Hangzhou City Basic Medical Insurance Scheme

Original Language Title: 杭州市城镇基本医疗保险办法

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(November 24, 2003 Hangzhou City Government 27th Times Executive Conference considered through November 30, 2003 Hangzhou City Government makes 199th, announced) first chapter General first article for established and perfect this city town basic medical insurance system, guarantees participate in basic medical insurance personnel (following referred to parameter insurance personnel) of basic medical, promote social stable and economic development, according to State on established town workers basic medical insurance system of decided, and social security fee levy paid interim regulations
    Issued relating to the people's Government of Zhejiang Province, Zhejiang Province and promote the reform of the basic medical insurance system for urban employees notice of the views of the relevant provisions of, this municipality actually, these measures are formulated.
    Article based on finance, affordability of the units and individuals, and gradually establish a socialist market economic system, guarantee the basic medical needs of the insured social basic medical insurance system.
    Third article established and perfect town basic medical insurance (following referred to basic medical insurance) system must insisted following principles: (a) basic medical insurance level should and economic and social development level phase adapted; (ii) is basic medical insurance parameter insurance range of units and personal are should participate in basic medical insurance, and implemented territorial management; (three) basic medical premium by parameter insurance units and parameter insurance personnel common bear, Government appropriate subsidies; (four) basic medical insurance fund implemented social and manpower and personal account phase combined;
    (E) mobilization and basic medical insurance premiums paid should reflect the rights and obligations corresponds to the principles in the process of reform of the basic medical insurance system, Government, insurance and insured persons shall bear the corresponding management and financial responsibilities. Fourth article this approach applies Yu Hangzhou City administrative within of following units and personal: (a) town various enterprise, and State, and institutions, and social groups, and private non-enterprises (following collectively parameter insurance units) and on-the-job workers; (ii) by provides agreement paid basic pension premium and basic medical premium of personnel (following referred to Association paid personnel); (three) this article subsection (a) items, and
    (B) other than those provided for by this co-ordinating compliance with the statutory age for employment of non-agriculture officials have not yet reached the legal retirement age (hereinafter referred to as flexible employment personnel) and (iv) participating in basic medical insurance as required and reaching the legal retirement age (hereinafter referred to as retirement, retirement, the same below) personnel (hereinafter referred to as retirees).
    Comply with the above conditions of insured units and individuals shall be included within 3 months from the date the insurance, basic medical insurance agency (hereinafter referred to as health care agencies) for the insurance procedures, insurance formalities is not within the specified time is deemed interruption insurance.
    According to the original of the Hangzhou City basic medical insurance schemes (municipal 189th) interrupted meet the insurance requirements under the insurance units and individuals, following the implementation of this approach, years of insurance insured person interrupt real accumulated.
    Article fifth in Hangzhou (does not contain Xiaoshan, Yuhang district), Xiaoshan, Yuhang district and counties (cities) separately as an independent and integrated region, in accordance with the principle of territorial management, implementation of basic medical insurance fund raising, and management.
    Xiaoshan, Yuhang district and counties (cities) under this approach, combined with the characteristics of the district economy development and economic structure, develop this area of the basic medical insurance scheme, implemented after approved by the municipal people's Government. Article sixth insurance and insurance of people participating in basic medical insurance at the same time, participating in the basic old-age insurance shall be in accordance with the relevant provisions.
    Among them, before June 30, 2004, males reaching the age of 45 and women over the age of 35 and the flexible employment of retired officers, separate participating in basic medical insurance, and within 6 months from the date of implementation of this approach for the basic medical insurance procedures.
    Article seventh Hangzhou people's Government according to the economic development and operation of the basic medical insurance system, pay for basic medical insurance payment ratio, standard ratio and maximum payment limit and the Government subsidy made timely adjustments implemented after approved by the provincial people's Government. Chapter II administrative bodies and duties Article eighth Hangzhou municipal labor and social security administrative departments in charge of the city's basic medical insurance. Xiaoshan, Yuhang district and the County (City) of the administrative departments of labor security in areas under their jurisdiction the basic medical insurance.
    Labor and social security administration departments at all levels under the health care agency has specific responsibility for the day-to-day management of basic medical insurance.
    Economic, health, drug, financial, taxation, industry and commerce, price control, auditing, personnel, and public security departments shall, in accordance with their respective responsibilities, to facilitate the implementation of the administrative departments of labor security in this approach.
    In the process of implementation of these measures, labor and social security administration heard similar views from trade unions, in the study of basic medical insurance policy and measures absorption at the participation of trade unions. Nineth article labor guarantees administrative sector of main duties: (a) is responsible for prepared and organization implementation this area basic medical insurance of development planning and General Programme; (ii) implementation basic medical insurance of about legal, and regulations and regulations, developed or with about sector developed basic medical insurance of supporting policy; (three) on basic medical insurance system implementation situation for supervision check, and law on violations behavior for processing; (four) with financial, and audit, sector on basic medical insurance fund of payments, and
    Monitor the running management; (e) in conjunction with the Department of health, drug, financial, pricing of medical institutions, drugstores in basic health care and administration of the inspection and assessment; (vi) jointly with the trade unions and the economy, industry and commerce, taxation, auditing, personnel, public security and other departments to handle basic medical insurance for work-related matters. Tenth Article Medicare handling institutions of main duties: (a) is responsible for basic medical insurance fund of raised, and management and using, specific handle basic medical insurance of parameter insurance, and payment, and audit and costs settlement, aspects of work; (ii) is responsible for basic medical insurance fund pre accounts draft of prepared and basic medical insurance fund of financial and internal audit work, on basic medical insurance fund of run situation for analysis, timely to superior sector provides basic medical insurance fund warning report; (three) by labor guarantees administrative sector delegate
    , In conjunction with the relevant departments of medical institutions, drugstores charge, medicine, basic medical insurance service, price supervision and inspection, (iv) commissioned by the administrative departments of labor security and irregularities in the implementation of basic medical insurance for investigation and processing; (v) provide basic medical insurance-related services.
    11th health care agencies funded by the financial sector according to the actual needs in basic medical insurance, budget allocated shall not be extracted from the basic medical insurance fund. Chapter III basic medical insurance fund raising section 12th medical premium by the insured and insured persons according to the following provisions, appropriate government subsidy: (a) the enterprise, private non-enterprise units and reference business insurance unit, Last month all employee wage bill as the base of this unit extracts 9.5%, 0.5% by insurance units according to a certain proportion of the base into the individual account, 9% by the insured monthly payment to the health-care agencies (including 6% funds for setting up a hospital and the disease clinic and Manpower, 3% for the outpatient social pool fund for retired personnel).
    On-the-job workers (except II, Serie b and the above revolution disability soldiers outside, with) by I Shang years average (below last year this and manpower area workers monthly wage 60% of, to last year this and manpower area workers months average of 60% for base; above last year this and manpower area workers monthly wage 300% of, to last year this and manpower area workers months average of 300% for base, with) of 2% paid, by parameter insurance units by months generation buckle.
    Employee payroll statistic calculated according to national requirements (below). (Ii) into civil servants medical grants range of State, and institutions and social groups, to last month this units all workers payroll for base, by months to Medicare handling institutions paid 15%, which base of 6% for established hospital and provides disease species outpatient and manpower Fund (following referred to hospital and manpower Fund), 9% for established enjoy civil servants medical grants of parameter insurance personnel outpatient and manpower Fund (following referred to civil servants outpatient and manpower Fund).
    I employed according to the 2% of the average wage paid by insurance units on a monthly basis to the Medicare agency paid after withholding.
    (C) payment of personnel according to the municipal people's Government on some of the laid off workers ' agreement to pay the basic old-age insurance and the relevant provisions of the basic medical insurance premiums. (D) flexible employees pooling area workers ' monthly salary in the previous year as the base, by individuals (including non-formal employment from the informal employment organizations management unit) monthly payment to the insurance agency 7.5%, which 5% used to establish base hospital funds 2.5% for establishment of outpatient medical expenses of retirees social pool Fund (hereinafter referred to as retirement funds for outpatient and Manpower).
    Families in Hangzhou City, held within the period of validity of the aid certificate documents of flexible employment and employment assistance, the overall monthly wage of staff and workers of 60% to the previous year as the base pay. (V) included retirees outpatient social plan (hereinafter referred to as outpatient and manpower of retirees) retirees per person as compared to standard 15% the overall average wages of workers pay a one-off start-up funding for outpatient and Manpower, used to establish a retiree clinic funds bankruptcy, closing and restructuring units has been retained by the regulation for medical expenses of retirees no longer paid.
    Is insurance for retired officers, management units or received by the insurance unit to pay insured in their personal capacity, and contributions from individuals, among them, the Association paid staff and families in Hangzhou City, held within the period of validity of the aid certificate of flexible employment, the overall average wage of workers in the region in the previous year base pay start-up funding for outpatient and manpower 60%. (Vi) by this co-ordinating the Government subsidize insurance units total wages of staff and workers of 0.5% (part of Medicaid for serious diseases).

    (VII) insurance units and manpower workers ' average monthly salary is lower than the previous year average monthly wage of employees 60%, the overall monthly wage of staff and workers of 60% to the previous year as the base pay higher than the overall average monthly wage of employees 300%, the overall monthly wage of staff and workers of 300% to the previous year as the base pay.
    Retirees out-integrated management of the specific measures shall be formulated separately by the municipal people's Government. 13th insured and insured persons shall pay by the month in addition to start-up funding for outpatient and manpower of basic medical insurance premiums.
    Basic medical insurance premiums not relief, regardless of the tax charges.
    Article 14th basic medical insurance premiums collected by the local tax authorities are responsible for, and included in the financial management of social security funds, earmarks, no unit or individual shall not be misappropriated. 15th article parameter insurance units extraction, and paid basic medical premium of expenditures channel, in accordance with parameter insurance units of different category, by following provides implementation: (a) for established hospital and manpower Fund of basic medical premium, State in "funding spending – personnel spending – social security payment" subjects in the expenditures, institutions (or social groups) in "career spending (or business spending) – personnel spending – social security payment" subjects in the expenditures, enterprise in "meet Welfare fee" subjects in the expenditures 60%, in "labor premium
    "Accounts would be covered by 40%.
    (B) used to establish the civil service clinic funds of basic medical insurance premiums, State organs "expenditures – spending on subsidies for individuals and families – medical expenses" account in Liechtenstein, public institutions (or society) "expenditure (or operating expenses)-spending on subsidies for individuals and families – medical expenses" account in Liechtenstein.
    (C) used to establish the retirement funds of basic medical insurance for outpatient and Manpower, public institutions (or society) "expenditure (or operating expenses)-spending on subsidies for individuals and families – medical expenses" account in Liechtenstein, enterprises in the "labor insurance premium" account in Liechtenstein.
    16th insurance unit is terminated in accordance with law, must pay off the outstanding basic medical insurance premiums.
    Basic medical insurance a insurance article 17th registration change or terminate insurance units shall alter or terminate within 30th of the health-care agencies go through the relevant formalities.
    18th that year to raise part of the basic medical insurance fund, according to Bank saving deposits carry interest at a rate over the same period; the previous year's carry-over funds and repay the 3 month lump-sum savings deposit interest rate interest; financial account accumulated funds in social security funds, according to lingcunzhengqu not less than 3-year bank deposits carry interest at a rate.
    The fourth chapter funds and personal accounts article 19th clinic funds used to build the civil service enjoy civil service medical benefits insured persons (hereinafter referred to as the civil service), personal accounts and payments meet the basic medical insurance expenditure ranges shall be coordinated by the civil service clinic fund part of the out-patient medical expenses (including General, emergency medical treatment and drugstores to buy drugs, the same below).
    Article 20th retirees out personal funds used to build retirement accounts and payments meet the basic health-care costs range up to the retiree fund part of outpatient clinic and manpower.
    21st hospital funds by insurance units last month, according to the workers wages of 6%, flexible employees according to the previous year this plan 5% of the workers ' monthly salary to be paid by basic health insurance and basic medical insurance 50% of the total fee paid personnel and so on.
    22nd hospital funds used to pay basic medical insurance expenditure ranges shall be coordinated by the Hospital Fund as part of disease outpatient and inpatient medical expenses.
    Provides disease refers to various types of cancer, systemic lupus erythematosus, aplastic anemia, hemophilia, schizophrenia, affective disorders and chronic renal failure, dialysis and project included in the diagnosis and treatment of anti-rejection therapy after organ transplantation.
    After the implementation of the present measures, administrative departments of labor security according to actual medical condition of disease, to make timely adjustments to provide disease type, approved by the municipal people's Government announced after the execution.
    Article 23rd, private non-enterprise units and reference business insurance unit, its workers individual accounts temporarily by insurance units to set up and manage, the health-care agencies are responsible for operational guidance, when conditions mature, established centrally by the insurance agency and management.
    Civil servants, paid staff and retirees participating in the clinic and manpower of retirees personal account by the health care agency responsible for building and managing.
    Flexible employment before retirement without establishing personal accounts, individuals whose retirement account by the health care agency responsible for building and managing. 24th article parameter insurance personnel of personal account by following provides established and management: (a) by parameter insurance units established and management of on-the-job workers personal account funds by two part composition: part by I by its Shang years average of 2% to this units by months paid, and all designated into its personal account; another part by parameter insurance units according to on-the-job workers of different age paragraph (is divided into 35 age following, and 35 age to 45 age following, and 45 age to retired Qian),
    From the insurance units last month, according to the all employee payroll 0.5% extraction of basic medical insurance premiums, proportionally to their personal accounts, specifically included in the proportions determined by the insurance units based. (Ii) civil servants of personal account funds by two part composition: part by on-the-job workers by I Shang years average of 2% to Medicare handling institutions by months paid, and all designated into its personal account; another part by Medicare handling institutions according to civil servants of different age paragraph, retired Qian by I Shang annual payroll, and retired Hou by I Shang annual basic pension (I basic pension below Shang annual this and manpower area by Medicare handling institutions unified established and management personal account of retired personnel per capita basic pension of, By last year, this integrated and centrally by the Medicare Agency to establish and manage individual account of basic pension for retirees per capita) a certain proportion, from civil service clinic funds into his personal account.
    Classified as: 1, 35 years of age in 0.4% 2, aged 35 to 45 years of age classified as 0.7%; 3, 45 years before retiring to the classified 1%; 4, retire until after 70 years of age classified 5.8%; 5, 70 years old and above (70 years old) into the 6.8%. (Three) participate in retired personnel outpatient and manpower of retired personnel of personal account funds, by Medicare handling institutions according to retired personnel of different age paragraph, by I Shang annual basic pension (I no basic pension or basic pension below Shang annual this and manpower area by Medicare handling institutions unified established and management personal account of retired personnel per capita basic pension of, by Shang annual this and manpower area by Medicare handling institutions unified established and management personal account of retired personnel per capita basic pension) of must proportion, Clinic from retirees the funds into his personal account.
    Classified as: 1 retirement until 70 years of age classified as 5.8%; 2, 70 years old and above (70 years old) into the 6.8%.
    (D) payment of personal account funds before retirement, according to the 50% of the total amount of basic medical insurance premiums paid into.
    (E) on a monthly basis of funds into a personal account.
    (Vi) the pooling area centrally by the Medicare Agency for the last year to establish and manage individual account of basic pension for retirees per capita, provided by the administrative departments of labor security in accordance with the relevant sector data audit determined.
    25th personal account when the funds used to pay basic medical insurance expenditure range of outpatient medical expenses; personal accounts over the funds to cover basic medical insurance expenditure range according to the provisions of the personal share of the outpatient disease outpatient and inpatient medical fees, and regulations (standards).
    26th personal personal account of principal and interest, can be carried forward to the next year and inherited according to law. Fifth chapter of basic medical insurance treatment 27th insured persons pay months of basic medical insurance covered by basic medical insurance treatment.
    After the insured shall be continuous to pay basic medical insurance premiums to the statutory retirement age, such as the interrupt payment for 3 months in a row, is deemed interruption insurance, fourth month ceased to enjoy medical insurance, basic medical insurance fund to pay for medical expenses not included in the scope.
    Interruption insurance for the insured individual reasons, disruption of basic medical insurance does not pay.
    Insured person interrupt due to insurance reasons caused insured or not complying with the provisions of basic medical insurance, be recovered by the insurance units in accordance with the regulations, the medical expenses of the insured person occurs during interrupt, in addition to should be borne by the individual parts, the remaining medical costs borne by the insured.
    28th interrupt when the insured person insured again, is overall non-farm household registration staff must be in continuous payment after the expiration of 6 months before they can enjoy basic medical insurance benefits, is overall non-farm household outside of insurance payment the month once again enjoy basic medical care insurance benefits.
    Article 29th when the insured person retired, basic medical insurance payment of less than 20 years, by the insured or insured persons at once after 20 years ' pay in order to continue to receive basic medical insurance treatment.
    Article 30th of basic medical insurance to pay base and rates for the pay procedures the standards.
    Insured persons required to pay basic medical insurance premiums at the same time, major diseases should pay Medicaid and manpower costs, which hold families in Hangzhou City, within the period of validity of the aid certificate of insured persons is exempt from its major diseases should pay fees for Medicaid and manpower.
    31st following basic medical insurance payment period: (a) actual payment years of basic medical insurance, (ii) identified by the administrative departments of labor security seen as a period of contributions, (iii) before December 31, 2002, in line with national, provincial, provided uninterrupted service.
    More than basic medical insurance payment period is not counted. 32nd article this way after the plan, insured persons when they retire, pay its cumulative interruption time of the following circumstances, according to the following regulations increased the percentage of post-retirement medical expenses personal responsibility:

    (A) basic medical insurance payment years (containing fill paid years, with) for 20, cumulative interrupted payment time 1 years above (containing 1 years, with) 3 years following of, its personal bear of medical in provides proportion of based Shang increased 20%; cumulative interrupted payment time 3 years above (containing 3 years, with) of, its personal bear of medical in provides proportion of based Shang increased 30%.
    (B) the period of contributions for more than 20 years of basic medical insurance to 25, cumulative interruption of contribution times for more than 1 year to 3 years, and their medical expenses within the prescribed rates of individuals based on 15% total interrupt payment time 3 years, their medical expenses within the prescribed rates of individuals based on 25%.
    (C) the duration of basic medical insurance for more than 25 years to 30 cumulative interruption of contribution times for more than 1 year to 3 years, and their medical expenses within the prescribed rates of individuals based on 10% total interrupt payment time 3 years, their medical expenses within the prescribed rates of individuals based on 20%.
    (D) the duration of basic medical insurance for more than 30 years, cumulative interruption of contribution times for more than 1 year to 3 years, and their medical expenses within the prescribed rates of individuals based on 5% total interrupt payment time 3 years, their medical expenses within the prescribed rates of individuals based on 15%.
    33rd insurance personnel in the administrative departments of labor security fixed-point medical institutions of choice for medical treatment, also available in drugstores to buy drugs (prescription drug prescriptions to be issued by the designated medical institutions).
    As stipulated in the rules kind of private medical records of the insured person, can be determined in the administrative departments of labor security designated medical institutions, select a fixed-point medical institutions of real time medical expenses, or select the two designated medical institutions by individuals after the full payment of medical expenses, after examination by the health care agency closing. Article 34th retirees out co-ordinating implementation of site management. Retirees who participate in the clinic and manpower of retirees in the administrative departments of Labor Security Clinic in agreed medical institutions choose a clinic agreed medical institutions and can be adjusted according to their will on a monthly basis.
    Retired due to illness require referral diagnosis and treatment, prescribed by the outpatient health care agency referral, go to the appropriate designated medical institutions for treatment.
    Article 35th of insured persons in accordance with range of inpatient medical expenditure of basic medical insurance fee settlement as follows: (a) standard of paying hospital funds (hereinafter referred to as the hospital pay standard): 800 yuan in three levels and the corresponding medical institutions, secondary and the corresponding medical facilities 600 Yuan, 400 Yuan in other medical institutions. Hospital payment standard is set for each hospitalization.
    During the year under a natural second inpatient hospital payment criteria laid down by the 75% calculation, third hospitalization required hospitalization and above pay the standard 50% and needs to be hospitalized several times because of various malignant tumor radiotherapy and chemotherapy treatment, calculated at designated medical institutions in the hospital level for the first time a hospital standards.
    (B) the standard of paying hospital following medical expenses borne by the individual.
    (C) during the year under a natural, insurance personnel from hospital funds and individuals share responsibility for medical expenses, the maximum payment limit of 80,000 yuan, maximum limit on an annual basis (subject to the discharge date) accumulated, medical expenses above the maximum limit Medicaid solutions by serious diseases. (Four) hospital up pay standard above highest paid limit following part of medical by hospital and manpower Fund and personal common bear, which personal of bear proportion by following provides implementation: 1, and hospital up pay standard above to 20,000 yuan of, retired Qian personal bear 20%, retired Hou personal bear 15%; 2, and 20,000 yuan above to 40,000 yuan of, retired Qian personal bear 15%, retired Hou personal bear 10%; 3, and 40,000 yuan above to 80,000 yuan of, retired Qian personal bear 10%, retired Hou personal bear 5%; 4, and
    Join the revolution before the founding of work borne by the old standards of workers per retired staff in half. Article 36th in a natural year in providing disease outpatient hospital settlement at a time, but do not offer inpatient payment standards.
    Within the category of the annual maximum limit including diseases outpatient and inpatient medical expenses.
    37th article in a natural annual within, on parameter insurance personnel of outpatient medical set a outpatient up pay standard: (a) retired Qian for 1000 Yuan; (ii) civil servants in the of retired personnel for 700 Yuan, which founding Qian participate in revolution work of old workers for 350 Yuan; (three) participate in retired personnel outpatient and manpower of retired personnel for 400 Yuan, which founding Qian participate in revolution work of old workers for 200 Yuan. 38th article parameter insurance personnel occurred of meet basic medical insurance expenditure range of outpatient medical first by its personal account when funds paid, personal account when underfunded paid of, by personal bear outpatient up pay standard, outpatient up pay standard above part of medical by following provides settlement: (a) is enterprise, and private non-enterprises and reference Enterprise parameter insurance of units on-the-job workers of, by parameter insurance units and personal common bear, which personal bear proportion for 20% around, personal bear proportion over 30% of,
    Shall be discussed by the unit to which the workers ' Congress passed, and reported to the parent organization for the record.
    (B) the staff outside the civil service, coordinated by the civil service clinic funds and individuals share responsibility, in which individuals at 20%.
    (C) is participating in outpatient and manpower of retirees and the Civil Service retirees, respectively for post-retirement clinic funds, civil service clinic funds and individuals share responsibility, in which individuals at 15%, before the founding of the proportion of older workers and individuals involved in the revolution of 5%. 39th flexible employment in out-patient medical expenses borne by individual before he retired.
    Payment occurs before the retirement of the out-patient medical expenses from their personal accounts to pay, personal account of funds paid and borne by the individual.
    After two retirements in the preceding paragraph, is not required to participate in outpatient and manpower of retirees, out-patient medical expenses from their personal accounts to pay, personal account of funds paid and borne by the individual.
    40th insured persons on three levels and the corresponding outpatient, inpatient, personal bear part of the costs for the required ratio of 120%; in the secondary and outpatient, inpatient, personal bear part of the costs for the required ratio of 100% in other outpatient, inpatient, personal bear part of the costs for the required ratio of 80%.
    Insured persons in drugstores to buy drugs, individuals bear part of the costs for the required ratio of 100%.
    41st insured persons approved by the Medicare agency go outside the city (limited to Shanghai, Beijing, Hong Kong) designated medical institutions for treatment, which meet the medical expenses of basic medical insurance expenditure range, first by individuals themselves 10% of the total medical expenses, and then press the article 35th to 40th on three levels and the corresponding provisions of the medical institution. Permanent Mission of 42nd field for more than 3 months of insured persons and relocation (including 1 years ' continuous residence in different places), retirees, and approved by the health care agency after registration can choose two regular residence near the designated medical institutions for treatment, one for outpatient appointment medical institutions.
    Meet the medical expenses of basic medical insurance expenditure range according to the rules of article 35th to 40th for processing.
    Article 43rd temporarily absent (including business trip) of insured persons suffering from temporary illness, you can choose a local medical institution, which meet the medical expenses of basic medical insurance expenditure range according to the rules of article 35th to 40th handle. The insured persons temporarily absent when suffering from a temporary disease, in a municipality other than the city, the provincial capital city, listed cities designated medical institutions for treatment of secondary and higher, and meet the medical expenses of basic medical insurance expenditure range, first by individuals themselves 10% of the total medical expenses, then this approach 35th to 40th of the relevant regulations.
    Among them, travel insured persons authorized by, its personal care 10% of the total medical expenses medical expenses borne by the sending units.
    44th personnel requires special medical equipment for sick insured checking and special treatment, category b list of drugs and the use of basic medical insurance, first by individuals by national, provincial and municipal regulations themselves after a certain proportion of medical costs, then article 35th of the present approach to the 43rd of the relevant regulations. 45th article parameter insurance personnel for following case occurred of medical, not included basic medical insurance fund paid range: (a) in Province provides of drug directory, and clinic project, and medical service facilities standard range yiwai of; (ii) without approved in non-Sentinel medical institutions and non-Sentinel pharmacy medical, and purchased drug of; (three) for illegal crime, and suicide, and self-harm, and fight fights, and drug, and alcohol, occurred of; (four) abroad, and exit during occurred of; (five) traffic accident, and medical accident, and
    Large areas of food poisoning and other persons from liability to pay; (f) into the scope of work-related injury insurance against injury at work and work-related relapse; (VII) female workers into the scope of reproductive insurance fertility, family planning, operation and its sequelae.
    Article 46th insured persons with large outbreaks of sexually transmitted diseases or medical expenses caused by large-scale natural disasters, by the people's Governments at the address. 47th to maintain existing levels of health care employees, businesses, private non-enterprise units and reference to the insurance business units participating in basic medical insurance on the basis of worker's supplementary medical insurance should be established. Employees ' supplementary medical insurance funds shall be borne by the insured portion of medical expenses and medical expenses difficult subsidy burden on workers. Employees ' supplementary medical insurance insured the welfare expenses payable account in Liechtenstein, lack of benefits paid, below the 4% the following sections can be included in the cost of the workers wages.

    48th article city level and the above model workers and 1955 to 1965 during by city level and the above government recognition named of advanced production (work) who and II, Serie b and the above revolution disability soldiers, occurred of by personal bear part of medical, first by its personal account funds paid, insufficient paid of, by personal first paid Hou, which participate in retired personnel outpatient and manpower of, by city Medicare handling institutions audit Hou, by hospital and manpower Fund or retired personnel outpatient and manpower Fund bear,
    Other staff according to the original channels.
    Second Serie b disabled revolutionary servicemen and above in accordance with the relevant provisions of care co-payments by an individual after the advance payment, which participate in the clinic and manpower of retirees, after examination by the city health agency, coordinated by the hospital outpatient and manpower Fund or retirement fund, others are still at the original channels.
    After the implementation of the present measures, national, provincial or municipal people's Government for the first two provisions of paragraph according to its provisions.
    49th medical protection for retired cadres, old Red Army enjoyed constant treatment, medical expenses according to the provisions prior to the implementation of the measures in connection with the channels, there is difficulty in paying, help solve the people's Governments at the same level. 50th enterprises, private non-enterprise units and reference business insurance unit, its staff to provide immediate family's medical expenses, insurance entities according to the original regulations.
    Children of civil servants Trade Union co-ordinating medical centrally managed by the health care agency.
    Sixth chapter major disease medical grants 51st article major disease medical grants funds by following two part composition: (a) from Government by this year this and manpower area parameter insurance units all workers payroll of 0.5% give of subsidies in the extraction part; (ii) parameter insurance personnel per person monthly paid 3 Yuan major disease medical grants and manpower fee, which holds validity within Hangzhou City difficult family rescue card of parameter insurance personnel from paid.
    Major medical subsidy paid by the Medicare Agency is responsible for the unified management and.
    52nd article in a natural annual within, parameter insurance personnel occurred of meet basic medical insurance expenditure range of hospital medical in 80,000 yuan above of part, in three level and the corresponding medical institutions medical of, personal bear of proportion for 12%; in two level and the corresponding medical institutions medical of, personal bear of proportion for 10%; in other medical institutions medical of, personal bear of proportion for 8%, remaining part of medical in major disease medical grants funds in the expenditures.
    53rd article parameter insurance units of parameter insurance personnel patient major disease or long-term sick, personal when bear of meet basic medical insurance expenditure range of medical, over its when family income (deduction this city town residents minimum life guarantees fee standard) of part, by parameter insurance units or received management units give solution, parameter insurance units or received management units unable to solution of, by parameter insurance personnel medical difficult mutual relief funds solution.
    Insurance medical difficulties relief the specific measures shall be formulated separately by the municipal people's Government for assistance.
    Seventh chapter basic medical insurance service and management 54th article by health administrative sector approved and made practice industry license of medical institutions, by army competent sector approved has qualification carried out foreign service and by place health administrative sector change registered made practice industry license of army medical institutions, by drug supervision management sector approved and made drug business enterprise license and license of drug retail pharmacy, are can to labor guarantees administrative sector application Sentinel qualification, by labor guarantees administrative sector audit determine Hou, to social announced.
    Designated medical institutions and drugstores management approach formulated by the municipal labor and social security administration departments, in conjunction with relevant departments separately.
    55th health care agencies should work with designated medical institutions and drugstores basic medical insurance service agreements signed, specify the rights and obligations of both parties.
    Article 56th medical separate accounting and management systems and centralized drug tender procurement system, competition from medical services and drug distribution mechanism controlling the medical expenses reasonably level.
    57th medical institutions and drugstores should strengthen internal management, strictly in accordance with the medical technical specifications and drug sales, provides medical services, purchase services, guarantee the quality of medical and pharmaceutical, for insured persons to provide quality, efficient, reasonable access to basic medical services.
    Designated medical institutions and drugstores should strictly enforce the price stipulated by the competent department charges and drug prices.
    Article 58th of retirees out of contract medical institutions shall assure the retirees medical needs, treatment, referral and purchase of medicines for retirees with ease.
    59th basic medical insurance card (card) by the Medicare Agency is responsible for uniformly made.
    Insured persons with basic medical insurance cards (card) when medical treatment, purchase of medicines, medical institutions and drugstores should be checking.
    Basic medical insurance card (card) may use, loan and forge.
    60th medical institutions received the insurance officer in hospital, may be appropriate to charge medical advance.
    61st medical billing according to the following provisions: (a) shall be coordinated by the Hospital Fund to pay for hospital treatment, by the designated medical institutions and health-care agencies on a monthly billing.
    (B) shall be coordinated by the Hospital Fund paid disease outpatient, real-time settlement as provided herein, by the designated medical institutions and health-care agencies on a monthly settlement from insured persons or insured to be paid, and by the health care agency are settled periodically.
    (C) shall pay the outpatient clinic funds by civil servants, by the designated medical institutions, drugstores and health-care agencies on a monthly billing.
    (D) the outpatient clinic funds paid by retirees, by the municipal health agency appointment with outpatient medical Protocol management, quota checking.
    Exceed the standards prescribed by the basic medical insurance and the range of health care, basic medical insurance fund not be paid.
    Outpatient medical expenses of retirees a fixed evaluation of specific measures formulated by the municipal labor and social security administration departments, in conjunction with relevant departments separately.
    62nd administrative departments of labor security organization established by the participation of representatives from all sectors of the community community supervision organization of basic medical insurance, with the relevant government departments to strengthen the basic medical insurance fund collection, management and use of supervision and inspection.
    63rd labour and social security administrative departments should strengthen the designated medical institutions, drugstores supervision, standardizing designated medical institutions, drugstores basic medical insurance service, and supervision and inspection, to the public.
    64th audit departments shall regularly for basic medical insurance fund raising, management and audit usage, ensure the safety of the basic medical insurance fund. 65th eighth chapter legal liability insurance unit does not pay or withhold payment of basic medical insurance premiums, the taxation authorities shall order their prescribed date; if not paid, except to pay unpaid extra, from the date of default of payment, plus 2 per thousand of the unpaid amount per day late fee, late fee into the basic medical insurance fund. And directly by the administrative departments of labor security in charge of personnel and other persons sentenced to more than 1000 Yuan fined not more than 5000 Yuan, if the circumstances are serious, punishable with more than 5000 10000 Yuan fine.
    Refusing to pay overdue insurance units of basic medical insurance, late fees, and enforced by the tax authorities to request the people's Court according to law. 66th article parameter insurance units has following behavior one of of, by Medicare handling institutions recovered violation provides spending of basic medical insurance fund, and by labor guarantees administrative sector ordered its deadline corrected and informed criticism; plot serious of, on parameter insurance units sentenced 5000 Yuan above 20000 Yuan following of fine, on directly is responsible for of competent personnel and other directly responsibility personnel sentenced 500 Yuan above 2000 Yuan following of fine: (a) will non-parameter insurance personnel included enjoy basic medical insurance treatment range of; (ii) false
    , Heavy medical expenses, (iii) forge false evidence, resulting in loss of basic medical insurance fund and (iv) other acts that violate the provisions of basic medical insurance.
    67th article parameter insurance personnel and the other personnel has following behavior one of of, by Medicare handling institutions recovered violation provides spending of basic medical insurance fund, and by labor guarantees administrative sector sentenced 500 Yuan above 2000 Yuan following of fine; according to plot weight, on parameter insurance personnel can while suspended its 6 months above 2 years following of basic medical insurance treatment: (a) will I of basic medical insurance card (card) lending others using of; (ii) forged or take with others of basic medical insurance card (card) visits of;
    (C) forging or falsification of medical documents, documents and other relevant documents, false impersonation of the basic medical insurance fund, and (d) by means of multiple visits, repeat visits, much match preparation and basic medical insurance for illness or medication compliance drug (v) other acts that violate the provisions of basic medical insurance. 68th article Sentinel medical institutions and staff has following behavior one of of, by Medicare handling institutions recovered violation provides spending of basic medical insurance fund; by violations costs accounted for Medicare handling institutions month audit medical of proportion, in Sentinel medical institutions month application allocated of medical total in the deduction; by labor guarantees administrative sector ordered its rectification, and on directly responsibility personnel sentenced 500 Yuan above 2000 Yuan following of fine, and can suspended its 6 months above 2 years following for parameter insurance personnel service of qualification
    ; Plot special serious, or refused to rectification and the rectification invalid of, by labor guarantees administrative sector canceled its Sentinel medical institutions qualification: (a) diagnosis and treatment, and accounting not check basic medical insurance card (card), will non-parameter insurance personnel of medical, and non-basic medical insurance fund paid range of costs included basic medical insurance fund paid range paid of; (ii) will not meet hospital conditions of parameter insurance personnel received live admitted or will meet discharged conditions should to discharged of parameter insurance personnel continues to stranded Hospital of; (Three) violation basic medical insurance clinic project, and service facilities standard and medication provides of; (four) not records records or records records not clear, and not full, and occurred of medical inconsistent of, or occurred of medical and illness inconsistent of; (five) reception Shi not review parameter insurance personnel yiqian of records records, repeat to drug, non-clinic need for check, and treatment or repeat check, and treatment of;

    (Six) violation charges provides, unauthorized improve charges standard, expanded or decomposition charges project, not implementation national provides of drug price, caused basic medical insurance fund loss of; (seven) not by prescription dose provides, excess to drug of; (eight) will basic medical insurance paid range of drug SWOP into other drug, and life supplies, and health supplies or other items of; (nine) will at their own expense drug and included basic medical insurance medication range of drug confusion pricing of; (10) to patients provides fake or expired drug of;
    (11) allow or condone using fake doctor, front man in hospital (12) other acts that violate the provisions of basic medical insurance. 69th article Sentinel Pharmacy and staff has following behavior one of of, by Medicare handling institutions recovered violation provides spending of medical insurance fund; by violations costs accounted for Medicare handling institutions month audit medical of proportion, in Sentinel pharmacy month application allocated of medical total in the deduction; by labor guarantees administrative sector ordered its rectification, and on directly responsibility personnel sentenced 500 Yuan above 2000 Yuan following of fine; plot special serious, or refused to rectification and the rectification invalid of,
    By labor guarantees administrative sector canceled its Sentinel pharmacy qualification: (a) not check basic medical insurance card (card), not by prescription provides distribution (sale) drug or Super dose distribution (sale) drug of; (ii) will non-basic medical insurance fund paid range of costs included basic medical insurance fund paid range paid of; (three) will basic medical insurance paid range of drug SWOP into other drug, and life supplies or health supplies of; (four) will at their own expense drug and included basic medical insurance medication range of drug confusion pricing of;
    (E) to provide fake or expired drugs; (f) does the national drug price, resulting in loss of basic medical insurance fund, (VII) other acts that violate the provisions of basic medical insurance.
    70th, health care agencies and their staff with one of the following acts, the administrative departments of labor security ordered to rectify, make up for economic losses, if the circumstances are serious, directly in charge of personnel and other persons sentenced to between 500 Yuan more than 2000 Yuan of fine, while administrative sanctions.
    (A) not by provides will basic medical premium into personal account and related Fund (funds) account of; (ii) relief or not by provides program verification parameter insurance units and parameter insurance personnel should paid of basic medical premium of; (three) unauthorized change basic medical insurance treatment or not by provides implementation basic medical insurance fund paid standard of; (four) deliberately delay paid Sentinel medical institutions, and Sentinel pharmacy should funding items of; (five) using positions and work of will seek self-interest, and bribery bribes of;
    (F) serious dereliction of duty or violation of basic medical insurance fund losses caused by financial discipline, and (VII) other acts that violate the provisions of basic medical insurance.
    71st labor and social security administration departments and other relevant administrative departments in charge of personnel who abuse their powers, neglect their duties, engages in, and by their work units or by the competent authorities, supervisory organs shall be subject to administrative liability.
    72nd article violates these rules, other laws and regulations, the relevant administrative authorities shall be subject to punishment.
    73rd party agency specific administrative acts in accordance with these measures may apply for administrative reconsideration or bring an administrative lawsuit in accordance with law.
    Before Nineth chapter supplementary articles article 74th execution of these measures, in accordance with the relevant provisions of the basic medical insurance individual businesses and their employees, still according to the original form of insurance to have basic medical insurance.
    75th basic medical insurance diagnosis and treatment projects, list of class b drug payment rates and service standards, as well as the referral, referral and other specific measures, jointly with relevant departments of the municipal labor and social security administration separately. 76th these measures come into force on January 1, 2004.
                                              November 18, 2002 published by the Hangzhou municipal people's Government of the Hangzhou City basic medical insurance schemes (municipal government, 189th) repealed simultaneously.