Wuhan, Wuhan Municipal People's Government On The Amendment Of The Decision Of The Urban Workers ' Basic Medical Insurance Scheme

Original Language Title: 武汉市人民政府关于修改《武汉市城镇职工基本医疗保险办法》的决定

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(June 20, 2005 the 29th Executive meeting of Wuhan municipal on July 22, 2005, 164th promulgated by the people's Government of Wuhan municipality as of September 1, 2005), Wuhan municipal people's Government for decision on the urban workers ' basic medical insurance schemes as follows: first, the 28th article modified to: "pay ceiling on funds pay standards and specific amounts and pooling Fund and individual proportion of the burden of adjustment
    By the municipal labor and Social Security Administration Department in conjunction with the municipal finance department comment submitted to the municipal people's Government for approval, to the public. " 46th, the second paragraph of article is revised as follows: "large medical insurance by the municipal labor and social security administration departments of health insurance institutions, or by the municipal labor and social security administration departments on behalf of the workers, retirees and signed an agreement with commercial insurance. ", 47th article is revised as follows:" big health insurance by personnel participating in basic medical insurance monthly payment standard, paid in monthly pay basic medical insurance when I, in which retirees by issuing pension units daikou; termination of labor contract staff continue to participate in the basic medical insurance, payment to the health insurance agencies. "Four article 48th, amended to read:" to have large medical insurance worker, retiree medical expenses exceeding a certain limit of 1 year parts, contracting out medical insurance, medical insurance agencies and individuals according to a certain proportion of the burden, but cumulative payments of medical expenses shall not exceed the ceiling. Belong to commercial insurance, pay for medical costs of insured in accordance with the municipal labor and social security administration departments enter into agreements with commercial insurance companies. "The second paragraph is amended as:" the concrete solution to large medical insurance, including persons insured monthly payment standard, standard and the proportion of the burden of medical expenses and cumulative limit on pay by the municipal labour and social security administrative departments in collaboration with the Municipal Finance Department in accordance with the relevant provisions of the State and this municipality actually separate.

    "Of the urban workers ' basic medical insurance in Wuhan City in accordance with this decision revised again to the public. Attached: Wuhan town workers basic medical insurance approach (2005 amendment this) (on October 31, 2001 Wuhan City Government 126th, makes announced, according to on June 20, 2005 City Government on modified straddling Wuhan town workers basic medical insurance approach of decided Amendment) first chapter General first article to guarantees town workers and retired personnel of basic medical, according to State on established town workers basic medical insurance system of decided (country sent [1998]
    44th), combined with the city's actual, these measures are formulated.
    Article in the administrative area of the city of organs, institutions, social organizations, cities and towns, private non-enterprise units (hereinafter referred to as the employer) and its employees and retirees (not including the employment of foreign personnel) management of basic medical insurance and related matters, these measures shall apply.
    Article basic medical insurance premiums by the employer and worker share; the basic medical insurance fund combines social pool and personal accounts in order to balance; level of basic medical insurance and the city's economic development and financial bodies, employers and individual affordability. Article implement the city's overall plan of basic medical insurance, and territorial management.
    Caidian, and Jiangxia, and Dong XI Hu, and Hannan, and Huang Po Xinzhou district and urban workers ' basic medical insurance temporarily by integrated management of this area, with conditions, incorporated into the integrated management of the city.
    The fifth of labour and social security administrative departments of basic medical insurance for urban employees work, is responsible for organizing the implementation of this approach under the medical insurance agency, is responsible for handling day-to-day operations of basic medical insurance for urban workers.
    Finance, health, administration, tax, audit, price and other administrative departments according to their respective duties, in collaboration with relevant work on basic medical insurance.
    Sixth in the establishment on the basis of the basic medical insurance system for urban employees, established a complete set of supplementary health insurance systems.
    Chapter II basic medical insurance premiums article collecting basic medical insurance premiums by the employer and workers ' monthly pay.
    Eighth article in my last year's average monthly wage of employees as a base, and press 2% to pay basic medical insurance premiums, by the units to withhold from the wages of employees paid.
    Not last year's average monthly wage of employees, with this year's average monthly wage as a base without this year's average monthly wage, salary as a base.
    Workers ' monthly wages or salary less than the city's average monthly wage of employees 60% for the last year, above the city's average monthly wage of employees 60% as base pay over 300% of the workers ' average monthly salary in the city last year, above the city's average monthly wage of employees 300% as a base.
    Retirees who retired formalities has been provided for by the State, individuals do not pay medical insurance premiums.
    Nineth employer to employees ' base pay in the sum as a base, and press 8% to pay basic medical insurance premiums.
    On the employing unit shall be governed by the annual average wage of staff and workers in the city of 50% basic medical insurance costs for retirees to pay a one-time, and the specific measures formulated by the municipal labor and social security administration departments.
    The tenth municipal people's Government, according to the economic development and consumption level of urban workers ' medical needs, adjustments may be made on basic medical insurance premiums paid by, submitted to the provincial people's Government for approval before implementation.
    The 11th basic medical insurance premiums paid by the employer, in accordance with the financial institutions channel expenses.
    On the workers ' basic medical insurance premiums paid by individuals are exempt from personal income tax.
    12th the employing unit shall, within the prescribed in the 30th participating in basic medical insurance, health insurance agencies and local tax authority registration procedures for registration and basic medical insurance payment; the new unit should be established within 30th of registration.
    Unit combination, separation, bankruptcy, dissolution and the establishment or termination of labor relations with the workers, should be within the 30th medical insurance agency and local taxation authorities for registration or cancellation of registration of basic medical insurance.
    13th regional tax authority responsible for collecting basic medical insurance and basic medical insurance premiums levied by transferred to the special account of the basic medical insurance fund in a timely manner.
    14th an employer should be in full and on time to the local tax authority to pay basic medical insurance premium, shall not be in arrears. 15th article by confirmed of SHC State-owned enterprise and bankruptcy, and restructuring State-owned enterprise lifted labor contract of workers and out re-employment service center lifted managed agreement, and lifted labor contract of workers, can appropriate reduced by employing units paid basic medical premium of proportion; State-owned enterprise re-employment service center managed of workers, its personal and employing units paid basic medical premium of base can appropriate reduced, and are by re-employment service center paid.
    Specific measures formulated by the Administration in conjunction with the municipal labor and Social Security Department.
    16th chapter III basic medical insurance fund basic medical insurance fund, administered by the following funds: (a) basic medical insurance premiums paid by employer, (ii) workers ' basic medical insurance premiums paid by (iii) interest on funds of basic medical insurance and (iv) late payment of basic medical insurance premiums (v) into the other funds of basic medical insurance fund in accordance with law. Article 17th medical insurance agencies should participate in the basic medical insurance for workers, retirees establish a personal account and a social security card (IC card).
    Individual accounts financed by funds of the following: (a) the workers ' basic medical insurance premiums paid by individuals, (ii) basic medical insurance premiums paid by employers in complying with the provisions included in part; (c) personal account interest; (iv) additional funds into personal accounts in accordance with law. 18th article employing units paid of basic medical premium should by following proportion designated into personal account: (a) workers age in 35 age (containing 35 age) following of, by I payment base of 1.1% designated into; (ii) workers age in 35 age to 45 age (containing 45 age) of, by I payment base of 1.4% designated into; (three) workers age in 45 age above of, by I payment base of 1.7% designated into; (four) retired personnel age in 70 age (containing 70 age) following of,
    In my monthly pension as the base of the previous year, according to 4.8% in (v) pensioners over 70 years of age in my monthly pension as the base of the previous year, according to 5.1% in.
    Not on the annual average monthly pension of retirees, to base my monthly pension of the year; without this year's average monthly retirement pay, base monthly pension retirement costs less than the city's average monthly wage of employees 80% for the last year, these annual base 80% monthly wage of workers in the city. 19th basic medical insurance premiums paid by the employer after deductions into personal accounts part of the basic medical insurance fund (hereinafter the funds).
    Financial inclusion and manpower of the following funds: (a) interest on funds; (b) late payment of funds; (c) into the other funds of funds in accordance with law.
    20th all principal and interest into his own personal account, earmarked for provision of basic medical insurance payment program, not cash, but can be carried forward and inheritance.
    Deaths of workers and retirees, their personal account storage capital into the heir individual accounts; heirs not participating in basic medical insurance, lump-sum payments their heirs to individual account stores funds; no heirs, to store funds into a personal account funds.
    Workers called up, into the city, transferring their storage personal account Fund in accordance with the regulations.
    21st basic medical insurance funds into the financial management accounts, earmarking may not be misappropriated.
    22nd year to raise part of the basic medical insurance fund, according to the bank deposits carry interest at a rate; the previous year's carry-over funds and repay the 3 month lump-sum deposit interest rates; financial account deposit funds of basic medical insurance, compared with 3-year lingcunzhengqu bank deposits carry interest at a rate not below the grade level of interest rates.
    Article 23rd medical insurance agency shall provide for the establishment of the basic medical insurance fund accounting and internal audit systems, preparation of the budget and final account of the basic medical insurance fund report. Article 24th of labour and social security administrative departments and financial departments should strengthen the supervision and management of the basic medical insurance fund.
    Audit departments shall regularly on the funds of basic medical insurance payments and management audit.
    25th established by relevant government departments, employers, medical service institutions, trade unions, personnel participating in basic medical insurance and the basic medical insurance fund Supervision Organization made up of experts, strengthen the supervision of basic medical insurance fund.
    Basic medical insurance benefits for the fourth chapter 26th basic medical insurance for employers and their employees by paying 1 month later, enjoy basic medical insurance benefits for employees and retirees; not complying with the provisions of basic medical insurance, shall not be covered by basic medical insurance treatment. 27th workers contribute years of basic medical insurance premiums (depending on the period of contributions and the actual payment years) male total over 30 years today, women 25 years of age, according to provisions of retirement procedures can enjoy basic medical insurance benefits for retirees. Duration of payment years under the provisions of this article, retired by the employer, the workers themselves required make up the basic medical insurance premiums shall be paid at once.
    The calculation of the period of contributions, by the municipal labor and social security administration departments.
    28th article on workers and retirees at designated medical institutions inpatient, outpatient, emergency meet the requirements of the basic medical insurance of medical expenses incurred, paid according to the following provisions: (a) medical expenses below the standard of pay in funds paid by the individual.
    (Ii) medical with in and manpower Fund up pay standard above part, according to medical institutions grade, by and manpower Fund and workers personal by following proportion paid, retired personnel personal since pay medical with of proportion for workers personal since pay proportion of 80%: 1. a level medical institutions and manpower Fund paid 88%, workers personal since pay 12%; 2. II level medical institutions and manpower Fund paid 85%, workers personal since pay 15%; 3. three level medical institutions and manpower Fund paid 82%, workers personal since pay 18%.
    (C) the overall payment ceiling for the Fund in a given year, according to the annual average wage of staff and workers in the city about 4 times to determine.
    Funds to pay standards, according to the annual average wage of staff and workers in the city of 10% on left and right combined with the medical institutions of different level; 2 or more times within the same year in hospital in half.
    Funds pay standards and maximum payment limit amount and pooling Fund and individual proportion of the burden of adjustment by the municipal labor and social security administration departments, financial departments, and reported to the municipal people's Government for approval, to the public.
    29th employee, retiree suffering from some severe illness in outpatient treatment, which meet the requirements of the basic medical insurance medical expenses paid by the proportion of funds to employees by 80%, paid to retirees by 85%.
    Outpatient treatment of severe diseases provided by the municipal administration of labor and social security authorities and the municipal public health Administrative Department.
    30th employee, retiree inpatient, outpatient, emergency and outpatient treatment of severe disease, belongs to the basic medical insurance funds to pay part of the costs of diagnosis and treatment project in the list of the basic medical insurance and drug and medical expenses of class b drugs, should begin with the individual pays 20%, the balance shall be handled according to article 28th of this approach.
    31st employee, retiree medical insurance agency agreed, at designated medical institutions in the city hospitals, according to the provisions of article 30th.
    Agreed by the health insurance agencies transferred to outside treatment, hospitalization expenses by an individual pays the first 10%, the balance according to the provisions of article 30th.
    32nd employee relocation for long in the field, and retirees, specified by the health insurance agencies in conjunction with the employers a local medical institution, which reimbursed medical expenses according to the relevant provisions in these procedures audit, specific measures formulated by the municipal labor and social security administration departments.
    33rd workers have one of the following, and, outside the clinic, its emergency medical expenses according to the provisions of article 30th: (a) for a business trip, (ii) go out during the family visit, (iii) go out during the statutory holiday.
    34th employee, retiree medical expenses incurred because of outbreaks of infectious diseases, submitted to the municipal people's Government coordination.
    35th article following medical costs, and manpower Fund, and personal account funds not paid: (a) except this approach has provides of outside, in non-Sentinel medical institutions and non-Sentinel retail pharmacy occurred of medical costs; (ii) medical or purchased drug by occurred of not meet basic medical insurance clinic project, and drug directory, and medical service facilities range and paid standard of medical costs; (three) for illegal crime, and suicide, and self-mutilation, occurred of medical costs; (four) should in other insurance or other lost pay responsibility range paid of medical costs. Fifth chapter 36th basic medical services management of basic medical insurance medical healthcare institutions and the management of appointed retail drugstores.
    Health and drug supervision and Administration Department for approval and to obtain a practising certificate of medical institutions and retail pharmacy, may be submitted to the municipal labor and social security administration to apply for the basic medical insurance medical services for and approved after examination by the municipal labor and social security medical services certificate issued by the administration of basic medical insurance.
    37th of municipal labor and social security administration departments in accordance with traditional Chinese and Western medicine simultaneously, grass-roots, both specialist and general medical institutions, principles of medical treatment and drugs for employees, retirees, and determine the designated medical institutions and appointed retail drugstores, provides basic medical services for workers and retirees.
    Workers and retirees can choose designated medical institutions appointed retail drugstores and medical treatment, purchase of medicines.
    Article 38th medical insurance agencies with designated medical institutions appointed retail drugstores and medical insurance medical services agreements specify the rights and obligations of both parties.
    39th designated medical institutions and appointed retail drugstores should set up specialized agencies or to equip fulltime staff, responsible for basic medical insurance-related work, strict implementation of basic medical insurance drug list, medical projects, health services and payment management requirements, it may not expand the scope of services and by falsifying information, Bill or other improper means to obtain medical insurance fund.
    Diagnosis and treatment of basic medical insurance drug list, items, medical services and payment management approach formulated by the Administration in conjunction with the municipal labor and Social Security Department.
    40th appointed retail drugstores must ensure the variety and quality of basic medical treatment, must consult with the drug business license unit purchases of drug control departments inspected drugs and implement drug prices under the price control Department standards.
    41st workers and retirees in the designated medical institution or designated retail pharmacies to buy drugs, shall produce their medical insurance documents; fixed-point medical institutions buy buy outpatient drugs or prescription to the designated retail pharmacies may decide.
    Designated medical institutions, designated retail pharmacies shall check the documents of basic medical insurance.
    Basic medical insurance certificates shall not be fraudulent, counterfeit, and lending.
    42nd appointed medical institutions of workers and retirees in the outpatient and medical expenses of appointed retail drugstores to buy drugs, in line with the provisions of the basic medical insurance, paid for by individual accounts, overrun at their own expense. Article 43rd workers and retirees at designated medical institutions meet the requirements of the basic medical insurance in hospital, outpatient, emergency and outpatient treatment of severe diseases medical expenses shall be borne by the individual parts, and I have designated medical institutions settled; part of should be paid from the funds, by the health insurance agencies and designated medical institutions settled.
    Specific measures for the settlement by the municipal labor and social security, health, finance, in conjunction with the Department of administration.
    44th of municipal labor and social security administration departments shall organize health, drug, price and other administrative departments in accordance with relevant provisions of the basic medical insurance, annual assessment of the designated medical institutions, annual qualification examination for fixed-point retail drugstore; assessment is not qualified or unqualified audit, canceled its targeted qualifications.
    45th article city health, and drug prison, and prices administration sector should according to national, and province, and city town medicine health reform of guide views and basic medical insurance medical service of provides and requirements, strengthening on Sentinel medical service institutions of supervision check, established new of medical institutions classification management system, implemented medicine separate accounting, and respectively management and drug concentrated tender procurement system, adjustment drug price, improve medical service quality.
    Sixth chapter supplementary health insurance in the 46th to establish large medical insurance to help reduce the burden of large medical expenses for employees, retirees.
    Large medical insurance by the municipal labor and social security administration departments of health insurance institutions, or by the municipal labor and social security administration departments on behalf of the workers, retirees and signed an agreement with commercial insurance.
    47th large medical insurance, by personnel participating in basic medical insurance monthly payment standard, paid in monthly pay basic medical insurance when I, in which retirees by issuing pension units daikou; termination of labor contract staff continue to participate in the basic medical insurance, payment to the health insurance agencies.
    Personnel participating in large medical insurance cover after 1 month and enjoy a large medical insurance benefits; not required pay large medical insurance premiums, to benefit large medical insurance benefits. 48th participate in large medical insurance worker, retiree medical expenses exceeding a certain limit of 1 year parts, contracting out medical insurance, medical insurance agencies and individuals according to a certain proportion of the burden, but cumulative payments of medical expenses shall not exceed the ceiling.
    Belong to commercial insurance, pay for medical costs of insured in accordance with the municipal labor and social security administration departments enter into agreements with commercial insurance companies.
    Specific measures for large medical insurance, including persons insured monthly payment standard, standard and the proportion of the burden of medical expenses and cumulative limit on pay by the municipal labour and social security administrative departments in collaboration with the Municipal Finance Department in accordance with the relevant provisions of the State and this municipality actually separate. 49th participating in basic medical insurance companies set up enterprise supplementary medical insurance according to the actual situation, to benefit out-of-Pocket medical expenses.
    Supplementary medical insurance during part of their employees ' wages in the 4%, be included in the cost.
    Enterprise complementary medical insurance guidelines formulated by the municipal labor and social security administration departments. 50th national civil servants on the basis of basic medical insurance and Medicaid. Medicaid implementation of municipal and district levels, management of State civil servants, burden of Medicaid funds according to the classification of existing financial management institutions.
    Organ directly under the national civil service medical subsidies from the municipal labor and social security administration departments, financial departments.
    National civil service medical coverage, according to the circular of the Ministry of labor and Social Security Ministry of notice of views on the implementation of civil service medical benefits (State [2000]37) shall apply.
    51st participating in basic medical insurance the employer can establish a unit employee medical insurance, to grant out-of-Pocket medical expenses.
    Medical mutual insurance guidance by the municipal labor and social security administration departments together with the municipal Federation of trade unions to develop.
    52nd founding a poor medical assistance system to help reduce an individual's medical expense burden on poor personnel.
    Specific measures by the political authorities and the city financial, health and other departments.
    Seventh chapter legal responsibility 53rd article employing units violation this approach 12th article of provides, not by provides handle parameter insurance registration, and change registration or cancellation registration of, labor and social security administration sector can ordered its deadline corrected; plot serious of, can on directly is responsible for of competent personnel and other directly responsibility personnel at 1000 Yuan above 5000 Yuan following of fine; plot special serious of, can at 5000 Yuan above 10,000 yuan following of fine. 54th article employing units violation this approach 14th article of provides, arrears basic medical premium of, labor and social security administration sector or place tax organ ordered its deadline paid, from owes paid of day up, daily by owes paid amount of 2 ‰ added received late fees, and on directly is responsible for of competent personnel and other directly responsibility personnel at 5000 Yuan above 20,000 yuan following of fine; late refused to paid basic medical premium, and late fees of, can law application Court forced levy paid
    ; Default losses due to health insurance costs to workers and retirees, paid for by the employer. 55th employing units and units responsible for pension payment not complying with the provisions of the present article 47th withholding payment of large medical premiums, the Administrative Department of labour and social security ordered to pay.
    Is not required to withhold payment of large medical insurance to workers and retirees caused by loss, unit and the unit responsible for pension payment of compensation.
    56th medical institutions and appointed retail drugstores in contravention of this article 39th, 41st paragraph, resulting in loss of health insurance fund, shall compensate for the losses, and by the labor and social security administration departments to a fine of less than 1000 Yuan and 10,000 yuan.
    57th individuals in violation of the provisions of article 41st, fraudulent use, forging, loan insurance documents, obtain medical insurance fund, the labor and social security administration departments to a fine of less than 100 Yuan more than 1000 Yuan constitutes a crime, drew attention to the judicial organs shall be investigated for criminal liability loss shall bear liability.
    Article 58th in violation of these regulations relating to health, drug, price control and other provisions, be dealt with by the relevant administrative department in accordance with the relevant provisions.
    Article 59th of labour and social security administrative departments and fines collected by local tax authorities should be turned over to the State Treasury in a timely manner, will collect a late fee into the basic medical insurance fund in a timely manner.
    60th medical insurance agency staff did not perform their duties, is not required to pay basic medical insurance premiums, criticized by labor and social security administrative departments shall be ordered to correct causing serious consequences, shall be given administrative sanctions.
    Article 61st of labour and social security administrative departments, health insurance agencies in violation prescribed in this way, abuse, deception, negligence, resulting in loss of basic medical insurance fund, the labor and social security administration departments to recover their losses, shall be given administrative sanctions constitutes a crime, the attention of the judicial organs shall investigate the criminal liability.
    62nd article units and personal can to labor and social security administration sector reported complaints following violation this approach provides of behavior: (a) employing units not by provides paid and generation buckle generation paid basic medical premium of; (ii) employing units and is responsible for pension issued of units not by provides generation buckle generation paid large medical premium of; (three) Sentinel medical institutions, and Sentinel retail pharmacy not by provides provides medical service of; (four) medical insurance handling institutions not by provides paid basic medical premium of;
    (E) other acts in violation of these rules.
    Administrative Department of labour and social security after receiving the complaint shall be investigated and dealt with in a timely manner.
    63rd participating in basic medical insurance of personnel by basic medical insurance dispute with the employer, to a labour dispute arbitration Committee for arbitration according to law; appeal against the arbitration decision, initiate proceedings in accordance with law.
    64th refuses to accept administrative punishment decision made by the Administrative Department of labour and social security, according to provisional regulations on collection and payment of social insurance and the People's Republic of China administrative review provisions of the Act, may apply for administrative reconsideration or bring an administrative suit.
    The eighth chapter supplementary articles the 65th town owners of individual economic organizations and their employees and in addition to the provisions of article 15th insolvency, restructuring enterprises, reemployment Service Center other than the employer terminate, termination of labor contract personnel of the basic medical insurance scheme, developed by the municipal labor and social security administration departments.
    Retired personnel, army, second grade b more disabled revolutionary medical expenses according to the original funding channels, and the specific measures formulated by the Administration in conjunction with the municipal labor and Social Security Department.
    Personnel participating in basic medical insurance to provide for the immediate family and the medical costs of college students, from access to capital expenditures.
    66th article of the specific problems in the implementation of the measures by the municipal labor and social security Administrative Department is responsible for the interpretation.
    67th article caidian, Jiangxia, and Dong XI Hu, Hannan, huangpi, Xinzhou district and in accordance with this approach to develop implementation plan, submitted to the municipal people's Government for approval before implementation.
                                                                                                                        68th these measures shall come into effect as of the date of, specific steps for implementation, organized by the municipal labor and social security administration departments.

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