Interim Measures For The Harbin City Basic Medical Insurance

Original Language Title: 哈尔滨市城镇基本医疗保险暂行办法

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(March 31, 2006 Harbin city government 53rd times Executive Conference considered through April 24, 2006 Harbin City Government makes 146th, announced since June 1, 2006 up purposes) first chapter General first article for perfect basic medical insurance system, guarantees participate in basic medical insurance personnel (following referred to parameter insurance personnel) of basic medical, maintenance social settled, according to State on established town workers basic medical insurance system of decided, about provides, combined I city actual,
    These measures are formulated. Second article where in this city administrative within town following employing units and personal (not containing in the straight provincial organ, and institutions, and social groups and staff and retired personnel), are should by this approach provides participate in basic medical insurance: (a) enterprise and workers; (ii) State, and institutions, and social groups, and private non-enterprises and staff; (three) individual organization owners and practitioners; (four) town registered and business of township enterprises and workers; (five) town flexible employment personnel, and
    Freelancer, non-agriculture persons, and migrant workers. Article III implementation of territorial management of basic medical insurance for urban workers.
    Railway, electricity and communication systems work place for employees of enterprises in the city, participating in basic medical insurance as provided herein.
    Article fourth urban basic medical insurance introduction of city and County (City) level management, city and County (City) level co-ordinating unit.
    Article fifth improve the urban basic medical insurance system, should adhere to the level of protection commensurate with the level of socio-economic development, society each other and self-protection combined unity of right and obligation, payment standards commensurate with the level of treatment principles.
    Sixth State organs, institutions, social organizations, enterprises, private non-enterprise units and individual organizations (hereinafter referred to as the employer) and its individual shall perform the obligation to pay basic medical insurance, the individual shall have the right to basic medical insurance treatment.
    Article seventh municipal labor and social security administration departments is the Department of basic medical insurance, responsible for organization and implementation of the measures.
    Counties (cities) in the administrative departments of labor security area of basic medical insurance for urban management.
    City, County (City) administrative departments of labor security medical insurance agency is responsible for the basic medical insurance premiums collection, management and payment of basic medical insurance and other routine work.
    Chapter II basic medical insurance premiums article eighth collecting basic medical insurance registration units should be produced to the social medical insurance agency license or unit approved the establishment of other documents, organization code certificate, bank account numbers, lists of insured persons.
    Employer medical insurance registration changes or the employer terminated according to law, shall change or termination date of the original registration agencies in the 30th such changes or termination of registration.
    Nineth article employing units years average above this city or County (City) Shang annual on-the-job workers average of, basic medical premium by following standard paid: (a) urban employing units according to this units workers Shang annual payroll of 7.5% paid; County (City) employing units according to this units workers Shang annual payroll of 6% around paid; (ii) on-the-job workers according to I Shang annual wage income of 2% paid.
    Urban flexible employees, freelancers, non-agriculture persons, and migrant workers in accordance with 9.5% in the previous year, average wage of fully employed staff pay.
    Tenth Article years average below this city urban Shang annual on-the-job workers average of enterprise and workers, flexible employment personnel, and Freelancer, and non-agriculture personnel, and town workers personnel, can select paid hospital medical and manpower fee, by urban employing units according to Shang annual this city urban on-the-job workers average of 6.5% paid, reached statutory retired age Hou, established personal account; or select according to Shang annual this city urban on-the-job workers average of 5% paid hospital medical and manpower fee, not established personal account.
    Migrant workers can also choose according to the annual average wage of staff and workers on duty in the city on 2.5% pay fees for hospitalization and Manpower, I only enjoy the treatment standards for medical and manpower 50%, does not establish individual accounts.
    11th people pay health insurance premiums of insured life of men under 30 years, women under 25 years (depending on the period of contributions, but the actual period of contributions not less than 10 years; insured persons in their personal capacity, the actual period of contributions for not less than 15), and upon reaching the legal retirement age do not pay health insurance premiums.
    12th after the implementation of the present measures in accordance with relevant State provisions for early retirement of officers, employers and individuals shall apply mutatis mutandis to payment standard before I retired, of medical insurance premiums paid to the statutory retirement age.
    13th salary in accordance with the National Bureau of statistics calculation of provisions included in the wage income.
    Workers wages higher than a year ago in the city or County (City) annual average wage of fully employed staff on 300%, determined in accordance with 300% of the average wage of fully employed staff base.
    Preferential reemployment certificate holders to participate in health insurance, according to the city or County (City) of 60% to determine the annual average wage of fully employed staff on base. 14th the employing units and individuals shall monthly pay basic medical insurance premiums.
    State organs, institutions, social organizations, enterprises, private non-enterprise units to pay basic medical insurance premiums, by unit of account issued by the Bank in accordance with the medical insurance agency voucher paid in its basic account; individual economic organizations from the health insurance agencies to pay employees pay part of the employing unit in the age of pay for deductions.
    Personnel participating in medical insurance in their personal capacity, should be opening individual savings accounts in banks, medical insurance medical insurance agency monthly transfers from personal savings accounts.
    15th basic medical insurance premiums paid by the employer, in accordance with the following channel expenditures: (a) as pre-tax expenditures of enterprises, (ii), assistance with financial institutions in the budgetary expenditures of State organs; (iii) other institutions in financial institutions as well as non-financial benefits of expenditures, (d) social groups and private non-enterprise units in income in Liechtenstein.
    16th unit consolidation, merger, Division, transfer, lease, when contracted, agreed to pay its arrears of basic medical insurance premiums and interest from receiving or continuing operators to pay basic medical insurance premiums for the employees.
    17th bankruptcy of enterprises according to law, shall be in accordance with the People's Republic of China on enterprise bankruptcy law (trial) and related provisions, priority debts due to the basic medical insurance premiums paid and the city's annual average wage of fully employed staff on 9.5% for retirees a one-time paid up to 70 years of basic medical insurance premiums; paying less than 5 years, or persons over 70 years of age, 5-year payment.
    Units were disbanded or withdrawn, according to the provisions of the preceding paragraph of this article to pay basic medical insurance premiums for employees.
    18th the employing unit shall not be any of the following acts: (a) concealing employees wages; (b) forged, fabricated and deliberately to destroy the books and materials.
    19th chapter III basic medical insurance management of basic medical insurance from: (a) basic medical insurance premiums paid by employers and individuals, hospitalization and manpower costs, (ii) revenue from interest and appreciation of basic medical insurance, (iii) required to charge late fees and (iv) other income provided for in laws and regulations.
    20th an employer and individual contributions to basic medical insurance, hospitalization and manpower costs, deposit insurance agencies to open bank "basic medical insurance income households", the basic medical insurance financial account, the implementation of two lines of income and expenditure, earmarking may not be appropriate or divert.
    Article 21st basic medical insurance premiums paid by employers and individuals, broken down by provisions for medical insurance payments and personal accounts in two parts, medical insurance payments and personal accounts separately. 22nd article medical insurance and manpower gold paid range: (a) hospital healing of disease, in Harbin city town basic medical insurance clinic project (following referred to clinic project) range within, using meet Heilongjiang province basic medical insurance and injury insurance drug directory (following referred to drug directory) of drug and used Harbin city town basic medical insurance service facilities range and paid standard (following referred to service facilities range and paid standard
    ) Medical service facilities should be part of medical insurance payments, (ii) specific disease clinics, treatment, payment of medical expenses should be coordinated by the health insurance section.
    The diagnosis and treatment projects and the service scope and standards of payment by the administrative departments of labor security in conjunction with the departments concerned, submitted to the municipal people's Government for the record.
    23rd basic medical insurance the year raised part and part personal accounts included in that year, according to the Bank's resident saving deposit interest rate in the same period interest; the previous year's carry-over funds and personal accounts of principal and interest, according to the Bank's earlier inhabitants of 3 month lump-sum deposit interest rates; deposit social security deposit fund accounts, according to the Bank's earlier inhabitants of 3-year zero-sum deposit interest rates.
    The fourth chapter of personal account management section 24th medical insurance agency should be established for people participating in basic medical insurance individual account in basic medical insurance.
    25th structure of basic medical insurance individual account: (a) I 2% basic medical insurance premiums base, (ii) from basic medical insurance premiums paid by employers or individuals, in accordance with my salary or pension percentage into the basic health insurance (c) stipulates that interest. 26th article participate in basic medical insurance of personal account according to age points grade to I payment wage or pension of following proportion designated into: (a) age in 45 age following (containing 45 age), urban of according to 1.1% designated into, County (City) of according to 1% around designated into; (ii) age in 45 age above, urban of according to 2% designated into, County (City) of according to 1.5% around designated into;

    (C) retirees in accordance with 5% in the urban area, and County (City) according to the 4% left and right into.
    Unit in accordance with the annual average wage of fully employed staff in the city of 6.5% on payment of hospitalization insurance personnel and manpower costs, upon reaching the statutory retirement age, according to the pension 5% in the urban area into.
    Pension is lower than last year's urban average pension for enterprise retirees, according to average annual urban Enterprise retiree pensions determined on base.
    27th personal-account payment: (a) costs incurred in designated outpatient, (ii) the cost of procuring medicines in drugstores, and (iii) at designated medical institutions in the hospital fees shall be borne by the individual. 28th insured individual account management implement a medical insurance card, by the health insurance agencies on a monthly basis for personnel participating in basic medical insurance individual account in basic medical insurance premiums.
    Principal and interest can be carried forward for use of personal accounts or inherited.
    Article 29th insured persons in mobility in the urban area of the city, and basic medical insurance relationship transfer formalities should not transform medical insurance individual account; trans-regional mobility, it should be for the surrender procedures, individual one-time settlement account balances.
    Article 30th insured person is interrupted during the personal account shall be maintained; again, after personal accounts to store accumulated and ongoing interest.
    31st persons insured abroad, outside the settlement, termination of the basic medical insurance relationship, should go through the surrender procedure, individual one-time settlement account balances.
    Article 32nd death of insured individual account balances may be carried over to its designated or legal heirs. The fifth chapter 33rd insured person sick of basic medical insurance treatment at designated medical institutions and drugstores for medical treatment, purchase of medicines.
    Outpatient at designated medical institutions, available at designated medical institutions buy drugs or prescription drugstores to buy medicine. Article 34th appointed medical institutions of insured persons in the hospital costs incurred, paid substandard paid by the individual. Up pay standard according to following provides implementation: (a) in community health service institutions Hospital of, for urban or County (City) Shang annual on-the-job workers average of 3%; (ii) in level medical institutions Hospital of, for urban or County (City) Shang annual on-the-job workers average of 5%; (three) in two level medical institutions Hospital of, for urban or County (City) Shang annual on-the-job workers average of 8%; (four) in three level medical institutions Hospital of,
    For the city or County (City) annual average wage of fully employed staff on 12%; in a natural year in hospital several times, since the second hospitalization, reduce 15% on the basis of the standards prescribed in the preceding paragraph. 35th disposable hospital refers patients once admitted, the discharge process. In the same outpatient emergency treatment and hospitalization of uninterrupted, as disposable hospital. 5th diagnosed infectious disease specialist hospital inpatients, approved may be regarded as disposable hospital, do high class standard of paying hospitals.
    One-time straddling the diagnosis and treatment process in hospital, according to the diagnosis and treatment of end time.
    Article 36th insured persons hospitalized in contracted medical institutions shall be made to the designated medical institutions to pay a certain amount of advance payment, to cover the cost should be borne by the individual parts of the. 37th hospitalized psychiatric patients in specialized medical institutions without paying standard, medical expenses borne by individual 20%.
    Specific disease clinics, treatment according to the different disease, coordinated by the health insurance burden of gold and the proportion of individuals in accordance with the regulations.
    Administrative departments of labor security in conjunction with the health insurance fund by the relevant departments, timely adjustment of outpatient examination and treatment items for inclusion in medical insurance payments and payments.
    Article 38th appointed medical institutions of insured persons in hospital medical costs above the standard of pay over medical insurance payments, borne by the health insurance payments and personal scale, medical insurance payment maximum payment limit in one-year account, for the city or County (City) of 4 times the annual average wage of fully employed staff. 39th article parameter insurance personnel in Sentinel medical institutions hospital occurred of medical costs over medical insurance and manpower gold up pay standard above, highest paid limit following part, personal by following proportion burden: (a) up pay standard above, 5000 Yuan following part, retired personnel for 7%, other personnel for 10%; (ii) 5000 Yuan above, 10000 Yuan following part, retired personnel for 11%, other personnel for 14%; (three) 10,000 yuan above, highest limit following part, retired personnel for 13%,
    Other personnel is 16%.
    In the affiliated hospital of Medical College (excluding medicine, Cancer Hospital) and insured personnel provincial General Hospital, medical risk ratio on the basis of the provisions of the preceding paragraph, the corresponding 3%.
    40th special disease needs to go toward offsite medical institutions where the hospital treatment, with designated medical institutions to produce evidence of the disease, after review by the administrative departments of labor security, immediately make a decision. 41st article parameter insurance personnel in Sentinel medical institutions for meet clinic project in the part paid costs of check, and treatment and using meet drug directory in the b class drug of, should consent of I or relatives agreed, by personal according to following proportion since pay Hou, remaining part according to this approach 39th article provides implementation: (a) check, and treatment using b class drug of, according to drug type personal since pay 20%-50%; (ii) organ organization transplant and installation artificial organ of, according to organ organization transplant, and
    Install personal pay 30%-50%. 42nd article following situation occurred of medical, first by personal advance, diagnosis and treatment end Hou, by employing units or I by medical insurance card, and records, and referral approval table, and diagnosis proved, and laboratory check report single, and duplex prescription, and discharged diagnosis, and medical details, and medical fee receipt until medical insurance handling institutions according to provides claims: (a) parameter insurance personnel for emergency in non-Sentinel medical institutions rescue occurred of hospital medical fee; (ii) travel, and visits, personnel in field (not containing outside) for emergency one-time Hospital of,
    During the admission period have notified the city health insurance agencies, within the specified disease medical costs incurred; (c) permanent in-service insurance field personnel or retirees who live in different places before leaving town in the municipal medical insurance agency for foreign fixed-point medical institutions of hospital after medical procedures medical expenses; (iv) transferred to remote diagnosis and treatment in medical institutions of health care.
    The preceding paragraph of this section (a), (b), (d) the provision using standard of paid medical insurance payment determined by type of corresponding designated medical institutions in the city, hospital standards and personal burden of increased 30%.
    Article 43rd after the insured person and the employer terminates the labor relations, can be flexible employment status for the health insurance Association, receiving the appropriate medical insurance benefits.
    44th the employer or individual failing to pay health insurance premiums, since months arrears ceased to enjoy medical insurance benefits, in full to pay arrears of basic medical insurance premiums or medical manpower costs and late fees after, restore health insurance benefits since next month.
    Article 45th assault, alcohol, suicide or accidents, medical malpractice injury or disability caused by factors such as medical treatment needs, medical insurance payment not be paid.
    Article 46th insured persons are not allowed to any of the following acts: (a) forged documents such as vouchers, altered prescriptions, costs, (ii) to provide medical documents, an impostor doctor.
    The sixth chapter 47th basic Medicare medical service management designated medical institutions and drugstores management and adopt an annual inspection system.
    Designated medical institutions and drugstores point qualification, validation standards and assessment methods, the administrative departments of labor security in conjunction with health and drug supervision departments concerned separately.
    48th medical institutions and drugstores, signed an agreement with medical insurance agency, and strictly enforced.
    Designated medical institutions and drugstores should be undertaken by specialized agencies or to designate a person responsible for management of basic medical insurance. 49th designated medical institutions should be due to illness and treatment, reasonable examination, rational drug use.
    Insured persons in hospital, shall comply with the health insurance regulations, list of designated medical institutions shall promptly provide a day and the cost breakdown, and hospital agreements with insured persons.
    Drugstores should perform drug retail prices, implementation of administrative provisions on prescription drugs and non-prescription drugs.
    50th designated medical institutions and drugstores should by 5th of each month last month, personal accounts and medical insurance payments submitted to the health insurance agencies. 51st medical insurance agencies should be coordinated by the health insurance to pay medical expenses, control of total amount of project management, the flat rate payment, and quality assessment.
    Specific settlement measures shall be formulated separately by the administrative departments of labor security. 52nd article Sentinel medical institutions no has following behavior: (a) charges project no price; (ii) using not qualified of dedicated prescription, and documents and account table; (three) admitted impostor personnel Hospital; (four) SWOP disease species or will not belongs to clinic project disease included medical insurance and manpower gold paid medical range; (five) will not belongs to drug directory of drug included medical insurance and manpower gold paid medical range; (six) will not belongs to service facilities range and paid standard
    Services included in the scope of medical insurance to pay medical expenses; (VII) beyond the need to check the patient's condition, treatment, medication, (VIII) general wards will be used (bed) insured persons in hospital, in the intensive care ward, a single sterile sterile isolation and single rooms; (IX) used to prescribe medicine on behalf of the insured person. 53rd drugstores not any of the following acts: (a)-prescription doses sold drugs, (ii) do not belong to the drug list of the medicines or range of items in the personal accounts to pay the costs, and (iii) does drugs provides retail and wholesale price.

    The seventh chapter monitor 54th administrative departments of labor security and management of the basic medical insurance of employer, designated medical institutions and drugstores for basic medical insurance policies, regulations, and compliance with management responsibilities related to inspection and examination.
    Employers and individuals, designated medical institutions and drugstores should truthfully provide information about materials.
    55th established by relevant Government Department representatives, employers ' representatives and representatives of designated medical institutions, drugstores representatives, Union representatives, employee representatives and experts and other components of the system of urban basic medical insurance supervisory committee, strengthen the supervision of basic medical insurance.
    Medical insurance agency should be the basic medical insurance supervisory committee regularly informed of basic medical insurance, and accept their supervision.
    56th employer workers ' Congress should this unit annually informed or disclosed to the employees in this unit the unit of basic medical insurance to pay, accept supervision of employees.
    57th medical insurance agencies, designated medical institutions and drugstores should receive participating in basic medical insurance individual queries for basic medical insurance policy. Article 58th medical insurance agency shall establish and improve the basic medical insurance, final accounting and internal audit systems.
    Labour and social security administrative departments are responsible for auditing the basic medical insurance medical insurance agency presentation and final accounts, draft basic inspection of the collection, management and use of medical insurance; financial and auditing departments should strengthen supervision of the basic medical insurance.
    59th institutions not participating in basic medical insurance or is not required to pay medical insurance premiums, the financial sector will not be allocated to basic medical insurance premiums.
    60th medical insurance agency business was funded by financial solutions.
    61st article basic medical insurance management staff no has following behavior; (a) not by provides will medical premium included medical insurance and manpower gold account and personal account; (ii) corruption, and misappropriated basic medical insurance; (three) violation basic medical insurance management provides, caused Fund loss; (four) unauthorized reduction, and from or increased employing units and personal payment base and proportion; (five) unauthorized change medical insurance treatment; (six) engages in, and bribes bribery.
    62nd eighth chapter legal liability if an employer violates this regulation fails to pay basic medical insurance by the municipal labor and social security administration ordered to pay, fails to pay, plus 2 of the daily late fee, late fee into the basic health insurance; if not paid, according to the relevant provisions of the labour inspection. 63rd article on violation this approach provides of, by labor guarantees administrative sector ordered deadline corrected, late not corrected of, by following provides processing; constitute crime of, law held criminal: (a) violation this approach 18th article provides of, sentenced 5000 Yuan above 20,000 yuan following fine; (ii) violation this approach 46th article provides of, recovered has paid of medical, sentenced 500 Yuan above 1000 Yuan following fine; (three) violation this approach 49th article provides of,
    Not pre paid medical insurance and manpower gold paid of medical costs; (four) violation this approach 52nd article (ii) items provides of, sentenced 200 Yuan above 500 Yuan following fine; (five) violation this approach 52nd article (three), and (four), and (five), and (six), and (seven), and (eight), and (nine) items and 53rd article (a), and (ii) items provides of, sentenced illegal amount 3 times times above 5 times times following fine; caused bad consequences of, labor guarantees administrative sector can canceled its Sentinel qualification.
    64th disobey 52nd (a) and 53rd (c) the provision, by the commodity price departments in accordance with the relevant provisions.
    65th in violation of the provisions of article 61st, cadre management authority administrative sanctions constitute a crime, criminal responsibility shall be investigated according to law. 66th on the administrative punishment is dissatisfied, he may apply for administrative reconsideration or bring an administrative suit.
    Otherwise provided by laws and regulations, according to the provisions of laws and regulations.
    67th fines to deal with, according to the relevant provisions of national and provincial implementation. 68th employers and insured persons, designated medical institutions, drugstores, between medical insurance agency when there is a controversy concerning the basic medical insurance by the disputing parties settled through consultation, arbitration or the administrative departments of labor security according to law put forward opinions.
    Not satisfied with the handling comments by the administrative departments of labor security, you can file an administrative lawsuit.
    Nineth chapter supplementary articles article 69th retired, old red, second grade b or above disabled revolutionary servicemen do not apply these measures. 70th an employer can establish supplementary medical insurance, supplementary medical insurance does not participate in co-ordinating, used by to establish supplementary medical insurance unit of workers.
    Supplementary health insurance in the total wage 4% within unit according to the provisions of part of expenses.
    71st of municipal administrative departments of labor security in accordance with the measures, formulate implementing rules, submitted to the municipal people's Government for approval.
    Counties (cities) should be based on local conditions, and adjust and improve the local medical insurance policies in a timely manner and submitted to the municipal labor and social security administration departments. 72nd these measures shall come into force on June 1, 2006.
                                                                                      December 13, 2000 issued by the Municipal Government of Harbin city basic medical insurance for urban workers interim measures be repealed simultaneously.