Key Benefits:
(Act No. 125 of 27 May 2003) Chapter I General Article 1 provides for the establishment of a system of medical guarantees for the sound Shenzhen City, which guarantees the basic medical rights of the employee, in accordance with the relevant national laws, regulations and regulations, to develop this approach in conjunction with the practice of this city. Article 2 The Government has established health insurance systems such as basic health insurance, local supplemental health insurance and maternity insurance. The Government has established medical assistance for civil servants and has encouraged and supported the establishment of complementary health insurance. Article 3. All user units and workers in this city must participate in basic health insurance, local supplemental health insurance and maternity health insurance, as required by this approach. This approach refers to all organs, business units, social groups, businesses, non-commercial units, brokering agencies within the city's administration. The scheme refers to employed persons who are members of the unit of the person, retirees under this scheme and unemployed persons who are of the origin of the home. This approach refers to the user units already involved in social health insurance. This approach refers to workers who have participated in social health insurance. Article IV Social health insurance systems should be guided by the principles of equity and efficiency, relative rights and obligations, and the level of safeguards adapted to the level of social productivity development. Article 5 provides a model of fund management that integrates social cohesion and individual accounts. The social integration of local supplemental health insurance and maternity health insurance was introduced. The Basic Health Insurance Fund, the Local Supplementary Health Insurance Fund and the Reproductive Health Insurance Fund are incorporated into the Social Security Finance Principals, which are managed on a cost-of-payment basis, with a dedicated section, prohibiting diversion. The basic health insurance fund, the local supplementary health insurance fund and the maternity health insurance fund are subsidized by municipal finance when they are not used. Article 6. Basic health insurance is divided into two forms of integrated health insurance and inpatient health insurance. The following persons participated in the integrated health insurance: (i) In-service staff of the city (with a blueprint, as follows); (ii) A resident of the city before retirement, paid by the municipal social insurance agency for the benefit of the old insurance; (iii) A retired person who has been resident in the home city prior to retirement, who is integrated in the old-age insurance industry and paid for the old-age insurance treatment by the social insurance agencies in the Province of Broad Orientale; (iv) Other active personnel provided by the municipality. The following persons participated in hospital health insurance: (i) In-service staff of non-resident city households; (ii) Retirement of non-residents who are paid by municipal social insurance agencies for the treatment of old-age insurance by month; (iii) Persons who are housed in the city and receive unemployment benefits. Upon request from the user's unit, the incumbents of the non-resident city may also participate in the integrated health insurance. Article 7. Those involved in integrated health insurance or inpatient health insurance should participate in local supplemental health insurance. In-services with the city's home should be involved in maternity health insurance. Article 8 Relevant sectors such as health, medicine, prices, plans and finance should assist the municipal social insurance institutions in their health insurance. Chapter II Article 9. The basic health insurance fund is funded by basic health insurance fees and their interest, financial subsidies and other income. Local supplemental health insurance funds are the source of supplementary health insurance payments and their interest and other income. The maternity health insurance fund is funded by the cost of maternity health insurance and its interest and other income. Article 10 (i) On-the-job personnel participating in the integrated health insurance, the total monthly salary is paid. The average monthly salary of the active staff exceeds 30 per cent of the average monthly salary of the previous year's urban worker in this city, which is 30 per cent of the average monthly salary of the previous year's urban worker; the monthly salary is less than 60 per cent of the average monthly salary of the previous year's urban worker in this city, with an average of 60 per cent of the monthly salary in the city's last year; (ii) Inpatient health insurance personnel, the average monthly salary of the annual urban worker in the city is denominated; (iii) Retirement under article 6, paragraph 2, for the basic monthly pension; (iv) Retirement under article 6, paragraph 2, paragraph 3, to the average monthly salary of its previous year's urban worker in the pre-retirement city; (v) The local supplement to the collection base for health insurance and maternity health insurance, which is determined in accordance with its basic health insurance contributions base. Article 11. Payment of basic medical insurance expenses by a user unit and a worker according to the following criteria: (i) Integrated medical insurance payments, which were paid by 8 per cent of the total pay base, of which 6 per cent were paid by the unit of the person in office and 2 per cent by the employee; (ii) Inpatient health insurance payments, under article 6, paragraph 3 (a), on-the-jobed workers, which are paid by a user unit of 0.8 per cent of the contributions base; persons under article 6, paragraphs 2 and 3, are paid by 0.8 per cent of the contribution base by the municipal social insurance agencies, respectively, and are covered by the basic old-age insurance funds and the unemployment insurance fund; (iii) Local supplemental health insurance payments, participate in the payment of 0.5 per cent of the contributory base; participate in the inpatient health insurance and receive 0.2 per cent of the contributory base. In addition to the contributions of the in-service staff by the user's unit, the channels of payment and the payment of other personnel are implemented in accordance with the previous two provisions; (iv) Maternity health insurance payments received by a user unit of 0.5 per cent of the contributions base. Article 12 Basic health insurance fees, local supplemental health insurance fees and maternity health insurance charges are transferred to the Social Insurance Fund accounts established by the municipal social insurance agencies in the banking sector after their arrival. Article 13 (i) Integral health insurance payments, the portion of the individual's contributions is fully taken into account in the personal accounts; in-service insured persons aged over 45 years of age (no 35 years of age) and 30 per cent in the personal accounts; in-service insured persons below 45 years of age (no 45 years of age), 40 per cent for personal accounts; in-service insured persons above 45 years of age, 50 per cent for personal accounts; and 60 per cent for retirees under article 6, paragraph 2, for personal accounts; (ii) Inpatient health insurance fees are fully included in the Integrated Fund for Basic Health Insurance and do not establish an individual account; (iii) Local supplemental health insurance fees are fully taken into account in local supplemental health insurance funds, which do not establish an individual account for the payment of local supplementary health insurance treatment; (iv) The maternity health insurance fee is fully included in the maternity health insurance fund, which does not establish an individual account to cover the costs of maternity health insurance. Article 14. The user unit shall, within 30 days of the establishment or acquisition of a licence of business, conduct a medical insurance registration and participation in the social insurance institution. Article 15 Entitles the home to the basic health insurance for more than one year, with no user unit paying the medical insurance expenses for it as a result of changes in work, may be paid on a continuing basis and, depending on the same contribution, up to three months for the duration of his continuing payment. Article 16 covers the costs of medical insurance paid by the enterprise, and the medical insurance payments paid by the agency's cause unit are charged in the administration's funds; and the medical insurance payments paid by individuals prior to the taxation. Article 17 Funds for social health insurance and personal accounts for insured persons are calculated on the basis of the relevant national provisions. Article 18 municipalities may adapt accordingly to the basic health insurance payments paid by the user units and the individual worker, local supplemental health insurance expenses and maternity health insurance standards, based on actual circumstances such as economic development, wage growth, price level and medical expenses. Chapter III Medical insurance treatment Article 19 The insured person enjoys medical insurance treatment under this scheme effective 1 January of his or her participation. The insured person or his or her unit ceased the payment of medical insurance payments, and the insured person ceased to enjoy medical insurance treatment effective 1 January of the month of payment, except in the personal accounts. Article 20 The insured person of the basic health insurance enjoys medical treatment and other medical treatment provided for in the terms of the directory of essential health insurance medicines, therapeutic projects and medical facilities. The local occupants who supplement health insurance are entitled to supplement health insurance treatment under this scheme. The insured person of the reproductive health insurance has access to maternity health insurance under this scheme. Article 21 lists of health insurance medicines and access to medical treatment projects. The directory of basic health insurance medicines is carried out in accordance with the directory published by the State and the social insurance administration in the Province of the Widespare; the basic health insurance treatment project, the basic medical facility standards and the local supplemental health insurance medicine and treatment projects are developed by the municipal social security agencies and made public. Article 22 takes part in the in-services of the integrated health insurance, which pays 90 per cent of the basic medical costs for the duration of their hospitalization by the Integrated Health Insurance Fund and 10 per cent for individuals; and for retirees participating in the integrated health insurance, the basic medical costs incurred during the hospital are 95% of the basic health insurance fund, and 5 per cent for individuals, with the exception of the scheme. Article 23 provides for basic medical care for the integrated health insurance occupants and for medical treatment projects using local supplemental health insurance medicines, medical treatment projects, to be paid by the individual accounts; under-payments in the personal accounts, which exceeds 10 per cent of the annual average annual salary for urban workers in the health insurance year; 70 per cent from the Integrated Health Insurance Fund and 30 per cent for individuals. Article 24 Basic medical costs for inpatient health insurance workers are paid by 90 per cent under the Integrated Health Insurance Fund and 10 per cent for individuals. However, the basic medical costs incurred during the hospital were 95% of the Fund's Integrated Health Insurance Fund and 5 per cent for individuals, with the exception of the scheme. Inpatient health insurance workers are self-satisfied with medical expenses other than article 27. Article 25. When the integrated health insurance takes part in the care of the insured person, the medical examination or treatment of large medical equipment is paid by the Integrated Health Insurance Fund for 80 per cent and 20 per cent by the individual after the medical care is required and approved by the municipal social insurance agency or its authorized medical institutions. Large medical equipment inspection projects and treatment projects are determined by the municipal social insurance agencies. Article 26 In the case of illness, the insured person, with the approval of the municipal social insurance agency, uses a special medical material or a single medical material of more than 1,000 dollars in the basic health insurance treatment project, as well as the installation or replacement of an organ, to pay 90 per cent of the average health insurance fund at the expense of the country's production; the non-state hygienic hygienic can pay 50 per cent of the total price of imports. The scope of special medical material, artificial organs is determined by municipal social insurance institutions. Article 27 provides a diagnosis of the chronic kidney function of the insured person, after-cruit medical treatment for the exclusion of medicines, the treatment of maloxinology, intervention in treatment, therapy or nuclear therapy, approved by the municipal social security agencies, with basic medical costs paid by 90 per cent of the basic health insurance fund and 10 per cent for individuals. The scope of organ transplanted is determined by the municipal social insurance institutions. Article 28, the maximum paid by the insured person for each health insurance year from the Integrated Fund for the Basic Health Insurance does not exceed 4 times the average annual salary for the last year's urban worker and is linked to the duration of the insurance period, with specific criteria: (i) In the second half of the period of stay, the Integrated Fund for Basic Health Insurance paid up a maximum of 0.5 times the average annual salary for the last year's urban workers; (ii) In the second half of the year, the Integrated Fund for Basic Health Insurance paid a maximum of one hundred times the average annual salary of the last year's urban worker; (iii) In the last year, the combined capital fund pays a maximum of two times the average annual salary of the last year's urban worker; (iv) During the period of up to two years, the Integrated Fund for Basic Health Insurance paid a maximum of three times the average annual salary of the last year's urban workers; (v) Over three years of continuous participation, the Integrated Fund for Basic Health Insurance pays a maximum of four times the average annual salary of the last year's urban worker. Article 29, Partner of the local supplemental health insurance, incurred 85 per cent of the fees paid by the local supplemental health insurance fund and 15 per cent for individuals. (i) The basic medical costs incurred by the Unified Fund for Basic Health Insurance; (ii) Costs for the use of local supplemental medicines under the pharmacies for health insurance and local supplemental medical treatment projects. Article 33 Participating in local supplemental health insurance, the maximum amount paid for medical expenses from the local supplementary health insurance fund for each year is linked to the duration of the basic medical insurance, with specific criteria: (i) In the second half of the year, the local supplemental health insurance fund pays a maximum of $50,000; (ii) In the last two years, the local supplemental health insurance fund pays a maximum of 100,000 dollars; (iii) During the period of up to 2 years, the maximum amount paid by the local supplemental health insurance fund amounted to 150,000 dollars; (iv) Over three years of continuous participation, the maximum amount paid by the local supplementary health insurance fund amounted to $200,000. Article 31 Inspection of the perinatal period of the child's insured person, inpatient delivery, post-natal visits, basic medical costs for family planning operations (excluding infant costs) are paid by the maternity health insurance fund. Article 32 is in compliance with the standards of the school, the targeted medical body confirms that it is still outside the school, and its hospitalization costs are paid by individuals from the date of the confirmation of arrival. The insured person may apply for accreditation by the municipal social insurance institutions within three working days from the date of the confirmation by the targeted medical institution, owing to the dispute between the board and the targeted medical institution. The municipal social insurance institutions should entrust the Committee of Experts on Health Insurance with the identification of the application and make the findings within seven working days from the date of the application of the insured person. The Committee of Experts on Health Insurance identified the dates of the school. The cost of medical services other than the coverage of basic health insurance, local supplemental health insurance and maternity insurance is paid by the insured person. The accumulated personal accounts amounted to the average monthly salary for the last two months of the year's urban worker, which is more than partially available for basic medical expenses paid by the targeted medical institutions in connection with the medical treatment, local supplemental medical costs, or non-participatory medicines within the base medical insurance directory and local supplemental medical care kits. Article 34 is involved in the health of the insured person, whose medical costs are covered by the basic health insurance and local supplemental health insurance, which is covered by the municipal social insurance institutions, and are implemented in accordance with the relevant provisions of the municipal government. Article 35 Medical expenses incurred by the insured person for work injury and occupational illness are implemented in accordance with the relevant provisions of the insurance. Article XVI left the city by the insured person and the balance of the individual accounts was transferred to the social security agency at the location of his or her family; there was no appropriate body on the ground and a one-time incident was sent to himself. Participating in the death of the insured person, the balance of the individual accounts was paid to the successor; the failure to heed was transferred to the Integrated Fund for Basic Health Insurance. In the case of public travel, visit of the insured person, emergency hospitalization in other cities (in Port-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-au-, sub-region), or referrals to other cities in the country, the basic medical and local supplemental medical costs incurred are subject to reimbursement under the relevant provisions of the scheme. The long-term presence of the occupants in other cities in the country, or the occupants who lived in other cities in the country after retirement, should be made available to the municipal social insurance institutions, whose basic medical and local supplemental medical costs occurred in the place of work or residence, are subject to the relevant provisions of the scheme. The custodians may deduct from their personal accounts on basic medical costs in other cities in the country. Article 338 attendees receive health insurance treatment at the municipal hospitals in accordance with the standard of reimbursement for medical insurance for public travel, visits to their families, emergency inpatient hospitals abroad or in ports, aucasinos. Article 39 is one of the following cases in which the insured person is not entitled to the medical insurance treatment provided under this scheme: (i) Self-governance to other cities in the country, or ports, treasury areas, or abroad; (ii) Medical care is available to non-scheduled medical institutions in the city, except for those that endanger the recruitment of life-threatening; (iii) The acquisition of medicines by themselves, with the exception provided in article 33, paragraph 2; (iv) Damage caused by traffic accidents, medical accidents or other liability accidents; (v) Damage caused by suicide, self-hurt, maiming, alcoholism, fighting or personal violations; (vi) Damage caused by other violations; (vii) Other conditions established by States, provinces and municipalities. Article 40 (i) Services projects such as walls, expatriate and special medical services; (ii) Non-communicable treatment projects such as syllabus, non-functional integrity, health tests, medical counselling and health prevention; (iii) Non-basic medical treatment projects such as e-launching (PET), sketches; (iv) One-time medical material not paid for basic health insurance; (v) Resistance equipment such as eye, teeth, helpers; (vi) The source or organization of organ transplanted by organs or organizations; (vii) Transplanation of other organs or organizations other than kidneys, gynaecology, and garners; (viii) Complementary treatment projects such as hydrocarbon treatment; (ix) A variety of treatment projects that do not provide for (micile) complications, sexual functional barriers; (x) Scientific research, clinical and clinical treatment projects; (xi) Other medical projects that are not reimbursed by national, provincial and municipal provisions. The specific scope of the medical and medical materials listed in the previous paragraph is provided by the municipal social insurance agencies and adjusted accordingly in accordance with the needs of social health insurance and the development of medical technology. Chapter IV Medical care establishments for medical care and custom retailers Article 40. Social health insurance is governed by targeted medical institutions, targeted retail pharmacies. The municipal social insurance institutions are qualification of the sanitary, pharmaceutical authorities in the form of pre-market medical institutions in accordance with the relevant provisions of the State. In accordance with the harmonized planning, rationalization, facilitation of medical treatment, needs-recognition, and the principle of encouraging competition, the establishment of targeted medical institutions and the customized retail shops. The State medical institutions are chosen by the municipal social insurance agencies to determine the establishment of a targeted medical institution, and other targeted medical institutions are determined by the municipal social insurance institutions in consultation with medical institutions. The municipal social insurance institutions should enter into agreements with targeted medical institutions. Article 43 thirteenth medical institutions should uphold the principle of “therapeutic treatment, reasonable inspection, reasonable medicines, reasonable treatment” and provide quality, efficient and affordable medical services to the insured person in accordance with the provisions of this approach and agreements. Article 44 quantified medical institutions should establish systems for medical treatment, pharmacization and management, regulate medical behaviour, reduce the proportion of the total medical costs paid by the insured person and reduce the economic burden of the insured person. Article 42 Medical establishments for targeted terminals and retail pharmacies should establish an internal management system adapted to the health insurance system. Article 46 quantified medical institutions should have more than 80 per cent of the health-care facilities in line with the basic health insurance service standards; targeted medical institutions and targeted retail pharmacies should have more than 80 per cent of the basic health insurance medicine catalogue and local supplemental health insurance kits. Article 47 quantified medical institutions and customized retail pharmacies should strictly implement the Government's provisions on medical fees and medicines prices and make them public. The targeted medical institutions should provide the insured person with a daily fee list. Article 48 provides for the provision of medical services by targeted medical institutions to implement the relevant regulations such as the directory of basic health insurance medicines, the medical treatment project, the medical facility standards and local supplemental health insurance kits, therapeutic projects. Targeted medical institutions should obtain the consent of the insured person for pharmaceuticals, treatment projects, medical facilities other than those provided for in the preceding paragraph. Article 49, when the insured person has a medical insurance document to purchase medicines at the custom retail pharmacies, the pharmacies should comply with the following provisions: (i) The sale of non- prescription drugs shall be subject to the provisions of article 33, paragraph 2, of the scheme; (ii) The sale of prescription drugs should be the subject of targeted medical institutions; (iii) Accrue in accordance with health insurance provisions. In carrying out inspections and supervision by the municipal social insurance institutions, targeted medical institutions, targeted retail pharmacies are obliged to provide information and cost lists. Inadequate or incomplete, the municipal social insurance institutions should reject the corresponding costs. Chapter V Article 50 provides for medical expenses incurred by the insured person in respect of medical treatment or the purchase of medicines in compliance with basic medical insurance, local supplemental medical insurance or maternity insurance, and for medical insurance documents of the insured person according to the following provisions: (i) Payments made by the Integrated Fund for Basic Health Insurance, the Local Supplementary Health Insurance Fund or the Reproductive Health Insurance Fund, and the targeted medical institutions should be paid in real terms; (ii) Payments made in the personal accounts of the targeted medical institution or the customized retail pharmacies should be deducted from the personal accounts of the insured person and the individual accounts are not paid and should be charged directly to the insured person. The medical expenses incurred by a targeted medical institution, a terminal retail pharmacies in connection with medical treatment or the purchase of medicines by the insured person are not covered by basic medical insurance, local supplemental health insurance or maternity insurance, and should be charged directly to the insured person. Article 52 addresses the health insurance fee settlement approach, including the settlement of service projects, the settlement of the service module, the settlement of the disease or the payment of the total amount. The municipal social insurance institutions determine the manner of settlement based on the different categories and circumstances of the targeted medical institutions and make it clear in the agreement signed between the municipal social insurance agencies and the targeted medical institutions. Article 53 is in line with article 23 of the scheme, which is paid by the Integrated Fund for Basic Health Insurance, and the insured person shall, within the next year of the health insurance, vouches, cost details, original fee receipts to the municipal social insurance agencies for the clearance of the mail charges. Article 54 quasi-custodian medical fees for other cities in the country and for the hospitalization of referrals to other cities in the country, are subject to a provision for reimbursement for medical care, inpatient medical certificates, in-house diagnostic certificates or medical clearances, cost details and original receipts. Those who are permanently present in other cities in the country are insured by the insured person or who resides in the rest of the country, who are covered by the local health insurance scheme for basic medical costs and local supplemental medical expenses, vetting of the illnesses, charging certificates or boarding, details of the costs and original receipts, are subject to the required clearance. Accused or sent to the port, in Macao, in the veterinary area, the voucher proves, the issuance of a national passport or a special licensor in the port of Macao, the medical calendar or the charging, the schedule of the fees and the original charges are reimbursed by the municipal social insurance agencies. Chapter VI Article 55 of this city establishes a social security oversight body composed of representatives of the Government, business representatives, trade unions and other representatives of society. Social Insurance oversight bodies monitor the implementation of health insurance laws, regulations, regulations and fund payments, use, management. Any units and individuals in Article 56 have the right to inspect the offences and violations committed by the medical institutions of the targeted medical institutions, the pharmacies, the insured person and members of the social insurance institutions in the city. The municipal social insurance institutions should give incentives to the prosecution, which amounted to 20 per cent of the total amount of violations and paid by the municipal social insurance agencies from the Integrated Fund for Basic Health Insurance. Article 57 Article 588 shall be issued to the worker every half of the year on the payment of the medical insurance fee. Article 599 conducts regular audits of the financial and balance of payments of the Medical Insurance Fund each year by the municipal audit body, which should be reported to the social security oversight bodies. The municipal social insurance institutions should establish financial systems and internal audit systems of the Fund. Article sixtieth states that health administration authorities at all levels should strengthen the oversight management of targeted medical institutions, incorporate the implementation of health insurance provisions into the examination of the integrated objective management of the targeted medical institutions and link them to the responsibility of the President for the term of office. Article 61. Municipal price management should enhance the supervision of targeted medical institutions and targeted retail pharmacies in implementing national, provincial, municipal health services and drug price policies. The municipal drug control management should strengthen surveillance of the quality of medicines for targeted medical institutions and targeted retail pharmacies. Article 62 Social Insurance institutions should conduct joint monitoring inspections with the relevant sectors such as health, prices, medicines, on a regular or non-recurrent basis for targeted medical institutions and custom retail pharmacies. In carrying out inspections by the municipal social insurance agencies, the inspectorate shall be subject to actual reflection and, as required, information; the inspector shall not refuse the inspection and shall not be falsely charged and concealed. When the municipal social insurance agencies check the payment of royalties to the insured units, it may request the inspectorate to provide information relating to the payment of medical insurance payments, the salary scales, the financial statements, etc., which can be recorded, recorded, video, photographed and replicated, but shall be confidential to the inspectorate. Article 64 Social Insurance institutions should be made available to society on a regular basis, on an audited basis, for the mobilization, payment, closure and use of the health insurance fund. Article 65 established a Committee of Experts on Health Insurance by the municipal social insurance institutions to undertake the following activities: (i) Provide advice on policies based on this approach by municipal social insurance institutions; (ii) Provision of technical guidance to the municipal social insurance institutions for the conduct of health insurance monitoring inspections, and the identification of medical concerns arising from inspections; (iii) Accreditation of the custodian and the targeted medical institutions for the conduct of disputes arising from the compound. The funding required for the activities of the Committee of Experts on Health Insurance is drawn by the municipal social insurance agencies from the annual health insurance fund to a maximum of 0.1 per cent. Chapter VII Legal responsibility Article 16 does not provide for the payment of health insurance payments by the user unit and the period of time is being changed by the municipal social insurance agency. The delay remained unchanged, with a fine of 10 per cent of the amount of unpaid or under-contributory medical insurance payments from the date of their self-responsibility. The medical insurance expenses incurred during the unpaid period are payable by the user unit in the light of the provisions of the scheme. Article 67 provides for medical insurance for persons other than those covered by this scheme, which is not ineffective in the health insurance relationship of the insured person and imposes a fine of more than 5,000 dollars for the insured units; and for the expenses incurred in the health insurance fund, the municipal social insurance institutions should be recovered to the insured unit; the parties constitute a crime and are criminally liable by the judiciary. Article 68, in violation of this scheme, does not conduct a medical insurance registration, conceal the number of insured persons, reject the provision of information or provide information that is correct by the municipal social insurance agencies, and is later uncorrected, imposes a fine of up to $50 million for the principal head of the SPLP. Article 69 impedes and obstructs the enforcement of public service by the members of the municipal social insurance institutions, which is punishable by law by the public security authorities; constitutes an offence punishable by law by the judiciary. Article 76 is one of the following acts by the insured person, and the municipal social insurance institutions should recover the fees paid by the Social Health Insurance Fund in accordance with the law and impose a fine on the directly responsible person for the payment of the health insurance fund, which constitutes a crime and be criminally liable by the judiciary. (i) The transfer of their own medical insurance documents to another person; (ii) Severe or take-offs such as illnesses, prescriptions, cost documents. Article 76 of the Final Medical Agency, the customary retail pharmacies in violation of the medical agreement of the medical establishment or the medical insurance licence agreement, and the municipal social insurance agency is responsible for default under the agreement. Article 72 contains one of the following acts, resulting in the loss of the health insurance fund, which shall be compensated for losses and shall be fined by the social insurance institutions of the city for more than 5,000 dollars; in exceptional circumstances, the suspension or removal of the qualifications of their targeted medical institutions: (i) Medical costs for non-insecution persons are paid by the Medical Insurance Fund; (ii) The medical costs to be paid by individuals should be taken into account in the coverage of the health insurance fund; (iii) The diversion of personal accounts of others; (iv) Inpatient treatment will be carried out by the insured person who does not meet the standards of hospitalization, or the arbitrary extension of the hospitalization time of the insured person, the use of his or her probationary, sub-prime or non-participant consent to his or her income over standard illnesses; (v) Other means to increase the payment of health insurance funds. Those directly responsible for the above-mentioned acts are warned by the municipal social insurance agencies in the light of the circumstances in which they are criticized or removed from their health insurance. Article 73 pharmacies violate the provisions of article 49 of this scheme, which is fined by the municipal social insurance agency of more than 100,000 dollars; in exceptional circumstances, the suspension or removal of the eligibility of their targeted retail pharmacies. Article 76 quantified medical institutions, customized retail pharmacies violate price management provisions and are punished by the price administration. Targeted medical institutions, targeted retail pharmacies violate the drug management provisions and are punished by the municipal drug control authorities. Article 765 Staff members of the municipal social insurance institutions misuse their duties, play negligence, favouring private fraud, are subject to administrative disposition by their units or the relevant departments; liability should be borne for the loss of the health insurance fund; and criminal liability by the judiciary. Article 76 shall apply for review or prosecution in accordance with the law by the party in respect of the notification of contributions made by the municipal social insurance institution or the letter of payment, punishment or medical treatment. Employers may lodge complaints to the municipal social insurance institutions and the relevant sectors or apply for arbitration to the labour arbitration agencies if they do not pay medical insurance fees or are not reimbursed under this scheme. Chapter VIII Article 7.7 Average monthly salary of the last year's urban worker is published in the municipal statistics sector. The average monthly salary of the last urban worker involved in this scheme is calculated at the average monthly salary of the last half year in the last two year's urban worker; and the average monthly salary for the first half year of the year's town worker. Article 78 Medical insurance for foreigners and ports employed in the city is governed by relevant national provisions. Article 79 may apply to the municipal social insurance agencies for a reduction in the payment of medical insurance fees due to special difficulties, if they are granted by the municipal social insurance agencies for a period of up to three months. The insured person may apply to the social insurance institutions for basic medical costs for the benefit of a higher amount of self-payment of medical expenses, resulting in a lower standard of living than the minimum level of living in the city. Unless the municipal social insurance agency approves the payment of health insurance payments, the medical expenses of the employee are paid by the user unit in the light of the scheme. Article 810 practitioners of the communes of the individual economic organization are implementing this approach. Article 81 of the health insurance year is from 1 July to 30 June. Article 82 provides for medical assistance for civil servants and the specific method for the replenishment of health insurance by the Government. Article 83 is implemented effective 1 July 2003. |
