Key Benefits:
(Adopted by the 13th ordinary meeting of the Government of the Hasahama on 21 September 2007, No. 176 of the Order of the People's Government of the city of Halara on 1 November 2007) Chapter I General Article 1, in order to further improve the health insurance system, establish a system of medical safeguards covering all urban residents, guarantee basic medical needs for the urban population and develop this approach in line with the relevant provisions of the State Department's guidance on the implementation of the basic health insurance pilots for urban residents. Article 2 is owned by towns in all municipalities and is not included in the basic health insurance coverage of urban workers (excluding university students) and may participate in the basic health insurance of the urban population on the basis of this scheme: (i) Non-employed residents aged 18 years or older (including 18 years) (hereinafter referred to as adult residents); (ii) Residents of the 18-year-old town, including infant-children (excluding 28 days of birth), preschool-school children, primary and secondary schools (including secondary professional schools, technic schools, secondary vocational technical schools, special schools) (hereinafter referred to as children). Article 3. This approach is organized by the municipal labour security administration. In accordance with the provisions of this approach, the IMS is specifically responsible for the accreditation of the basic health insurance for the host urban population, the payment of fees, the payment of medical expenses, and the day-to-day work on medical management. Sectoral labour security administration and health insurance institutions, street offices, community labour security services are specifically responsible for the registration of basic health insurance for urban residents, information changes and policy advice. Sectors such as urban development reform, finance, health, civil affairs, education, drug surveillance, public safety and disability should be based on their respective functions on basic health insurance for the urban population. Article IV upholds the following principles for the basic health insurance system for the urban population: (i) A low level of time and a reasonable determination of the level of funding and the standards of safeguards, with a focus on safeguarding the health-care needs of the urban non-affected population; (ii) The rights and obligations of the resident in the occupies are commensurate with the level of financing; (iii) Medical insurance costs are shared by the family and the Government; (iv) The use of the Fund is consistent with the receipt, balance of payments and a slight balance; (v) Explanatory management and integration at the municipal level. The basic policies, standards and management measures for the basic health insurance of the urban population are linked to the basic health insurance system of the urban workers, and the mechanisms for the establishment of funding levels, annual pay and treatment levels are gradually explored; (vi) To encourage urban residents with labour capacity within the age of labour to participate in the basic health insurance for urban workers through multiple forms of employment. Article 5 Article 6. The Basic Health Insurance Fund is used primarily for hospitalization and special illness treatment for residents of the insured town, for personal accounts and for the management of the health insurance card. Article 7. Generic health insurance systems for urban residents are subject to targeted medical care and referrals. Chapter II Article 8 (i) The standard of funding for adult residents is $330 per year. Of these, the Government grants US$ 60 and 270 to individuals. For the elderly aged 60 years and above who are at least insured, with a heavy disability and low-income households, the Government grants US$ 265 and the individual pays US$ 65. (ii) Student funding standards are $90 per person per year. Of these, the Government grants US$ 60 and the family pays US$ 30. Students with low-insecure or severe disabilities are receiving $80 per year by the Government and 10 by the family. The residents of the newly encumbered town shall be held from 1 September to 20 December each year, the original identification card and its photocopy, the near-term non-open photograph 2 to the community labour security services in the area where the household is located. Low-insurance targets and older persons over 60 years of age in low-income households should provide the Minimum Living Guarantees for the City of Harhama and low-income certificates; and the People's Republic of China Disability certificate should be provided by the heavy disability. Students are subject to uniform registration and payment procedures by their schools or childcare agencies. Newborns may be held by parents after 28 days of birth to take part in the home-based community labour security services. Access to basic health insurance was granted in the month of payment. Article 10, after registration of the resident of the occupants of the occupants, pays a lump-sum medical insurance fee in full to the designated bank for the period of payment. The Community Labour Security Service (WAS) has not been properly reviewed for the release of basic information into the computer, which is actually transmitted to the IMS. The municipal health insurance agency produced the Basic Health Insurance Certificate for the Residents of the town of Hara, to be issued by the Community Labour Security Service. Article 11. Basic health insurance expenses for the urban population are subject to annual pre-payments for the first year of basic health insurance payments for the urban population from 1 September to 20 December each year. Article 12 Article 13 Removal of the basic health insurance treatment of the urban population by providing for conversion to the basic health insurance of the urban worker or other forms of medical security by the Government shall not be accorded to the basic health insurance of the urban population and the payment of the expenses shall not be returned. Article 14. The municipal health insurance agency prepares a government subsidy scheme for the basic health insurance of the urban population each year and reports to the municipal financial sector. Chapter III Basic health insurance treatment Article 15. Adult residents are involved in the custody process and paid their basic medical insurance expenses in full, and have received basic medical treatment effective 1 January of the contributory year. Students pay health insurance fees for the year of study and receive basic health insurance treatment from their contributions. Article 16 is hospitalized by the residents of the insured towns and implements the provisions of the national, provincial and provincial drug catalogues, therapeutic projects and the range of services facilities. Article 17 Medical expenses incurred are paid under the payment criteria and are paid by individuals. The payment criteria are implemented in accordance with the following provisions: (i) Adult residents are inpatient in community health services, amounting to $2.0; inpatient hospitals at the level of medical institutions at the level of 240; inpatient hospitals at the secondary level, at $480; and inpatient hospitals at the third level, at $720. (ii) Students are inpatient in community health services, amounting to US$ 150; in-patient hospitalization at the level of medical institutions at the level of US$ 200; inpatient hospitalization at the secondary level; and US$ 400 at the third level of medical institutions. In one natural year, the rate of payment was reduced by 10 per cent from the second inpatient hospital, and the implementation of the 2 inpatient care standards was observed on a number of occasions. Article 18 is a one-time hospital that refers to the process of the patient's conduct of a school and a hospital. Emergency rescue and inpatient inpatient detention are considered a one-time hospitalization. In the 5 days of hospitalization, the referral of infectious diseases to specialized hospitals may be considered a one-time hospital and the implementation of the payment standards for higher categories of hospitals. The one-time inpatient process is multi-year and is determined at the end of the treatment. Article 19 Residents of the occupier's medical institutions should be hospitalized and a certain amount of advance payments should be made to targeted medical institutions to cover costs that should be borne by individuals. Article 20 states that persons with mental illness are hospitalized in specialized medical institutions and that there is no standard of payment, in line with 25 per cent of the medical expenses paid by the Integrated Fund. Article 21 Medical costs incurred by the residents of the occupier medical institution inpatient care are higher than the standard of payment for the Integrated Fund, with the highest payment limit being shared by the Integrated Fund and individuals on the basis of the level of medical institutions. Inpatient medical costs incurred by adult residents are shared according to the following proportion: (i) Inpatient hospitals in community health services institutions, the Integrated Fund paid 65 per cent and the individual burdens 35 per cent; (ii) Inpatient hospitalization at the level of medical institutions, 60% of the integrated fund and 40 per cent of the individual burden; (iii) Inpatient hospitals in secondary medical institutions, 55% of the Integrated Fund and 45 per cent of the individual burden; (iv) Inpatient hospitalization at three levels of medical institutions (excluding part of the city's referral hospitals), the Integrated Fund paid 50 per cent and the personal burden of 50 per cent. Inpatient medical costs incurred by students are 70% of the Integrated Fund and 30% of the individual burden. Some provincial hospitals are identified as the primary health insurance referral for urban residents. As a result of the illness, the proportion of the medical expenses incurred increased by 5 per cent, with the approval of the municipal health insurance agency for referrals to the medical institutions of some provinces. The scope of the referral medical institution is determined separately by the municipal health insurance agency in accordance with the accumulation of the Integrated Fund. Article 2 states that the residents of the occupants in the occupants of the occupancy in a natural year are subject to the highest payment limit of $350,000. Students are settled on an annual basis. The treatment of special illnesses by urban residents is covered by the Integrated Fund. In a natural year, the minimum payment threshold for the Integrated Fund for Adult Residents is payable at the highest rate of US$ 0.5 million; the Integrated Fund for Students does not pay up to 2.5 million. Special diseases refer to stereotyped treatment for maloxinology, blood uroid (diagram) and kidney transplant. In addition to the above-mentioned illnesses, the special illnesses of children include blood, re-hurdle blood, systematic manpower. Targeted medical management is carried out for the special diseases of the insured urban population. The standard for the payment of special illnesses is set out separately by the municipal labour security sector. In accordance with article 24, the following cases occurred in order to meet the payment of medical fees, first paid by a person, after the end of the treatment, the relevant material was reimbursed by the municipal health insurance institution: (i) Visitors in the field (non-considence outside) to visit their homes, tourism, in line with emergency one-time hospitalization within the scope of the basic urban health insurance provision, or in line with the provisions of the basic urban health insurance, emergency medical care institutions for non-urban residents in the city are advised to the municipal health insurance institutions within five working days of the entry into the compound; (ii) In the light of the needs of the disease, the municipal labour security administration has approved the referral of treatment to the different medical institutions; (iii) In the field, the residents of the occupants of the occupants of the occupants of the occupants, who have reached 60 years of age, have reached 55 years of age and have been hospitalized by the selected local targeted medical institutions. The rate of payment criteria and personal burdens for personnel using the Integrated Fund for Health Insurance is corresponding to 20 per cent in subparagraphs (i), (ii) of this article. Article 25 Residents in the occupants of the occupants do not pay their health insurance payments as prescribed, and in the three-month period they receive health insurance treatment. More than three months, the process of re-insecution during the payment period specified in the previous year has been reintroduced. The Integrated Health Insurance Fund for Medical Cost incurred during the interruption of the payment period is not paid. Article 26 is one of the following conditions for the residents of the insured town, and the Integrated Fund for Medical Cost Insurance does not pay: (i) Treatment in foreign or port, Macao and tandem; (ii) Piracy, alcohol abuse, maiming, suicide, drug abuse and ill-treatment; (iii) Traffic accidents, accidental injuries and medical accidents. Article 27 does not apply to residents of the insured town: (i) Evidence of falsification, alteration and cost documents; (ii) Provide health insurance documents to others and take the lead. Chapter IV Fund management Article 28 Sources of the Basic Health Insurance Fund for Urban Residents: (i) Funds for basic medical insurance payments paid by the residents of the insured town and for the medical assistance of the urban population invested by the Government; (ii) The interest and value-added income of the basic health insurance fund. Article 29 Integration of the Basic Health Insurance Fund for Urban Residents into the integrated management of the Fund's financial exclusives, separate accounts, specialized funds, no unit or individual shall be excluded and diverted. Chapter V Article 33 ISA should enter into an agreement with the urban dwellers' targeted medical institutions to clarify their responsibilities, rights and obligations. Article 31 Medical institutions for urban residents should be provided with a monthly list and cost details in a timely manner, for disease treatment, reasonable inspection, reasonable medicines, and in accordance with the provision of inpatient agreements with residents of inpatient towns. Article 32, the municipal labour security administration is responsible for overseeing the implementation of the basic health insurance policies, regulations and performance of management duties for urban residents by targeted medical institutions. Article 33 does not allow for the following acts by a targeted medical body: (i) The cost-of-charge project is not at a minimum price; (ii) Use of non-qualified specialized agencies, documents and statements; (iii) Inpatient pools; (iv) A variety of diseases, drugs and services that are not covered by the Integrated Fund for Health Insurance, or will not be covered by the ITS project, the directory of medicines and services; (v) There is a need for screening, treatment and medication beyond patients' morbidity; (vi) The use of work is forbidden in the name of the insured urban population. Article 34, paragraph 1, of the Basic Health Insurance Management staff of the urban population is not subject to the following: (i) The inclusion of health insurance fees in the integrated fund accounts, as prescribed; (ii) Corruption, diversion of basic health insurance funds; (iii) In violation of the basic health insurance pension management provisions, resulting in the loss of funds; (iv) Exemption, exemption or increase of personal contributions base; (v) Removal of the treatment of health insurance; (vi) To favour private fraud and bribe. Chapter VI Legal responsibility Article 33 XV, in violation of the provisions of this approach, is corrected by a time limit for the executive branch of municipal labour security, which is not later rectified and is dealt with in accordance with the following provisions; constitutes a crime and is criminally liable by law: (i) In violation of article 27 of the scheme, medical expenses paid were recovered and fined by more than 1000 dollars; (ii) In violation of article 31 of this scheme, the medical costs paid by the Integrated Fund for Health Insurance are not payable; (iii) In violation of article 33, subparagraph (ii), of this approach, fines of more than 200 million dollars; (iv) In violation of the provisions of article 33 (iii), (iv), (v), (vi) of this approach, the penalties for more than three times the amount of the offence are fined; the adverse consequences may be eliminated. Article 36, in violation of article 33 (i) of this approach, is punishable by the price sector in accordance with the relevant provisions. Article 337, in violation of article 34 of this approach, is to be administratively disposed of by the competent authority of management; constitutes an offence and is criminalized by law. Article 338 was resolved by the parties in consultation with the dispute regarding the basic health insurance of the residents of the occupants of the occupants of the occupants of the occupier, the medical establishment, the medical insurance agency, and the medical insurance agency concerned; the consultations were not agreed and were conducted by law or by the labour security administration. Administrative litigation can be initiated against the management of labour guarantees. Chapter VII Article 39 personnel who have participated in the basic health insurance for the workers of the town and who have disbanded the labour relationship with the enterprise, and as a result of the lack of employment or economic hardship to proceed with the health insurance, the basic health insurance coverage of the urban population is provided for in this scheme, which is based on the average salary of the employee in the above-year communes, which is estimated at 9.5 per cent or 5 per cent of the contributions paid to the basic health insurance for the urban workers, and an additional 15 years of the health insurance. Since the change of month, the corresponding pension health insurance treatment has been enjoyed. Article 40 is in line with the scope of insurance provided for in this scheme, which is subject to the relevant provisions to participate in the basic health insurance of the urban population, may continue to be insured in accordance with the provisions of the former, without the benefit of the Government; also participate in the basic health insurance of the urban population under this scheme and be processed by 30 November 2007 to municipal health insurance institutions. In accordance with this approach, the payment of medical insurance fees has not been incurred and the payment of medical insurance payments has been returned; the medical costs incurred are less than the payment of medical insurance payments and the remaining medical insurance payments have been returned. Article 40. Funding standards for the basic health insurance of the urban population, government subsidies standards, the standard of payment for the integrated fund, the maximum payment limits and the proportion of payments are adjusted by the municipal labour guarantee administration, in accordance with the level of funding and operation of the previous annual health insurance fund, to be followed by the approval of the Government of the city. Article 42 states that, during the financial period of the financial system, the Accommodity shall not enjoy the municipal fiscal support policy and, on the basis of the central, provincial subsidies, the city's finances are provided to the urban population in the Territory and integrated into the municipal level. Upon harmonization of the financial system, the corresponding municipal fiscal support policy is available. A conditioned unit of an agent may grant assistance to the employee's family for payment. Persons participating in the basic health insurance of the urban population may participate in commercial supplementary health insurance. Business insurance bidding programmes and specific approaches for urban residents are developed by the municipal labour security sector and implemented after approval by the municipality. Article 44 |
