferred according to the regulations and the annual period of payment. The Office shall liquidate the individual accounts of the insured person in the course of the transfer proceedings. Article 15 shall not involve a person who has lost or has lost his or her labour capacity to participate in the basic health insurance of the urban worker on the basis of new labour relations and to receive medical insurance treatment. Chapter III Basic health insurance for urban residents Article 16: (i) No basic medical insurance for urban workers, who have reached 60 years of age and who have reached 55 years of age; (ii) Be up to 16 years of age, the age of 60 years for males, the age of 55 years for females and the unfettered occupation, the unspeakable income and the urban population without social security; (iii) A variety of pupils in schools (including kindergartens, primary schools, early secondary schools, high-level, special schools) and infants; (iv) The children of non-resident urban occupants who take up primary schools in this integrated area and whose parents have participated in social insurance in this integrated area; (v) Students at all-time, secondary colleges and technics. Article 17 is a person participating in the basic health insurance of the urban population and shall be subject to the registration process in the place of his or her residence or in the street (town). Article 18 The financial support is paid to the elderly population, to the minimum number of living guarantees, to persons with disabilities and to students. The user units share a portion of the costs for the participation of the child of the worker in line with family planning policies. Article 19 During the period specified, the registration process and the payment of royalties in full enjoy the basic health insurance treatment of the urban population effective 1 January of the contributory year. Article 20 establishes the Basic Health Insurance Fund for Urban Residents, consisting of financial subsidies, personal contributions and interest. The basic health insurance for the urban population does not establish an individual account. Chapter IV Article 21, for farmers who have already established labour relations, the user units shall be required to participate in the basic health insurance for their workers in towns, as well as for the short-term employment and employment of peasant workers, and for the user's units or employers must participate in the health insurance for their farmers. Article 2 Article 23 provides for low rates of health insurance for farmers in order to take care of the current period and to protect the disease. Farmers are paying the average annual salary of their workers in the integrated area. Farmers are not able to establish personal accounts. Farmers are paid by the user's unit in the month. Since the contributory month, the farmers' workers can benefit from the health insurance. Supplementary health insurance Article 24 participates in the basic health insurance of the urban workers and should be accompanied by medical assistance. The medical assistance rate is paid on a monthly basis by the individual participating in the care (including retirement, re-entry). The General Medical Relief Fund includes major medical assistance, interest and other income paid by individuals. Article 25 provides for the establishment of a supplementary health insurance for business workers. The cost of additional health insurance for employees is set up by the user unit, with a total salary of 4 per cent within the workforce, which is covered by the cost. Article 26 persons involved in the health insurance for farmers should participate simultaneously in the mutual health assistance insurance for their work. Farmers are paid by individuals according to their regulations and are charged with deducting them. Chapter VI Medical insurance treatment Article 27 Changes in the status of the insured person may be transferred between the provision of basic medical insurance for the workers in the town, the basic health insurance for the urban population and the health insurance for farmers. Specific approaches are developed by the municipal labour security administration with the relevant sectors. Article 28 (i) The cost of the general clinic is paid by the individual account or by the individual; (ii) The application of a limit grant for the treatment of chronic illnesses at the prescribed rate of payment; (iii) Disbursement of specific project costs by a specified proportion; (iv) The provision of targeted assistance for the treatment of mental illnesses and for the treatment of AIDS; (v) Inpatient costs are paid in proportion to the standard of payment and the maximum payment limit, which is paid by the insured person, the basic health insurance fund for the urban workers, and the Medical Relief Fund; (vi) Exclusive support for the costs of the family beds; (vii) Other basic health insurance treatment is implemented in accordance with the relevant provisions. Article 29 Access to basic health insurance benefits for the basic health insurance of the urban population is as follows: (i) Exclusive grants for treatment and treatment costs, which are higher than the payment rate and the maximum payment limit; (ii) Inpatient costs are paid above the threshold and the maximum payment thresholds are paid by the insured person, the basic health insurance fund for the urban population; (iii) Other basic health insurance treatment is implemented in accordance with the relevant provisions. Article 33 Employer workers in large-scale health insurance coverage are provided for inpatient and inpatient treatment. The cost of diagnosis and inpatient care is paid above the standard of payment and the maximum payment limit, as prescribed. Article 31 Standards of payment of basic social health insurance in towns, the highest payment thresholds and the proportion of personal self-payments are developed by the Integrated Regional Labour Guarantee Administration. Article 32 provides for the implementation of the relevant provisions of the Integrated Area Labour Guarantees Administration and the application for access and clearance management. Article 33 of the Basic Health Insurance for Urban Employers is carried out in accordance with the relevant provisions of the State and the province, and the coverage of medical services takes into account the relevant provisions of the State and the province. Access to health-care hospital preparations and the proportion of payments for medical services are determined by the Integrated Regional Labour Guarantee Administration in conjunction with sectors such as health, medicine regulation. The basic health insurance of the urban workers is covered by the provisions of the basic health insurance. The coverage of medical and medical services for basic health insurance for urban residents and for farmers' health insurance workers is carried out in the light of the relevant provisions of the basic health insurance for urban workers. Article 34 interruptions or failure to pay in full after taking part in the basic medical insurance for the workers in the town, the suspension of the basic medical treatment of their insured persons (including retirements, retiring personnel) from the previous month and the suspension of the payment of accounts to the individual accounts; the release of a person's unit within three months, the recovery of basic medical treatment from the end of the month of payment, the transfer of an individual account and the payment of medical expenses incurred during the period of the payment; and the payment of the medical expenses incurred in excess of three months after the payment is provided for the rehabilitation of the fund. Flexible employed persons were discontinued or paid in full after the basic medical insurance for their workers in the town, who had suspended their basic health insurance treatment since the month of the month and had suspended their accounts; in the three-month period, paid accounts were added to the individual accounts, paid for a continuing period of time and returned to the basic health insurance entitlements from the time of the replenishment; and in excess of three months' repayments had to be paid for basic health insurance treatment, which would have to be recalculated for the consecutive year. The Integrated Fund for Medical Costs and the Medical Relief Fund, which were incurred during the flexibilities of employed persons, were not paid. The urban population has not been subject to a specified period of time or to the suspension of follow-up insurance, and is subject to a system of waiting periods. Medical expenses incurred during the interruption of payment and pending periods are not paid by the basic health insurance fund for the urban population. In the absence of a provision for participation in large-scale health insurance or disruption of contributions by farmers, the medical costs incurred by farm workers are in line with the portions paid by the Farmers' Health Insurance Scheme. Article 35 Medical expenses incurred by the insured person in the following cases are not included in the coverage of the Basic Social Insurance Fund for Towns: (i) Medical costs other than the coverage and standards of basic social health insurance in towns; (ii) Medical costs incurred by non-scheduled medical institutions (other than rescue) and the purchase of medicines in non-suited retail shops; (iii) Medical costs that fall within the scope of work injury and maternity insurance; (iv) Medical costs incurred by an offence committed by itself; (v) Medical accidents, pharmacies, transport accidents, etc. (vi) Medical costs resulting from suicide, self-immobilization (other than psychiatric persons), alcohol abuse; (vii) Medical costs incurred during the departure period; (viii) Other expenses that should not be included in the coverage of basic social health insurance in the town. Chapter VII Article 36 provides for the introduction of targeted medical institutions for basic health insurance for urban workers, and for the management of targeted retail pharmacies. The basic health insurance for the urban population and the health insurance for farmers are administered by targeted medical institutions. The Labour Guarantees Administration should determine, in accordance with the principles of unified planning, reasonable downturn, easy access to medical care, the need for balance and fair competition, targeted medical institutions and targeted retail stores with the relevant departments. Article 37 provides for conditional medical institutions and retail pharmacies, which can apply to the integrated area of labour security administration for basic health insurance. The Labour Guarantees Administration examines the qualifications of the choice. The Labour Guarantees Administration should determine, in accordance with the relevant provisions, the exact retail pharmacies through marketization, such as tendering. The office should enter into a service agreement with the targeted medical institutions and the terminal retail pharmacies and be made public to the community for the choice of the insured person. Article 338 The Social Security Cardage, which is to be issued jointly by the Office of the United Nations High Commissioner for Refugees, shall be subject to medical treatment (other than pillage) or purchase of medicines. In the case of medical care and purchase of medicines, the targeted medical institutions and the terminal retail pharmacies should be subject to nuclear tests. The insured person shall not transfer his or her social security card to another person or otherwise deceasing the basic social health insurance treatment, a basic health insurance fund. Article 39 encourages and directs insured persons to consult with community health services institutions. The basic health insurance for the urban population is the first, referral system, which is the primary health service provider. The occupants need referrals, with the responsibility of the first medical institution. Article 40 Medical institutions should uphold the principle of reasonable inspection, reasonable medicines, reasonable treatment, reasonable fees and provide quality and affordable medical services to the insured person. The targeted medical institutions should regulate medical behaviour, reduce the proportion of self-payments paid by the insured person and alleviate the economic burden of the insured person. The following acts are prohibited by a targeted medical institution and a targeted retail pharmacies: (i) The absence of a medical certificate resulting in the loss of the health insurance fund; (ii) Including non-fundamental health insurance diseases, medicines, medical treatment projects and special medical material, or including medical expenses paid by the non-health insurance fund in the coverage of the health insurance fund; (iii) Removal of medicines, e-projects, pharmacies, and deceasing expenditures from the health insurance fund; (iv) In the form of falsification of medical diagnostics or forfeiture of medical treatment projects, deceasing expenditures from the health insurance fund; (v) Other acts of fraud in the treatment of health insurance or of the receipt of expenses of the health insurance fund. Chapter VIII Article 42 includes the coverage of the basic social health insurance costs of the town, in line with the medical costs of the basic health insurance, the scope of medical services and the payment standards. The settlement of the basic social health insurance costs of the town should be monitored in due course by the computer information network system. Article 43 (i) Parts to be paid by the individual accounts shall be settled by the Office of the United Nations High Commissioner for Human Rights, in accordance with the provisions of the targeted medical institution and the customized retail pharmacies; (ii) Individual cash payments should be made by targeted medical institutions, targeted retail pharmacies and individuals; (iii) The integration and disbursement of portions of the basic health insurance of the urban workers and the payment of the Sickness Relief Fund shall be made periodically by the Office of the United Nations High Commissioner for Human Rights, subject to the provision of the regulations and the customary medical institutions, the customary retailer. Medical expenses for basic health insurance for the urban population and for the work of the farmers' health insurance are covered by basic medical insurance for the urban workers. Article 44 requires the referral of treatment by the insured person to be carried out in accordance with the relevant provisions of the integrated area. Retiring (service) personnel or those in field missions have been trained for more than six months (hereinafter referred to as long-term outposts) and should be provided with medical treatment at the local targeted medical institutions in their application and for an integrated regional office. Medical expenses incurred by referrals, long-term expatriate personnel after the processing of the case were incurred by the different-size medical institutions, and medical expenses incurred by the insured person during the temporary departure period due to hospitalization, are reimbursed according to the relevant provisions. Oversight and management Article 42 (i) Registration, investigation, statistics for basic social insurance in towns; (ii) In accordance with the regulations governing the management of the Basic Social Insurance Fund for Towns, the basic social health insurance treatment is approved; (iii) The implementation of basic health insurance laws, regulations and inspections by law of targeted medical institutions, targeted retail pharmacies; (iv) Provision of free advisory services to the insured persons and participating units; (v) Other functions to be performed by the provision. Article 46 provides for the cause of the institution not to be drawn from the Basic Social Insurance Fund of Towns, which is included in the annual financial budget. Article 47 should enhance the supervision of targeted medical institutions. Price management should strengthen the supervision of the implementation of national, provincial, municipal health services and drug price policies by targeted medical institutions and targeted retailers. Food and drug surveillance management should enhance surveillance of the quality of medicines at targeted medical institutions and at-point retail pharmacies. Article 48 provides for the management of the two line lines of pre-, description and income. The Fund is included in the financial pool and is earmarked for separately accounting. The financial, audit and labour security administration should monitor the income and expenditure of the Basic Medical Insurance Fund for Towns by law. Any unit or individual is entitled to inspect the law and violations committed by the targeted medical institution, the custom retail pharmacies, the user unit, the insured person and the staff of the institution. The labour security administration can grant incentives to the reporting person as prescribed. Article 50 provides the right of the user unit and the insured person to consult the institution or his medical insurance contributions and treatment payments. Article 50 states that a person's unit shall be made available to the worker on an annual basis for the payment of the medical insurance. Article 52 guarantees the executive branch to establish a customary medical institution and a customized system for retail stores. Upon inspection by the Agency of targeted medical institutions, customized retail pharmacies, the targeted medical institutions and the terminal retail pharmacies are obliged to provide information and cost lists. Inadequate provision or provision, the duration of the duty is provided or filled; the uncorrected delay is not covered by the Basic Social Insurance Fund for Towns. In violation of the health insurance laws, regulations and regulations by targeted medical institutions and custom retail shops, the labour security administration can be made public to society. Article 53 provides for the establishment of a social basic health insurance risk reserve at the appropriate time of the city. Risk reserves have been extracted from the cashed Town Social Health Insurance Fund. Chapter X Legal responsibility Article 54 does not pay in full the payment of basic social health insurance fees in the town or non-performance obligations, which are addressed by the relevant departments in accordance with the relevant provisions of the State Department's Labour Guarantee Monitoring Regulations and the Social Insurance Reimbursement Provisional Regulations. In violation of article 15 of this approach, the health insurance relationship of the insured person is null and void, and the institution should recover the costs paid by the basic health insurance fund to the user unit and the labour security administration may impose a fine of more than 5,000 yen units. Article 56, in violation of article 38, paragraph 3, of this approach, shall recover the costs incurred by the basic health insurance fund in accordance with the law. The labour security administration can impose a fine of more than three times the number of participants in the basic health insurance fund. In violation of article 41 of the scheme by the targeted medical institutions and the customized retail pharmacies, the medical insurance treatment or the receipt of the expenses of the health insurance fund shall be charged by the institution in accordance with the law. The Labour Guarantees Administration may impose a fine of up to $300,000 for targeted medical institutions, which imposes a fine of more than 100,000 dollars for the fixed-point retail pharmacies, or suspends or removes the qualifications of its targeted medical institutions and the fixed-point retail pharmacies, and publicize them. Article 58 guarantees the executive branch, the executing agency and other government departments toys negligence, abuse of authority, provocative fraud, resulting in the loss of the health insurance fund, or the infringement of the interests of the user's unit, the insured person, administrative disposition by their units or superior authorities; and criminal responsibility is lawfully prosecuted. Article 599 allows parties to apply for review or prosecution in accordance with the law to the executive branch of labour security, the management decision of the institution and the decision of the punishment. Chapter XI Article sixtieth imposes medical costs due to non-resistance factors such as mass sexual abuse or mass natural disasters, in accordance with the relevant provisions. The medical treatment of the old-age army and the rest of the population is carried out in accordance with the relevant provisions of national and provincial municipalities. The medical treatment of school students at the tertiary level is implemented in accordance with the relevant provisions of the State and the province. In accordance with article 62, the executive branch of the municipal labour security administration will establish rules for implementation with the relevant departments. Article 63/ ter. In the area of Jenin, the che, the six zones, the watershed wards, the Hon-Khet may, on the basis of this approach, develop implementation approaches in the local context. Article 64 of this approach is implemented effective 1 April 2008. This approach is based on the fact that the basic health insurance provisions developed by the former city are inconsistent with this approach. |
