Key Benefits:
(Adopted by the 79th Standing Committee of the People's Government of the fertilities of 8 December 2006 No. 125 of 13 December 2006 by Order No. 125 of the Government of the People's Republic of Pornography on 1 January 2007) In order to strengthen the supervision and management of the basic health insurance fund in my city, to combat the use of the basic health insurance fund and to promote health development in the health insurance system, the following changes have been made to the provisional provisions of the Basic Health Insurance for Workers in Pyipe Towns, in accordance with the relevant legal regulations: Article 33 adds a paragraph to read as paragraph 2: “The participant shall not transfer his or her social security card to another person's hospital and shall not be redirected or provided with false medical receipts and medical instruments”. Article 31, paragraph (iv), was amended to “take basic health insurance funds, including drug abuse, by sub-patient, false hospitalization, inpatient hospitalization, reduction of admission standards, and the conversion of essential health insurance to medicines or other goods, and the misuse of drugs”. Article 47 was amended to read: “The final medical institution and its staff are subject to a fine of up to 300,000 dollars in violation of article 34 of this provision, which may impose a fine of up to $100,000, directly responsible supervisors and other directly responsible personnel liable for a fine of 1,000 dollars; in exceptional circumstances, until the release of the qualifications of the targeted medical institution, the dismissal of the principal head of the medical institution shall be subject to the appropriate administration until the removal of the probationary service, and the removal of the amount shall be deducted from the sum of the cost of the medical insurance. Article 48 was amended to read: “The fixed-point retail pharmacies and their staff members are in violation of article 37 of this provision, the health insurance agencies shall refuse to pay or recover the corresponding costs incurred and shall be reduced by two to three times, the amount of nuclear reductions shall be deducted from the amount to be paid in the end of the month, while at the same time the payment of the basic health insurance funds is suspended; the unit may impose a fine of up to 300,000 dollars, with the principal holder, the direct holder and other personnel liable to a fine of 1000 dollars. In addition, as article 50, “Partners are in breach of article 33, paragraph 2, the Medical Insurance Service shall recover the corresponding costs incurred and suspend the medical treatment of the insured person for a period of 3 to 6 months, and the medical expenses incurred during the suspension shall be borne by themselves; the criminal liability shall be held in accordance with the law. Article 57, “Instructions and individuals who report violations of the basic health insurance fund acts, are granted by the Labour Guarantee Administration and are funded separately from the same level of finance, specifically by the municipal labour security administration. In addition, the order and part of the provisions are adjusted accordingly and modified. This decision is implemented effective 1 January 2007. The provisional provision for basic health insurance for fertilized urban workers is revised in accordance with this decision and re-published. Annex: Provisional provision for basic health insurance for fertilized urban workers (Amendment 2006) (Act No. 82 of 14 November 2000 of the People's Government Order No. 82 of 14 November 2000 on the revision of regulations such as the Decision of the Government of the fertilities of 10 January 2005 on the revision of the provisional provisions on basic health insurance for the workers of the fertilized municipalities, in accordance with the Decision of the Government of the People's Government of the fertilities of 13 December 2006 on the revision of the provisional provisions of the health insurance for the workers in the communes) Chapter I General Article 1 provides for the establishment of a basic health insurance system for urban workers, the protection of basic health care for workers, the improvement of the level of health of workers and the promotion of health development in the health of medical care, in line with the provisions of the State Department's Decision on the establishment of a basic health insurance system for urban workers, the implementation of the reform of the residential health insurance system, in the Ablem province. Article 2 (i) State organs, utilities and their employees; (ii) Social groups, civil service units and their employees; (iii) Retirement in accordance with national provisions in the units of the user participating in the basic health insurance. Town enterprises and their employees, owners of the town's individual economic organization and their practitioners will not participate in the basic health insurance. Article 3 Central and provincial authorities, entrepreneurship units and their employees are functioning in the same policy, subsectional operation, and central and provincial enterprises that have participated in the fertilization market-based insurance are integrated into the basic health insurance coverage of the fertility city. Found, fertile and fertile are integrated in the districts. The Article IV Labour Guarantees Administration is the competent authority for the basic health insurance of workers in the city, with the specific responsibility of health insurance agencies. The sectors such as health, medicine, finance, geo taxes, prices and audits are working together on basic health insurance, in close collaboration with their respective responsibilities. Article 5 Article 6. Units and individuals must fulfil their obligations under the law to pay basic medical insurance expenses, and the insured persons have the right to basic medical insurance treatment. Chapter II Article 7. Basic health insurance expenses are paid jointly by the user unit and the employee in the month. The total monthly salary of all employees of this unit is paid at a rate of 8 per cent in the proportion of contributions paid for medical insurance payments in the month of the month, and the average monthly salary income of the employee is paid at a rate of 2 per cent for the year from 1 July to the end of June. The monthly payment rate for each unit is less than 60 per cent of the average monthly salary for all employees in the previous year, which is determined by 60 per cent of the contributions base; the average monthly salary of 30 per cent for all employees in the previous year, at 30 per cent. The monthly salary income of the employee is less than 60 per cent of the average monthly salary of the full-time employee, which is determined by 60 per cent, and the average monthly salary of 30 per cent for all employees in the previous year, at 30 per cent. The total salary of the employee is calculated in accordance with the statistical calibre established by the State. In the event of the new unit's attendance at security, the average monthly salary of the employee in the region is higher than the number of employees in the unit as a unit pay base, with the average monthly salary of the employee in the region as a contribution base. During the Centre, basic medical insurance payments (including unit contributions and personal contributions) were paid by the Re-Eurgation Services Centre at 60 per cent of the average monthly salary of employees in the region. Article 8 (i) Agencies, social groups units are charged with social security payments that are recurrent; (ii) The treasury unit is charged from the social security fee incurred by the cause; (iii) Enterprises are ranked from employee benefits; (iv) The payment of basic medical insurance expenses paid by the individual worker from the employee's salary; (v) Basic health insurance fees for national businesses entering the Re-Eurgation Service Centre, which are included in the basic life safety requirements of the re-employment service centre. Article 9 Individuals of retirees do not pay basic medical insurance fees. The participating units must be charged directly, in accordance with the monthly amount of medical insurance payments to be paid to the tax sector. Article 10 shall be subject to the Social Insurance Registration Certificate when the person is in the custody of the insured person, and the following procedures shall be handled by the health insurance institution: (i) To complete the participation of the fertile regional user units in the basic health insurance application form, the roster of insured persons, the salary statements, etc.; (ii) A basic health insurance agreement; (iii) A social security card. Article 11 (i) The inclusion of persons not covered by the basic health insurance; (ii) The total salary of the minor; (iii) Recruitment of persons with sickness and non-compliance with the conditions of insurance to the unit for basic health insurance; (iv) Provision of false vouchers to health insurance institutions resulting in loss of the basic health insurance fund. Article 12 Changes in the name of the participating units, bank accounts, representatives of legal persons, addresses and persons, wages, etc., must be made available to the health insurance agencies, if they have been declared in real terms by 5 May. Article 13 Chapter III Integrated Funds and Individual accounts Article 14. The basic health insurance fees paid by the insured units and individuals form the basic health insurance fund, which is divided into the integrated funds and individual accounts, and the integrated funds and individual accounts shall be accounted separately and shall not be convicted. Article 15. The personal accounts shall be divided on a monthly basis according to the following provisions: (i) The basic medical insurance fees paid by the insured person are fully charged to the personal accounts; (ii) The basic medical insurance fee paid by the insured unit is divided into the personal accounts in proportion to a monthly rate of 1 per cent of the salary paid by the employee under 45 years of age and 1.5 per cent of the salary paid by the employee (45 years) above, and is accounted for by the average of 4 per cent of the average monthly salary of retired workers in the region. Article 16 covers the principal and interest in the personal accounts of the individual, which is exclusively used for his medical expenses, and cannot be diverted from the use and succession. In the context of cross-cutting regional mobility, the balance of the individual accounts was transferred with the unit to the health insurance agency for the transfer of health insurance. Individual accounts shall be established in banks established by the Medical Insurance Agency to harmonize the Personal Account for the Basic Medical Insurance of Workers in the Perinatal Towns for the purpose of documenting the income and expenditure of the individual health insurance accounts, which shall be maintained and used by the insured person. Article 18 Integrated funds include: (i) The total contributions of all participating units in the integrated area shall be deducted from the remaining portion of the individual accounts; (ii) Financial subsidies; (iii) Social contributions; (iv) Bank interest; (v) Flagna; (vi) Other. Article 19 Instructions, mergers, mergers and transfers, coalitions, leases, contractors, the receiving party or the continuing operator must assume the responsibility for the medical insurance of the unit's employee (container) and pay the basic medical insurance expenses of the employee on time. Chapter IV Basic health insurance treatment Article 20, after the self-payment obligations of the insured person and the individual, received the treatment of the basic health insurance from the second month without the unit for which the payment was paid, the insured person could not enjoy the basic health insurance treatment. Article 21 Participating the insured person's social security card may receive medical treatment, buying medicines or buying medicines at any customary medical facility within the city. The portion of the medical treatment, the purchase of medical fees and the payment of personal self-payments in hospital medical fees is paid by the individual accounts and is not paid in part. The second article, in which the insured person has a social security card, may be inpatient in a hospital with a specific point of hospitalization. Article 23. Medical expenses incurred in hospitalization of insured persons are mainly paid by the Integrated Fund. At the level and at the secondary and tertiary hospitals, the standard of payment for the Integrated Fund was 8 per cent, 10 per cent and 12 per cent of the average annual salary for the previous year of workers in the region. In the same year, the payment rate has been reduced by 2 percentage points to a minimum of 5 per cent. The medical expenses below the standard of payment are paid by individuals. Over the above-mentioned portion of the standard paid by the Integrated Fund, the individuals who are integrated and insured are paid under the “counter” scheme. The Fund's highest pay limit within a medical year is 4 times the average annual wage for the workers in the region. At the time of the hospitalization of the insured person, a certain amount of advance payments must be paid to the hospital to cover medical expenses paid by individuals. Article 24, while participating in the basic health insurance, should be fully staffed (including retired persons) in the medical care insurance, paying a medical insurance premium for each insured person per year, paying a fee rate of about 6 per person per month and adjusted for a year-by-year basis, in accordance with the principle of “repayment, balance of payments”. The Medical Relief Fund is administered by the Medical Insurance Agency and is dedicated to the most part of the Fund's disbursements, with a specific approach being developed. Article 25 Costs incurred in the use of opioid drugs at the time of hospitalization are paid in accordance with basic medical insurance provisions; medical treatment projects, medical services, which are used for part of the payment of part of the batch and basic health insurance, are paid by the insured person for a proportion of payments and the remainder is paid in part by the basic medical insurance. Article 26 Medical expenses incurred in hospitalization and inpatient care in the city and elsewhere (non-sexclusive placements) In the context of the basic health insurance, medical expenses incurred in the city are settled on the basis of the standard of hospitalization for the secondary hospital; medical expenses incurred in various locations are paid by individuals for up to 10 per cent and the remaining portion is settled in accordance with the standard of hospitalization at the third level of the city. Accused public medical agency with immediate care in the city and in varying locations should be informed within 3 days (subsistance on holidays) of the medical insurance agency, otherwise the Integrated Fund for Medical Costs does not pay. In the second article, the insured person has three times of heart disease, high blood pressure, diabetes, heinous diabetes, psychiatry, heptitude, kidneys, kidney vegetation, and, after the medical expert group has been identified, the Medical Medical Clinic Medical Clinic has been processed. In one medical year, a person with special illness may have access to a medical treatment for the near-selection of one targeted hospital. The targeted hospitals can meet medical costs in real time or on a regular basis with the insured person. Other medical diseases during the period require inpatient treatment, and inpatient medical fees with the above-mentioned medical expenses, the amount paid in the Integrated Fund in one medical year shall not exceed the maximum amount paid by the Integrated Fund. Article 28 of the Convention on the Rights of Persons with Disabilities is difficult to establish a diagnosis or diagnosis at the third targeted hospitals (or specialist hospitals) in this city, but without treatment, may apply for referral to a differentiation. The medical costs incurred by the referral chamber are paid by individuals or units, and the medical end of one month is settled by the patient (or the family) and the health insurance agency, with a maximum of 10 per cent paid by the individual, with the remaining portion being settled in accordance with the standard of hospitalization at the third municipal hospital. Article 29 Post-retired home placements, or more than one year after the spouse, the child lived in a differentiation area, completed the registration form of the fertilization of retired persons in the fertility city health insurance and, after confirmation by the original unit or the street, the application was made to the health insurance agency. Removal of retired persons shall be established in the place of residence for three different-tier medical institutions to be hospitalized as their specific points and for special sick treatment hospitals, as well as for the medical insurance offices. In the case of hospitalization, which is determined by a different location, retired persons shall be notified to the health insurance agencies within 3 days (subsistance on holidays). Its medical expenses are paid by individuals or units and are settled by the health insurance agencies within one month of the school. Any medical expenses incurred under the basic medical insurance shall be settled in accordance with the inpatient hospitals in my city. Differences in the placement of retirees with special illnesses within the scope of the provisions of my municipal health insurance policy, and following the identification of my municipal medical expert group, the Medical Clinic Medical Clinic is being processed. Vulnerable hospital treatment for retirees was determined by a variety of locations, which was covered by a medical fee within the basic health insurance, and in July and the second year, the hospital hospital in my city was regulated by the medical insurance agency. Article 33 Medical expenses incurred by the insured person in the following circumstances shall not be paid by the Integrated Fund: (i) Death of female workers due to public (workers); (ii) In the country, visits, studies, refreshers and lectures are carried out in ports, aucasinos; (iii) Crime, fighting, alcohol abuse, maiming, suicide, transport accidents and medical accidents. The insured person shall not transfer his or her social security card to another hospital and shall not modify or provide false medical receipts and medical instruments. Chapter V Management of basic health insurance services Article 31 of the Basic Health Insurance is governed by targeted medical institutions and custom retail pharmacies. Article 32 of this city's administration is subject to approval by the health administration and access to medical institutions of the Medical Agency's Excellence, as well as to military medical institutions authorized by the military authorities and eligible for external services in the health administration, which may apply to the labour security administration for the operation of basic health insurance services, subject to review approval, and the granting of a certificate of eligibility for the targeted medical institutions. The targeted medical institutions must enter into agreements with the health insurance agencies to clarify their respective responsibilities, rights and obligations. Article 33 quantified medical institutions must comply with the following provisions: (i) Establish specialized health insurance management, specialized health insurance windows; (ii) Use of subsidiaries, illnesses and checklists with a uniform health insurance mark; (iii) Execution of walls, medical treatment, sale, vouchers, referral fees, pharmaceutical services and medical days settlement systems; (iv) Implementation of the directory of essential health insurance medicines, therapeutic projects, the scope of medical facilities and the payment standards; (v) Sustain disease, reasonable inspection, reasonable medicines and reasonable fees; (vi) Exclusive medical accounting and management. Article 34 quantified medical institutions and their staff shall not have the following acts in the delivery of basic medical services: (i) To reject the choice of certainty by the insured person; (ii) To deny access to medical care and inpatient care by the medical institutions; (iii) Non-resistance in the treatment of illnesses, with the inclusion of medical costs; (iv) A combination of medicines or other goods, such as drug abuse, for example, through sub-prime, false hospitalization, inpatient hospitalization, in-patient hospitalization, in-patient hospitalization, increment, incremental hospitalization, increment of essential health insurance funds. Article 33XV holds the Licence for the operation of the pharmaceutical operation and the Business Licence, which is certified by the pharmaceutical surveillance management for the quality management of the pharmaceutical operation, and is willing to assume the retail pharmacies of the basic medical insurance scheme of the urban workers, may apply to the labour security administration for hosting the operation of basic health insurance services and, subject to review approval, for the granting of a certificate of eligibility for the terminal retail pharmacies. The customized retail pharmacies must enter into agreements with the health insurance agencies to clarify their respective responsibilities, rights and obligations. Article XVI provides for the use of the uniform health insurance mark by the fixed-point retail pharmacies, with dedicated (and part) managers. The pharmacies are required to ensure the availability and quality of basic health insurance medicines, to control the cost of drug services and to facilitate the purchase of medicines by insured persons. Article 37 No action shall be taken in the course of the provision of basic medical services: (i) No dose in dose in drugs; (ii) The directory of basic health insurance for workers for medicines or other goods. Article 338 of the Labour Guarantees Administration publishes health-care and retail pharmacies that are eligible for entry into society, and is issued by the Medical Insurance Agency. Article 39 of the Labour Guarantees Administration introduced a system of annual review of targeted medical institutions and targeted retail pharmacies, which is responsible for the maintenance of the prescribed medical institutions and the targeted retail pharmacies. Chapter VI Article 40 Integration of the Basic Health Insurance Fund into the Financial Excellence of the Social Security Fund, the introduction of two income-of-payment line management, the exclusive allocation of funds, any unit and individual may not be diverted. Article 40 of the Basic Health Insurance Fund is administered by the Medical Insurance Agency, which conducts medical expenses in accordance with the principle of “recovery and balance of payments”. Article 42 establishes a system of pre-accounting for the health insurance fund, the financial accounting system and the internal audit system; the introduction of the Integrated Fund's early warning reporting system, which, in the event of an over-recurrent expenditure of the Fund, is to be reported to the executive branch and the local government in a timely manner, with careful analysis of the reasons for preventive measures. Article 43, when the basic health insurance fund was raised in the year, is paid at the rate of interest in the life-saving term; the funds transferred in the previous year were relocated to the bank's deposit interest rate at three months; the deposit funds deposited into the health insurance finance-care fund were deposited with the end-of-householding rate of savings, which was not lower than the level of interest. Article 44 guarantees the administration and the financial sector responsible for monitoring the basic health insurance fund, and the audit department is responsible for auditing the payments and management of the funds of the Medical Insurance Service. A health insurance fund oversight organization, with the participation of government departments, user unit representatives, health agencies, trade union representatives, employee representatives and relevant experts, has been established to strengthen social oversight of the basic health insurance fund. The participating units are subject to the supervision of the employee by making the payment of the medical insurance expenses of the unit available to the employee every half year. The health insurance agencies receive social oversight on a regular basis for the collection of health insurance fees and the use of the Integrated Fund for Health Insurance. Chapter VII Legal responsibility Article 42 does not provide for the registration of basic health insurance, which is not subject to prescribed changes, write-offs, or the amount of basic medical insurance expenses that are not reported to be paid in accordance with the regulations, and is subject to the payment of the provisional regulations in accordance with the Social Insurance. Article 46 rejects the payment of basic medical insurance fees for delays, such as the payment of contributions, arrears or contributions, by letter of payment from the labour security administration to the insurance unit, which must pay the basic medical insurance fee within 15 days of the date of the letter of payment; the late non-payment, the payment of lags from the date of the surrender and the punishment of the direct-holder and other responsible personnel in accordance with the provisional social insurance regulations. Article 47 quantified medical institutions and their staff are in breach of article 34 of this provision, which imposes a fine of up to 300,000 dollars for units, which may be liable to a fine of 1,000 dollars for the principal heads, direct responsible supervisors and other directly responsible personnel; in the event of a severe suspension until the removal of the qualifications of the medical establishment of the targeted medical institution, and shall be deducted from the sum of the total amount of the authorized medical facility to the extent that the principal head of the medical institution is granted by the competent authority to the appropriate administration until the level of the removal and dismissal; Article 48 of the pharmacies and their staff are subject to one of the circumstances of article 37 of this provision, and the Medical Insurance Agency shall reject the corresponding costs incurred or recovered and shall deduct the amount of the nuclear reductions from the amount due to be paid in the month of the month, with the suspension of the payment of the basic health insurance fund; impose a fine of more than 100,000 dollars for the unit, and impose a fine of 1,000 dollars for the principal head, the direct responsible and other direct responsibilities; Article 49 contains one of the conditions under article 11 of this provision, resulting in losses of the basic health insurance fund and recovery of economic losses. A fine of up to $50 million may be imposed on the direct responsible supervisors and other direct responsibilities. Article 50 is in violation of article 31, paragraph 2, of this provision, and the Medical Insurance Agency shall recover the corresponding costs incurred and suspend the medical treatment of the insured person for a period of 3 to 6 months, the medical expenses incurred during the suspension shall be borne by himself; and the criminal liability shall be held by law. Article 50 of the Medical Insurance Agency and its staff are in the process of invoking private fraud, damaging public fertilizers, or using their functions and working bribes, compliciting private gain and loss of the basic health insurance fund, recovering economic losses, granting administrative penalties for the direct responsible and their direct responsibilities, and imposing a fine of more than 500,000 yen; constituting an offence, criminal liability. Administrative penalties under article 52 are imposed by the Labour Security Administration. Article 53 does not impose administrative penalties on the parties and may apply for administrative review or administrative proceedings in accordance with the law. The administration of labour guarantees the executive to apply for enforcement to the people's courts in which the perpetrators are punished. Chapter VIII The medical treatment of persons with disabilities in the racketed, old-age and second-class revolution is unchanged, and the medical management approach is implemented in accordance with the relevant provisions of the province. The general high school attendance at schoolchildren, the immediate family of the employee's care is not involved in the basic health insurance, and its medical costs are addressed in accordance with existing provisions. Article 55 allows eligible enterprises to establish supplementary health insurance based on their participation in basic health insurance, supplemented by 4 per cent of their total salary, from the employee welfare fee and under-recovered portions of the welfare cost, with approval by the same financial sector. Article 56 funds for the cause of the health insurance institutions are included in the financial budget resolution and cannot be extracted from the health insurance fund. Article 57 provides appropriate incentives by the Labour Security Administration for the reporting of violations against the units and individuals of the Basic Health Insurance Fund, which are separate from the same level of finance, with a specific approach developed by the municipal labour security administration with the financial sector. The question of the specific application of this provision is explained by the municipal labour security administration. Article 59 provides for implementation from the date of publication. |
