Key Benefits:
(Adopted by the 25th ordinary meeting of the Government of the commune on 8 June 2005 No. 111 of the Order of the People's Government of 8 June 2005 and published as of 1 August 2005) Chapter I General Article 1 provides for the establishment of a basic health insurance system for our urban workers, the maintenance of the interests of the worker and the improvement of the level of health, in line with the decisions of the Department of State on the establishment of a basic health insurance system for urban workers and the reforms of the system for the health insurance of the urban workers in the Province of Excellence, which is being developed in the context of my city's practice. Article 2 Basic health insurance is a mandatory social insurance by the Government to effectively guarantee the interests of the user and the worker, and all user units and their employees must participate in the basic health insurance in accordance with the provisions of the scheme. Article 3 (i) State organs, utilities, social groups and their employees; (ii) State-owned enterprises, urban collective enterprises, corporate enterprises, partnerships, individual-source businesses and other towns and their employees; (iii) Integral and field presences at all levels, business units and their employees; (iv) External investment enterprises and their secondary workers; (v) Civil service units and their employees; (vi) Participation in the basic health insurance scheme is in line with the State's mandated retirement (service) personnel. Article IV Basic health insurance for urban workers adheres to the principle that basic health insurance is adapted to the level of productivity development in the region; upholds the principle that basic health insurance payments are shared by both the insured units and the workers; upholds the principles of the basic health insurance fund to receive payment, balance of payments; and upholds the principle of the integration of the health insurance funds into the social integration and personal accounts. Article 5 provides for integrated management at the municipal and district levels. The municipal, district labour security administration is responsible for the implementation of the scheme, and the municipal and district health insurance agencies are responsible for hosting basic health insurance operations under the supervision of the same-level labour security administration. The municipal health insurance agency is responsible for the operational guidance of district health insurance institutions. Article 6. Chapter II Article 7. Basic health insurance expenses are paid jointly by the insured units and individual workers. The total annual salary of the insured unit is paid at 7 per cent for the active employee, and the full annual salary of the active worker is paid as a contribution base of 2 per cent and is paid by the participating insurance unit from its salary. Retirements paid for basic health insurance payments for 30 years for men and 25 years for women (previously in keeping with the State's fixed-term age of continuing work may be paid for the same-payment) shall not be paid. The proportion of retirees and active workers exceeds 1.1.8 hours, and the insured units should pay the health insurance risk premium. Article 8. Article 9. Employers who participate in the work of the current city or are redirected to work in the current city shall be charged with the total monthly salary as the contributory base; the total wage is not clear and the average salary of the entire occupants for the year is denominated. Article 10. After the transfer of the insurance units, the continuing operators must assume basic health insurance responsibilities for the insured units and their employees. Article 11. Participatory units shall be in bankruptcy, cancellation, sale or termination of their operation for other reasons, and shall pay a lump sum of basic medical insurance expenses for their active workers for a period of two years for the benefit of the pensioner for the basic health insurance expenses in the average life expectancy. Article 12. In the absence of a payment of basic health insurance fees under the provisions, the insured person was suspended from the previous month of the payment of the insurance premium. In the 90-day period (90 days) after the payment of medical insurance fees and lags, the insured person has been reinstated to receive medical treatment for the medical expenses incurred by the insured person during the collateral medical institution, the terminal pharmacies and the medical expenses incurred by the insured unit in the medical certificate, IC cards, receipts and related medical material, and, after medical insurance clearance by the medical insurance agencies, the reimbursement process is governed by the relevant provisions. More than 90 days of unpaid medical insurance payments and the accompanying insurance units of lags are processed automatically. The medical expenses incurred during the period of the suspension of the contribution are not reimbursed as a result of the automatic suspension of the insurance. Chapter III Article 13. The basic health insurance fund consists of an integrated fund and individual accounts. The personal accounts are reflected in the form of ICK (hereinafter referred to as ICK). Article 14. The basic health insurance fees paid by the insured unit and the individual worker are transferred to the personal accounts on a monthly basis in accordance with his/her contribution base or pension: (i) The age of 45 (45 years) is divided by 2.5 per cent; (ii) The age of 46 to 55 years is 3.0 per cent; (iii) The age of 56 to 69 years is 4.0 per cent; (iv) More than 70 years of age (70 years of age) are classified by 4.8 per cent. Article 15 Participation in the insurance unit and the basic medical insurance payments paid by the individual worker, after the percentage of the individual accounts has been transferred, the remainder has entered the Integrated Fund. The lag and other income received under this scheme are incorporated into the Integrated Fund. Article 16 provides for the establishment of a personal account for the insured person, the establishment of a medical insurance number and the manufacture of IC cards. IC card is a special voucher of the insured person for medical, purchase and settlement of medical costs. The principal and interest in the personal accounts are owned by the insured person for medical expenses (with a personal burden), which may be transferred, transferred and inherited. Article 18 Investigation of the insured person from the city shall be transferred to the individual accounts and to the IC card write-off procedure, with the funds transferred from the individual accounts. It was not possible to transfer, and a one-time payment could be made to him, as approved by the Medical Insurance Agency. Those in the field are to be transferred to the present city by processing medical insurance procedures and establishing individual accounts, while transferring balance funds to the individual accounts. The individual accounts and IC cards shall be cancelled within 30 days when the insured person died. A one-time payment of the personal account balance was made to the successor. Chapter IV Basic health insurance treatment Article 20, after 30 days of the payment of basic health insurance expenses by the user unit, the insured person started to receive the basic health insurance treatment as prescribed. Article 21 Medical fees incurred by members of the custoded medical institutions for treatment and purchase of pharmacies are paid by the individual accounts, partly due to personal burdens. The medical costs incurred in the hospitalization of the insured person are covered by the Integrated Fund and individuals are required to pay standard expenses. For the first time inpatient care of the insured person, in accordance with the standard cost of the first hospital, such as three A, three-tier b, municipal specialist hospitals, secondary hospitals, community hospitals, the amount of 700 yen, 600 yen, 500 yen, 300 yen, 200 yen, respectively. During the year, each inpatient was reduced by $100, but the minimum was not less than 200/persons. Article 23 provides for inpatient treatment at three integrated hospitals, town-level specialist hospitals (including secondary integrated hospitals), community hospitals (including integrated hospitals at the level of level), with an individual burden of 15 per cent, 12 per cent, 10 per cent, and 10 per cent for retirees. Article 24 confirms the medical needs of the insured person, with the consent of the targeted medical institution, and with the approval of the Medical Insurance Agency, the medical expenses incurred in hospitalization in the outside city are 1000/personal, with a personal burden of 35%, 25 per cent of the retirees' burden and, after the end of the treatment, valid vouchers to be transferred medical institutions. Article 25 Article 26, when the insured person temporarily suffers from acute illnesses, has access to health care and has valid evidence of the medical costs incurred to the local health insurance agency. In the year, the Fund paid a maximum of four times the average salary for all workers in the previous year, exceeding four times the medical fees paid by the Integrated Fund for the basic medical expenses of the insured person (including inpatient and clinical chronic medical fees). All user units and workers must participate in the major supplemental health insurance while attending basic health insurance. Article 28 allows for the establishment of an enterprise supplemental health insurance based on participation in basic health insurance and the replenishment of health insurance. The enterprise supplements the health insurance fee in part of the total wage of 4 per cent, from the employee welfare fee and the portion of the benefits underfunded, with the approval of the same financial tax sector. The medical costs incurred by the insured persons are subject to the provisions of the Quenin Province's Basic Medical Insurance Medicology, the Basic Medical Care for Workers in Municipalities (Amendment) Project (Amendment) and the Provisional Approach to Standards Management. Chapter V Basic health insurance management and services Article 33 The user unit shall, within 30 days of the date of the approval of the establishment, enter into the medical insurance registration process by the health insurance agency. Article 31 Changes in the health insurance registration of the insured unit or termination by law shall be due to changes or cancellation of the medical insurance registration process by the health insurance agency within 30 days of the date of the change or termination. Article 32 provides for the management of targeted medical institutions and targeted pharmacies. The occupants have chosen to purchase pharmacies for medical and targeted pharmacies, and pharmacies are required to purchase medicines by prescription medical institutions or by targeted pharmacies. Article 33 Medical institutions and pharmacies operating under the law within the city's administration can apply to the municipal labour security administration for the operation of basic health insurance services and, with the approval of the municipal labour guarantee administration, the pharmaceutical surveillance sector, the granting of a certificate of eligibility for the targeted medical institution or a targeted pharmacies. The Medical Insurance Agency is responsible for identifying targeted medical institutions and targeted pharmacies, in accordance with secondary medical care and in line with the principles of medical treatment, buying medicines. Article 344 of the Medical Insurance Agency is required to enter into a basic health insurance service agreement with targeted medical institutions and targeted pharmacies to clarify the responsibility, rights and obligations of both parties. The Medical Insurance Agency is required to meet the costs of the targeted medical institutions and targeted pharmacies, in accordance with the policy provisions of the basic health insurance and the agreements signed with the targeted medical institutions. Article XV Medical institutions and pharmacies should strengthen operational technical training and vocational ethics education for medical and service personnel, develop and improve the necessary systems to ensure the quality of medical and medicine, adhere to medical treatment, scientific diagnosis, reasonable use of medicines and effective treatment. The price of medicines must be implemented in accordance with the fees established by the State, the provincial and municipal price administrations for health-care projects, subject to inspection by the municipal labour security administration, the price administration and the supervision of the various sectors of society. In the case of the hospitalization of the insured person, the targeted medical institutions are required to conduct inspections and treatment based on the condition of the insured person. In accordance with the inspection and treatment required by the insured person, the Medical Insurance Agency shall not reject the costs incurred. In the case of medical treatment, the targeted medical institutions should test their medical insurance certificates, detect the existence of a false, intrusive or courier health insurance certificate, and report on the medical insurance institution in a timely manner. The following acts are prohibited by targeted medical institutions and their staff in the delivery of basic health insurance services: (i) Include medical costs for non-scheduled medical institutions, coverage of non-fundamental health insurance funds in the payment of the basic health insurance fund and non-managed medical costs; (ii) The non-nuclear inspection of medical insurance certificates, IC cards and the inclusion of medical costs for non-insecution personnel in the basic health insurance fund; (iii) To refuse to receive patients within the scope of the treatment of the medical institution or to refuse to use the medical insurance IC card to settle medical costs; (iv) Inadvertently restrict the amount of prescriptions and the cost of hospitalization; (v) The use of the basic health insurance fund by means of unjustifiable methods such as wallbeds, distributing inpatient hospitals and reducing inpatient standards; (vi) The non-implementation of the prescribed medical fee standards and the price of medicines, as well as the violation of price management-related charges, resulting in losses of the basic health insurance fund. The following acts are prohibited in the process of providing basic health insurance services: (i) No dose in dose in drugs; (ii) The sale of medicines or other goods other than the directory of basic health insurance medicines; (iii) The loss of the basic health insurance fund in violation of drug price management provisions. Article 40 prohibits the following acts in the course of medical, purchase and settlement of medical expenses: (i) The medical insurance certificate and the transfer of IC cards to others; (ii) Evidence such as falsification, alteration of paints or medical charges, which are falsely false, intrusive and intrusive. In the event of the disputed basic health insurance controversy between the insured unit, the insured person, the targeted medical institution, the pharmacies, the medical insurance agency, the parties of the dispute were resolved in consultation with the disputed parties, and the consultations were not in a position to apply to the labour security administration for the decision or the prosecution of the people's courts in accordance with the law. Chapter VI Article 42 states that the basic health insurance fund is used to collect, harmonize and harmonize payments. Article 43 XIII incorporates the Fund's financial exclusives, implements both income and expenditure line management, ensures that the Fund is fully used to secure basic medical treatment for the insured person and that no unit or person shall be excluded or diverted or shall not be used for a balanced budget. The municipal finance, labour security administration is responsible for the management and supervision of the basic health insurance fund. The audit department is responsible for auditing the payments and management of the Fund. Article 44 should establish a system of pre-approval, financial accounting system and internal auditing of the Basic Medical Insurance Fund and, within the time frame, submit the relevant statements to the municipal labour security administration and the financial sector. Article 42 provides for the office of the health insurance agency to be fully financed by the same level of finance and shall not be used or transferred to the basic health insurance fund. Article 46, Partners and insured persons have the right to consult the health insurance agencies on the payment of basic medical insurance expenses and the income and expenditure of the individual accounts. Article 47 of the Labour Guarantees Administration has the right to review the accounts of the participating units, targeted medical institutions, targeted pharmacies, statements to verify the number of insured persons, the payment base and the total pension. The health insurance agencies are entrusted by the labour security administration and can conduct inspection, investigation and investigation into matters related to the health insurance operations in the insurance units, targeted medical institutions and targeted pharmacies. Article 48 is required to designate the basic health insurance management operations of the specialized and part-time personnel for this unit. The participating units regularly disclose the total annual salary and the payment of basic medical insurance expenses to the worker and receive the supervision of the employee. The health insurance agencies should publish the annual use of the health insurance fund on a regular basis and receive oversight by the insured units and the insured persons. Chapter VII Corporal punishment Article 49, in violation of article 30 of this approach, is changing by the time limit for the executive branch responsible for labour security, in serious circumstances, with a fine of up to 5,000 dollars for heads of units and other direct responsibilities. Article 50 quantified medical institutions, targeted pharmacies violate the provisions of article 38 of this scheme, article 39, which is fined by over 5,000 dollars of the executive branch of the municipal labour security administration, resulting in the loss of the Fund, with the exception of recovery and removal of its finality, which amounts to more than 5,000 fines; accountable administrative responsibility for the direct responsible and direct responsibilities. Article 50, in violation of article 40 of this approach, is criticized by the municipal labour security administration; causes losses of the Fund, with a fine of up to 500 dollars, except for recovery. Article 52 abuses by the staff of the health insurance institutions, in favour of private fraud, are criticized by their authorities for educational and administrative disposal, which constitutes a crime and is criminalized by the judiciary. Chapter VIII Article 53 may be implemented in the light of this approach by individual workers in the town, free occupations and persons removed from labour relations with the user's units, which are otherwise developed by the municipal labour security administration. Article 54 calculates the year for basic medical costs for workers from 1 January to 31 December each year. Article 55 The provisional provision of the basic health insurance for urban workers (Peace Order No. 74 of the Municipal Government) was repealed. |
