Key Benefits:
(Summit 4th ordinary meeting of the Government of the Shanghai City on 24 March 2008 to consider the adoption of Decree No. 1 of 28 March 2008 on the date of publication of People's Government Order No. 1 of the Shanghai City) The Government of the city has decided to amend the Basic Health Insurance Scheme for Employers in the Shanghai City as follows: Article 9, paragraph 2, was amended to read: The basic health insurance payments paid by the user unit are included in the integrated fund, in addition to the inclusion in the personal medical accounts in accordance with article 11 of this scheme. Paragraphs 2 and 3 were amended to read as follows: About 30 per cent of the basic health insurance fees paid by the user unit is included in the personal medical accounts. The basic health insurance fees paid by the user unit are taken into account in the personal medical accounts and are distinguished according to the age. Paragraphs Page The age of the employee is divided as follows: (i) The age of 34; (ii) The age of 35 to 44 years; (iii) Be of 45 years of age. The age group of retirees is divided as follows: (i) Retirement to the age of 74; (ii) Age of 75. The basic health insurance payments paid by the user unit are taken into account in the specific standards of the individual medical account and their adjustments, which are made public by the Municipal Medical Insurance Agency, with the consent of the Government of the municipality, to study, validate the post-community government. Article 12 amends as follows: Employers should pay unpaid basic health insurance fees or interrupt the enjoyment of basic old-age insurance treatment and cease to account for funds under article 11 of this scheme. Article 21, paragraph 1, was amended to read: Employees' units and their employees pay health insurance fees according to the provisions, workers have access to basic health insurance treatment since the last month of payment of health insurance payments, and workers cannot receive basic health insurance treatment. Add a paragraph to Article 21, paragraph 5: After the retirement age, after the retirement process, a worker may receive a pension, the basic health insurance payments paid by a person's unit are taken into account in part of his personal medical accounts, in accordance with the standards for the last month of his or her work, and the payment of his medical expenses is carried out in accordance with the basic health insurance provisions of the retired person. The former paragraph is paragraph 6. Paragraphs Page Costs other than those set out in article 24, article 25, of the current scheme, are paid by their personal medical account funds during a one-year emergency medical clinic for medical treatment or for the pharmacies of the custom. Inadequate portions are paid by individuals to the standard of self-sufficiency, exceeding a portion of the payments made under the following provisions (excluding the costs incurred in the distribution of medicines in targeted retail shops): (i) Be born by 31 December 1955 and attended by 31 December 2000, the eligibility criteria for the MTS were 1,500, with more than 70 per cent of the medical costs paid by the Supplementary Fund and the remainder being self-sufficient by the active staff. (ii) Be born from 1 January to 31 December 1956 and attended by 31 December 2000, the eligibility rate was €1500, exceeding a portion of the medical costs paid by an additional fund of 60 per cent, while the remaining portion was self-sufficient by active workers. (iii) Be born after 1 January 1966 and attended by 31 December 2000, the eligibility criteria for the emergency medical treatment were €1500, with more than 50 per cent of the medical costs paid by the Supplementary Fund and the remainder being self-sufficient by the active staff. (iv) Newly attended work after 1 January 2001, with a self-critical rate of 1,500, more than 50 per cent of the medical costs paid by the additional fund, and the remainder being borne by in-service workers. Article 23. The expenses incurred in connection with the treatment of emergency medical treatment in the case of medical care or for the distribution of medicines in the targeted retail pharmacies are covered by their personal medical accounts. Inadequate portions are paid by individuals to the standard of self-sufficiency, exceeding a portion of the payments made under the following provisions (incompared to the expenses incurred in the pharmacies in the targeted retail stores): (i) Retirement proceedings had been processed by 31 December 2000, with a standard of 300 per cent for emergency medical treatment at the level of emergency medical care, more than 90 per cent of the medical costs paid by the additional fund; at the secondary medical facility, more than 85 per cent of the medical costs had been paid by the additional fund; in the second-level medical facility, more than a portion of the medical expenses had been paid by the additional fund; in the case of emergency medical treatment at the third medical facility, more than 80 per cent of the medical costs were paid by the additional fund; and in part, the remaining self-expatriots. (ii) Be born by 31 December 1955 and attended by 31 December 2000 and after 1 January 2001, the eligibility criteria for emergency medical treatment were €700, in the case of emergency medical institutions at the primary level, with more than 85 per cent of the medical costs paid by the additional fund; in the second-tier medical facility, more than 80 per cent of the medical costs were paid by the additional fund; and in the three-tier medical institutions, more than 75 per cent of the remaining medical costs were paid by the remaining retirees; (iii) Be born from 1 January to 31 December 1956, attended by 31 December 2000, and after 1 January 2001, the eligibility criteria for emergency medical treatment amounted to $70, with over 70 per cent of the medical costs paid by an additional fund; (iv) After birth on 1 January 1966, participation at 31 December 2000 and after 1 January 2001, the eligibility criteria for emergency medical treatment were €700, in the first-level medical institution, over a portion of the medical costs paid by an additional fund; in the second-tier medical facility, more than 50 per cent of the medical costs were paid by the additional fund; and in the third medical facility's emergency, more than 45 per cent of the remaining medical expenses were paid by retirees; (v) After 1 January 2001 and after the retirement process, the eligibility criteria for the emergency medical treatment were €700, the high-level medical clinic was paid by an additional fund for more than 55 per cent; in the second-tier medical institution, more than 50 per cent of the medical costs were paid by the additional fund; in the case of a medical facility, more than 50 per cent was paid by the Fund; in the case of a medical clinic at the third level, more than 45 per cent of the medical expenses were paid by the additional fund; and in part, the remaining portion of the pension. Article 25, paragraph 1, was amended to read: The medical costs incurred by the In-Central Employees in hospitalization or by the IGO were established. The payment rate is €1,500. Paragraph 1 of article 26 reads as follows: The medical costs incurred by retired persons in hospitalization or by the IRS Observatory are subject to the standard of payment. The payment rate was €700 by 31 December 2000; after 1 January 2001, the payment rate was 1,200. Paragraphs Page The maximum payment limit for the Integrated Fund amounted to $700,000. In the first year, the cost of medical expenses incurred by workers in hospitalization, emergency observation office observation observation, as well as medical expenses for the medical treatment of the sick or the family beds, is paid by the Integrated Fund in accordance with articles 24, 25, 26 of this scheme. Article 33 was amended to read: The Municipal Medical Insurance Agency may take a total advance settlement, the settlement of service projects, the settlement of service modules, and the processing of service modules, to address medical costs with targeted medical institutions, beyond the settlement standard medical costs, which are shared by the Medical Insurance Fund with the targeted medical institutions. Articles 11 and 35 were amended to read as follows: The Municipal Medical Insurance Agency and district, district medical offices should conduct oversight inspections of targeted medical institutions, targeted retail stores, personal medical expenses settlement, and the inspection units and individuals should provide information, if any, on settlement-related records, prescriptions and morbidity history. Add a paragraph to article 35, paragraph 2: Individual patient care is likely to go beyond normal conditions for the number of medical treatment or the costs incurred, and the commune health services can take measures to change the cost-recovery approach. Articles 12 and 36 were amended to read as follows: (b) In the event of serious circumstances, the suspension of its basic health insurance relationship or the removal of its threshold qualifications should be warranted by the municipal health services, the recovery of the medical costs already paid and the imposition of a fine of up to 10,000 dollars. Add a paragraph to article 36, paragraph 2: The relevant sections and staff of the pharmacies of the targeted medical institutions and the pharmacies constitute a serious violation of the health insurance provisions, and the municipal health service may take measures to suspend the payment of its health insurance costs. Articles XIII and XVII were amended to read as follows: In violation of article 20, paragraph 3, article 33, or in violation of other health insurance provisions, the Municipal Medical Insurance Agency shall be responsible for the revision of its deadline, the recovery of the medical costs already paid and may be subject to a warning and a fine of over 1 million dollars. Article 14, paragraph 1, was amended to read: The management and oversight activities of the Integrated Fund and the Supplementary Fund are carried out in accordance with the relevant provisions of the National and Beni City Social Insurance Fund. The Integrated Fund and the Additional Fund are incorporated into the Financial Excellencies of the Social Security Fund, which are managed in a unified manner, separately, earmarked and should be subject to the supervision of the Social Insurance Fund, established by the Government of the city, as well as financial, auditing sector oversight. Article 43: The standard of self-sufficiency, the standard of payment for the Integrated Fund and the maximum payment threshold for the Integrated Fund should be adjusted in the light of actual circumstances. Specific adjustments are made by the Municipal Medical Insurance Agency, in conjunction with the relevant sectoral studies, post-relead People's Government, which is published with the consent of the Government. Article 46, article 43, reads as follows: This decision is implemented since the date of publication. The Basic Health Insurance Scheme for the Workers in the City of Shanghai was re-published in accordance with this decision. Annex: Basic health insurance scheme for urban workers in Shanghai City (as amended in 2008) (Act No. 92 of the Supreme People's Government Order No. 92 of 20 October 2000, as amended by Decision No. 1 of the Shanghai People's Government Order No. 1 of 28 March 2008 on the revision of the Basic Health Insurance Scheme for Employers in the Shanghai City) Chapter I General Article 1 In order to guarantee basic medical needs for workers, this approach has been developed in accordance with the implementation programme of the decision of the Shanghai City to establish a basic health insurance system for urban workers. Article 2 This approach applies to urban enterprises, agencies, business units, social groups and non-commercial units within the scope of this city (hereinafter referred to as the user unit) and their basic health insurance and related management activities. Employees referred to in this approach, including in-service, retired and other insured persons. Article 3 (Management) The Shanghai Medical Insurance Agency (hereinafter referred to as the Medical Insurance Service) is the administrative authority for the basic health insurance in the city and is responsible for the uniform management of the basic health insurance in the city. Various districts, district health insurance offices (hereinafter referred to as districts, district health insurance offices) are responsible for the management of basic health insurance in this area. The sectors such as urban health, labour guarantees, finance, audit, drug surveillance and civil affairs are in line with their respective responsibilities to coordinate the management of basic health insurance. The Social Insurance Service of the city is responsible for the collection of health insurance fees. The Medical Insurance Management Centre of the Shanghai City (hereinafter referred to as the Medical Insurance Centre) is the Medical Insurance Service of the city, which is responsible for the settlement of medical expenses, the allocation and management of the basic health insurance personal accounts (hereinafter referred to as the personal medical accounts). Chapter II Registration and payment Article IV In accordance with the provisions of the Municipal Medical Insurance Agency, a person's unit handles the basic health insurance registration process to a designated social insurance agency; the new user unit should be in place within 30 days of the establishment. The owner's unit shall terminate or change the registration of the basic health insurance subject to the law and shall, within 30 days of the date of the occurrence of the relevant circumstances, write-off or modification of the registration procedure to the original registration body. When dealing with the procedure set out in paragraph 2 of this article, the Social Insurance Agency shall be subject to a review at the request of the Municipal Medical Insurance Agency and, in accordance with the provisions, promptly communicate the registration, registration or registration of the user unit to the Medical Insurance Service. Article 5 The average monthly salary of the current employee was the average of the pay base. The average monthly salary for the previous year exceeded the average monthly salary of 30 per cent for active workers in the current city, which was more than partially not taken into account in the payment base; less than 60 per cent of the average monthly salary for active workers in the previous year; and 60 per cent of the average monthly salary for active workers in the current city. Individuals of active workers should pay basic medical insurance expenses at a rate of 2 per cent of their contributions. Individuals of retirees do not pay basic medical insurance fees. Article 6 The number of contributions from the user unit is based on the number of contributions paid by the employee of the unit. The user unit shall pay the basic health insurance fee at a rate of 10 per cent of its contribution base and pay local health insurance payments at a rate of 2 per cent of its contributions. Article 7 The medical insurance fees paid by the user unit are charged on the basis of the channels provided by the financial sector. Article 8 The calculations of the amount of contributions paid by the user unit and in-service workers, the procedures for payment and the handling of the dispute are implemented in accordance with the relevant provisions of the management of the social insurance. Chapter III Article 9 (Basic Health Insurance Fund) The basic health insurance fund consists of an integrated fund and a personal medical account. The basic health insurance payments paid by the user unit are included in the integrated fund, in addition to the inclusion in the personal medical accounts in accordance with article 11 of this scheme. Article 10 The Medical Insurance Centre should establish a personal medical account for the worker after the person's unit handles the registration procedures for the basic health insurance and pays the medical insurance fees as prescribed. Article 11 The basic health insurance payments paid by the in-service worker are fully taken into account in his personal medical accounts. About 30 per cent of the basic health insurance fees paid by the user unit is included in the personal medical accounts. The basic health insurance fees paid by the user unit are taken into account in the personal medical accounts and are distinguished according to the age. The age of the employee is divided as follows: (i) The age of 34; (ii) The age of 35 to 44 years; (iii) Be of 45 years of age. The age group of retirees is divided as follows: (i) Retirement to the age of 74; (ii) Age of 75. The basic health insurance payments paid by the user unit are taken into account in the specific standards of the individual medical account and their adjustments, which are made public by the Municipal Medical Insurance Agency, with the consent of the Government of the municipality, to study, validate the post-community government. Article 12 Employers should pay unpaid basic health insurance fees or interrupt the enjoyment of basic old-age insurance treatment and cease to account for funds under article 11 of this scheme. Article 13 The funds of the individual medical accounts are owned by the individual and can be transferred across the year and inherited by law. Funds for the personal medical accounts are divided into funds and calendar year balances. The end-of-year funding of the individual medical account is based on the relevant provisions and is included in the personal medical accounts. Article 14. Employers can access the credit and expenditure of funds in their personal medical accounts, and the Municipal Medical Insurance Agency, the District Medical Insurance Service and the Urban Medical Insurance Centre shall facilitate the search of workers. Article 15 An additional health insurance fee paid by a user unit is included in the local health insurance fund (hereinafter referred to as an additional fund). Chapter IV Article 16 The targeted medical institutions referred to in this approach refer to medical institutions granted to establish basic health insurance settlement relations with the approval of the health administration to obtain the authorization of the executive branch and the approval of the municipal health service. The targeted retail shops described in this approach refer to the granting of a retailer of medicines linked to basic health insurance coverage after the approval of the pharmaceutical supervision management for the acquisition of operational qualifications and the clearance of the municipal health service. Article 17 Targeted medical institutions, customized retail pharmacies should provide services to workers and apply for medical expenses in accordance with basic health insurance medical treatment projects, medical facilities and the scope of medicines and the payment criteria. Article 18 The basic health insurance treatment projects in the city, the scope of medical care facilities and the use of medicines, and the payment standards, are developed by the Medical Insurance Agency in conjunction with the relevant authorities in accordance with national provisions. Article 19 Employers may be medically available to the targeted medical institutions within the scope of this city. Employers may be equipped with medicines in targeted medical institutions or may be equipped with medicines according to the regulations. The place of employment of workers or residence in the city of Orientale province, as well as in the city of Orientale province, can be accessed to local medical institutions. Article 20 Employers should present their health insurance certificates when they are equipped with medicines for medical care at the targeted medical institutions in the city. The identification of a medical institution or a pharmacies should be carried out for the medical insurance certificate of the employee. Any individual shall not be able to use, forfeiture, transgender and borrow medical certificates. Chapter V Article 21 Employees' units and their employees pay health insurance fees according to the provisions, workers have access to basic health insurance treatment since the last month of payment of health insurance payments, and workers cannot receive basic health insurance treatment. In accordance with the relevant provisions, the user unit applied for the payment of a medical insurance fee, and during the approved period, the employee did not stop the enjoyment of basic health insurance treatment. Employees who have not paid medical insurance fees and their employees should be paid, and workers may continue to receive basic health insurance treatment after paying their health insurance payments in full. The length of the payment of health insurance expenses by the user unit and its employees (considered to as the contributory period) exceeds 15 years, and after the retirement of the employee, the basic health insurance treatment can be enjoyed. Depending on the calculation of the annual payment period, the municipal health service is provided separately. After the retirement age, after the retirement process, a worker may receive a pension, the basic health insurance payments paid by a person's unit are taken into account in part of his personal medical accounts, in accordance with the standards for the last month of his or her work, and the payment of his medical expenses is carried out in accordance with the basic health insurance provisions of the retired person. Retires who have received basic medical treatment under the relevant provisions are not subject to the limitations set out in this article. Article 2 (Asss of emergency medical treatment for active workers) Costs other than those set out in article 24, article 25, of the current scheme, are paid by their personal medical account funds during a one-year emergency medical clinic for medical treatment or for the pharmacies of the custom. Inadequate portions are paid by individuals to the standard of self-sufficiency, exceeding a portion of the payments made under the following provisions (excluding the costs incurred in the distribution of medicines in targeted retail shops): (i) Be born by 31 December 1955 and attended by 31 December 2000, the eligibility criteria for the MTS were 1,500, with more than 70 per cent of the medical costs paid by the Supplementary Fund and the remainder being self-sufficient by the active staff. (ii) Be born from 1 January to 31 December 1956 and attended by 31 December 2000, the eligibility rate was €1500, exceeding a portion of the medical costs paid by an additional fund of 60 per cent, while the remaining portion was self-sufficient by active workers. (iii) Be born after 1 January 1966 and attended by 31 December 2000, the eligibility criteria for the emergency medical treatment were €1500, with more than 50 per cent of the medical costs paid by the Supplementary Fund and the remainder being self-sufficient by the active staff. (iv) Newly attended work after 1 January 2001, with a self-critical rate of 1,500, more than 50 per cent of the medical costs paid by the additional fund, and the remainder being borne by in-service workers. Article 23 The expenses incurred in connection with the treatment of emergency medical treatment in the case of medical care or for the distribution of medicines in the targeted retail pharmacies are covered by their personal medical accounts. Inadequate portions are paid by individuals to the standard of self-sufficiency, exceeding a portion of the payments made under the following provisions (excluding the costs incurred in the distribution of medicines in targeted retail shops): (i) Retirement proceedings had been processed by 31 December 2000, with a standard of 300 per cent for emergency medical treatment at the level of emergency medical care, more than 90 per cent of the medical costs paid by the additional fund; at the secondary medical facility, more than 85 per cent of the medical costs had been paid by the additional fund; in the second-level medical facility, more than a portion of the medical expenses had been paid by the additional fund; in the case of emergency medical treatment at the third medical facility, more than 80 per cent of the medical costs were paid by the additional fund; and in part, the remaining self-expatriots. (ii) Be born by 31 December 1955 and attended by 31 December 2000 and after 1 January 2001, the eligibility criteria for emergency medical treatment were €700, in the case of emergency medical institutions at the primary level, with more than 85 per cent of the medical costs paid by the additional fund; in the second-tier medical facility, more than 80 per cent of the medical costs were paid by the additional fund; and in the three-tier medical institutions, more than 75 per cent of the remaining medical costs were paid by the remaining retirees; (iii) Be born from 1 January to 31 December 1956, attended by 31 December 2000, and after 1 January 2001, the eligibility criteria for emergency medical treatment amounted to $70, with over 70 per cent of the medical costs paid by an additional fund; (iv) After birth on 1 January 1966, participation at 31 December 2000 and after 1 January 2001, the eligibility criteria for emergency medical treatment were €700, in the first-level medical institution, over a portion of the medical costs paid by an additional fund; in the second-tier medical facility, more than 50 per cent of the medical costs were paid by the additional fund; and in the third medical facility's emergency, more than 45 per cent of the remaining medical expenses were paid by retirees; (v) After 1 January 2001 and after the retirement process, the eligibility criteria for the emergency medical treatment were €700, the high-level medical clinic was paid by an additional fund for more than 55 per cent; in the second-tier medical institution, more than 50 per cent of the medical costs were paid by the additional fund; in the case of a medical facility, more than 50 per cent was paid by the Fund; in the case of a medical clinic at the third level, more than 45 per cent of the medical expenses were paid by the additional fund; and in part, the remaining portion of the pension. Article 24 The medical expenses incurred by workers in connection with the urus of heavy complications, the treatment of toxicology and radiological treatment (hereinafter referred to as a medical clinic) were paid by the Integrated Fund by 85 per cent; and the retirement pension was paid by the Integrated Fund by 92 per cent. The remaining portion is paid by its personal medical accounts for the previous year's balances, which are not partially financed by the worker. The medical costs incurred by the employee's family beds are paid by the Integrated Fund by 80 per cent, while the remaining portion is paid by the individual medical accounts for the calendar year and is insufficiently paid by the employee. Article 25 The medical costs incurred by the In-Central Employees in hospitalization or by the IGO were established. The payment rate is €1,500. The medical costs incurred by the in-service worker in hospitalization or by the IGO are accumulated over the portion of the payment standard and are paid by the Integrated Fund by 85 per cent. The medical costs incurred by the in-service worker and the medical expenses incurred in the remaining portion of the after-payment by the Integrated Fund are paid by the individual medical accounts for the previous year's balances and are not covered by the in-service worker. Article 26 The medical costs incurred by retired persons in hospitalization or by the IRS Observatory are subject to the standard of payment. The payment rate was €700 by 31 December 2000; after 1 January 2001, the payment rate was 1,200. The medical costs incurred during the year's hospitalization or observation of the Acquisition Unit have resulted in a cumulative excess of the payment standard, with 92 per cent being paid by the Integrated Fund. The medical costs incurred by retirees and the remaining portions of the medical expenses incurred after the integrated funds are paid by the individual medical accounts for the previous year's balances, which are not partially borne by retirees. Article 27 The maximum payment limit for the Integrated Fund amounted to $700,000. In the first year, the cost of medical expenses incurred by workers in hospitalization, emergency observation office observation observation, as well as medical expenses for the medical treatment of the sick or the family beds, is paid by the Integrated Fund in accordance with articles 24, 25, 26 of this scheme. The Fund pays the medical expenses above the maximum limit, which is paid by an additional fund of 80 per cent and the rest is self-sufficient. Article 28 (Summit of medical expenses for some special diseases) The medical costs incurred by the employee in connection with the Epidemiology, the Family Planning Operations and the Survivals in compliance with the basic health insurance requirements are met by the Integrated Fund. The medical costs incurred by the employee for work injury, inpatient hospitalization of occupational illnesses or observation of the emergency observation room are higher than the standard of payment for the Integrated Fund, with more than 50 per cent of the cost paid by the Integrated Fund, and the remaining portion and the related patient medical costs are borne by the user unit in accordance with the relevant provisions of the State and the city. Article 29 In one of the following cases, funds from the Integrated Fund, the Fund and the Personal Medical Account are not paid: (i) Medical expenses incurred by workers in connection with medical treatment, pharmacization or the distribution of pharmacies at non-settlement points; (ii) Medical expenses incurred by workers in connection with medical treatment or treatment that are not in accordance with basic health insurance treatment projects, medical services facilities, drug use and payment standards; (iii) Medical expenses incurred by workers in connection with suicide, self-immobilization, fighting, drug abuse, medical accidents or traffic accidents; (iv) Other cases provided by the State and the city. Chapter VI Article 33 (Chiefs and accounts for medical expenses) The medical expenses incurred by workers in connection with medical treatment or the distribution of medicines are in compliance with the basic health insurance requirements, and the medical certificate of the employee is governed by the following provisions: (i) Unpaid by the Integrated Fund and the Supplementary Fund, the targeted medical institutions should be accounted for as a matter of fact; (ii) Payments made under the personal medical accounts, the customary medical institution or the customary retail pharmacies should be deducted from the personal medical accounts of the employee, and the personal medical accounts are underfunded and should be charged to the worker. The medical expenses incurred by the targeted medical institutions, the pharmacies, or the pharmacies that are not in compliance with the basic health insurance requirements should be charged to the worker. Article 31 The medical expenses incurred from the personal medical accounts of the employee, are settled on a monthly basis to the designated district and district medical offices. The targeted medical institutions are reimbursed for the medical expenses incurred by the Integrated Fund and the Supplementary Fund, which are settled on a monthly basis to designated districts, district medical offices. Employers' medical expenses incurred pursuant to article 19, paragraph 3, of this scheme may be paid through the Integrated Fund, the Supplementary Fund or the Personal Medical Accounts Fund, which are settled by their medical certificates to designated areas and district medical offices. Article 32 (Application and allocation of medical expenses) The medical expenses incurred by district, district medical insurance for the settlement of the application shall be held in the first instance within 10 working days of the date of receipt of the request for settlement and the first instance shall be sent to the Medical Insurance Service. The Municipal Medical Insurance Agency shall, within 10 working days of the date of receipt of the first instance opinion of district, district medical service, make decisions for granting payment, suspension or non-payment of payment. After a suspension of the payment decision, the Municipal Medical Insurance Agency shall, within 90 days, make a decision to grant payment or not to pay and inform the relevant units. In accordance with the medical costs approved by the Municipal Medical Insurance Agency, the Urban Medical Insurance Centre shall be allocated within seven working days of the date of approval from the fund's expenditure; the medical expenses incurred without payment are approved by the Municipal Medical Insurance Agency, the customized retailing of the medical store or the self-payment of the employee. Article 33 (Pay of medical costs) The Municipal Medical Insurance Agency may take a total advance settlement, the settlement of service projects, the settlement of service modules, and the processing of service modules, to address medical costs with targeted medical institutions, beyond the settlement standard medical costs, which are shared by the Medical Insurance Fund with the targeted medical institutions. Article 34 Targeted medical institutions, customized retail stores or individuals shall not resolve medical costs by falsification or conversion of accounts, information, referrals, medical fees documents, etc. Article XV (Regional inspection) The Municipal Medical Insurance Agency and district, district medical offices should conduct oversight inspections of targeted medical institutions, targeted retail stores, personal medical expenses settlement, and the inspection units and individuals should provide information, if any, on settlement-related records, prescriptions and morbidity history. Individual patient care is likely to go beyond normal conditions for the number of medical treatment or the costs incurred, and the commune health services can take measures to change the cost-recovery approach. Chapter VII Legal responsibility Article XVI (Criminal responsibility for offences committed by targeted medical institutions, targeted retail shops) (b) In the event of serious circumstances, the suspension of its basic health insurance relationship or the removal of its threshold qualifications should be warranted by the municipal health services, the recovery of the medical costs already paid and the imposition of a fine of up to 10,000 dollars. The relevant sections and staff of the pharmacies of the targeted medical institutions and the pharmacies constitute a serious violation of the health insurance provisions, and the municipal health service may take measures to suspend the payment of its health insurance costs. Article 37 (Legal responsibility for personal offences) In violation of article 20, paragraph 3, article 33, or in violation of other health insurance provisions, the Municipal Medical Insurance Agency shall be responsible for the revision of its deadline, the recovery of the medical costs already paid and may be subject to a warning and a fine of over 1 million dollars. Article 338 (Legal responsibility for offences committed by health-care authorities) The health insurance administration and municipal health insurance centre staff abuse their duties, favour private fraud, play a role in play, resulting in the loss of the health insurance fund, which was recovered by the Municipal Medical Insurance Agency; constituted criminal liability by law; they were not criminalized by the law; and were not criminalized by the law. Chapter VIII Article 39 (Management and oversight of the Medical Insurance Fund) The management and oversight activities of the Integrated Fund and the Supplementary Fund are carried out in accordance with the relevant provisions of the National and Beni City Social Insurance Fund. The Integrated Fund and the Additional Fund are incorporated into the Financial Excellencies of the Social Security Fund, which are managed in a unified manner, separately, earmarked and should be subject to the supervision of the Social Insurance Fund, established by the Government of the city, as well as financial, auditing sector oversight. The budget and accounts of the Integrated Fund and the Supplementary Fund are prepared by the Municipal Medical Insurance Agency in accordance with the provisions of the Municipal Finance Agency and are reported to be implemented after the approval of the Government. Article 40 (Basic health insurance for other personnel) The specific approach to basic health insurance for free occupational personnel is set out in the Home Economic Organization and its practitioners in the city. The basic health insurance for the period of unemployment insurance coverage was implemented in accordance with the relevant provisions of the State and the city. Article 40 Access to the mandatory retirement age, in accordance with the State's provisions for persons who are not subject to retirement proceedings and for the extension of the work period, is carried out in accordance with the basic health insurance provisions of the current employee; after the retirement process, the basic health insurance provisions of the same age pension have been implemented. Article 42 Within one year from the date of implementation of this approach, a transition period for the management of basic health insurance was introduced in the city, with specific operational options for the transition period. Article 43 The standard of self-sufficiency, the standard of payment for the Integrated Fund and the maximum payment threshold for the Integrated Fund should be adjusted in the light of actual circumstances. Specific adjustments are made by the Municipal Medical Insurance Agency, in conjunction with the relevant sectoral studies, post-relead People's Government, which is published with the consent of the Government. Article 44 This approach was implemented effective 1 December 2000. The relevant provisions previously issued by the commune are inconsistent with this approach. |
