Key Benefits:
(Adopted by the 31st ordinary meeting of the People's Government of Youth on 15 May 2007, No. 191 of 17 May 2007 of the Order of the People's Government of Blue Island, which came into force on 1 July 2007) Chapter I General In order to guarantee basic medical care for the urban population, a system of multi-tier medical safeguards covering all categories of urban residents is established and this approach is based on national, provincial and relevant provisions. Article 2 applies to the following urban residents who are not included in the basic health insurance coverage of urban workers in the city's South, the northern area of the city, the Quartet, the area of Leeby, the mountainous areas, the area of yellow, the city's active area. (i) In schoolchildren, children in institutions of childcare and other young children who are under the age of 18 years of age (hereinafter referred to as juvenile children); (ii) Full-time school students (hereinafter referred to as university students); (iii) Persons with disabilities with a total loss or most of the heavy impairment of the labour capacity (hereinafter referred to as a heavy disability); (iv) A resident of the city, who has a residence of 60 years of age and 50 years of age (hereinafter referred to as the elderly); (v) Other non- practitioners with noholding in the city's towns (hereinafter referred to as non- practitioners in the town). Article 3. The basic health insurance system for urban residents upholds the following principles: (i) The level of medical safeguards is adapted to the level of economic development in the city and to the affordability of the parties, with a focus on ensuring inpatient and curative medical treatment and not establishing an individual account. The way in which the medical costs are integrated is gradually piloted. (ii) Basic health insurance charges are raised and used in accordance with the principles of receipt, balance of payments, and a slight balance. On the basis of personal and family burdens, health insurance payments are granted adequate subsidies and social contributions. (iii) The basic policy balance between the various categories of medical safeguards. (iv) Reforms of three systems of health insurance, health care and the flow of medicines are synergized and implemented. Article IV. The Social Insurance Agency is specifically responsible for the collection, payment and management of the basic health insurance fund for urban residents. The Street Labour Security Service Centre was able to receive contributions under the supervision of the district labour security administration. The sectors such as finance, health, material prices, audit, education, civil affairs, population counts, food medicine surveillance, trade unions and maiming should be carried out in accordance with their respective responsibilities in relation to basic health insurance for the urban population. Various district governments, street offices, resident councils are responsible for the organization of tenure for urban residents within the Territory. Chapter II Fund mobilization Article 5 (i) Young children are raised in accordance with the standard of 100 per person per year. Of these, the individual paid US$ 40 and FC$60. Young children are single-parent children, with a financial grant of $5. (ii) Students raise according to the standard of $40 per person per year. Of these, the financial grant of $20 is partially addressed by individuals or by the source. (iii) Removal of persons with disabilities according to the standard of $900 per person per year. Of these, individuals paid US$ 150 and 750. (iv) Older residents are raised in accordance with the standards of $900 per person per year. Of these, the individual paid US$ 300 and FCF 600. (v) In towns, non- practitioners raise the standards of $900 per person per year. Of these, the individual paid US$ 720, with financial support of US$ 180. Funding standards are adjusted on the basis of income and expenditure for urban residents. Access to the minimum living security of the urban population, the presence of the special hardship worker and the right to pay, and his personal contributions are paid in full financial terms. Article 6. Basic health insurance fees for urban residents are collected by the following units: (i) In-house children in school students, childcare institutions are responsible for receiving them; (ii) Older residents, persons with heavy disability, non-agricultural practitioners and other young children are collected by their place of origin or by labour security services in the street. The financial support fund is financed by financial sharing at the municipal, district level, which is transferred directly to the accounts of the Basic Health Insurance Fund for the urban population. Article 7 collected units should be equipped with basic medical insurance fees collection, health insurance policy advocacy, registration and change, assistance to the social insurance agencies to participate in other relevant work, such as the recognition of insurance information, and the timely transfer of basic health insurance fees to social insurance institutions without interception and diversion. Article 8 Payments were made by 30 September, and basic health insurance treatment was granted effective 1 October. Each year, from 1 October to 30 September, is an insurance year. Emerging persons, such as newborns, who meet the conditions of participation, may participate at the time of payment and receive basic health insurance treatment for the coming month. Article 9 is a non-conductor of the basic health insurance for the urban population, who participates in the basic health insurance for the workers of the town after the start of the operation, and when retirement is less than the minimum payment for the basic medical insurance of the urban worker, the cumulative payment of the basic medical insurance premiums for their urban residents can be offset by the payment of the basic medical insurance premiums for their workers. Article 10 Residents of the town are eligible for non-time payment, and in subsequent years they should be added to the basic medical insurance expenses that should be borne by the individual and receive basic health insurance treatment from the paying month. The residents of the town interrupt the payment of their contributions, and the period of recuperation shall be subject to the basic medical insurance expenses borne by the individual and receive the basic medical insurance treatment from the contributory month. The basic health insurance fund for medical expenses incurred during the interruption was not paid. Chapter III Basic health insurance treatment Article 11. Basic health insurance for the urban population is a major guarantee of hospitalization and medical treatment. Medical care for older persons, persons with heavy disabilities is duly treated with general treatment, with appropriate satisfaction for young children and students. Article 12. The scope of the basic health insurance for the urban population, the medical treatment project, the scope of service facilities and the payment criteria are implemented in accordance with the relevant provisions of the basic health insurance for the urban workers. Adequate increases in medicines, diagnostic projects and services for the treatment of young children. Specific approaches are developed by the municipal labour security administration. Article 13. Older residents, persons with heavy disabilities, piloted a stereotyped management of the general medical fee, which requires medical treatment, should select a community health service agency as a medical agency for their own referrals. In one year, the medical fees incurred by the community-based health service agencies in their own targeted locations amounted to more than 100 million dollars, more than partially paid under 30 per cent of the basic health insurance clinic. The basic health insurance fund is not paid at a medical fee incurred by the non-suit community health service agency. Article 14. Older residents, heavy-disabled persons and non-commercials are subject to inpatient treatment and their inpatient medical expenses are included in the coverage of the basic health insurance fund. Inpatient medical fees are paid in accordance with the provisions of the basic health insurance for the urban workers. More than 50 per cent of medical expenses are paid by the Basic Medical Insurance Fund in accordance with the methodology calculated in the sketches: 50 per cent are paid in three medical institutions, 60 per cent at the secondary level and in the following medical institutions; $5000 to 10000, $55 per cent in three medical institutions, 65 per cent at the secondary and below medical institutions; $100,000 to 0, 60 per cent in three medical institutions, 70 per cent at the secondary level and below; and 70 per cent in the total medical facility, irrespective of the level. During a medical year, the maximum payment limit for the basic health insurance fund was $100,000. Article 15. Older persons, persons with heavy disability and urban non- practitioners are subject to medical treatment, which is certified by the Social Insurance Agency and incorporated in the coverage of the basic health insurance fund. The treatment of the sick and the criteria for validation are carried out in accordance with the relevant provisions of the basic health insurance coverage for urban workers. The medical fee is governed by the limits and a medical year has set up a pay standard. The payment criteria are implemented in accordance with the provisions of the Basic Health Insurance for Urban Employers. The basic health insurance fund for the targeted community health services has been paid for more than 60 per cent, and 50 per cent for the basic health insurance fund for other targeted medical institutions. The medical fees for urine syllabus treatment, organ transplanatory treatment, white blood disease, maloxinal stereotyped patients are not established separately and the payment standards for the basic health insurance fund are implemented in accordance with the standards of hospitalization. The basic health insurance fund is paid in accordance with the general clinic for patients who have been identified for medical treatment. Article 16 requires inpatient care for young children, students who suffer from illness, and their inpatient medical expenses are included in the coverage of the basic health insurance fund. The standard of payment for hospitalization is set up in accordance with the standard of €500, tier 2 and 300 of the three medical institutions. In one medical year, the first inpatient rate was implemented in accordance with 100 per cent; in the second inpatient, the payment criteria were implemented by 50 per cent; in the third and above-run hospitalizations, no payment criteria were established. The above-mentioned medical fees are paid by the Basic Medical Insurance Fund in accordance with the methodology calculated at the end of the cycle: 70 per cent is paid in three medical institutions, 75 per cent at the secondary level and in the following medical institutions; $5,000 to $100,000, 80 per cent at the third level of medical institutions, 85 per cent at the secondary level and in the following medical institutions; more than 100,000 dollars, irrespective of the level of the medical agency. During a medical year, the maximum payment rate for the basic health insurance fund amounted to $120,000. Article 17 Adolescent children, students with high illnesses, are subject to medical treatment by social insurance agencies, and their medical fees are covered by the basic health insurance fund. The diarrhoea and the criteria for validation are carried out in accordance with the provisions of the basic health insurance for urban workers and are effectively adjusted by the municipal labour guarantee administration in accordance with the medical characteristics of juvenile children. A medical year for the diagnosis was established with a separate payment standard. The above-mentioned medical fees are paid by the Basic Medical Insurance Fund in accordance with the standards of hospitalization. The medical fees for urine syllabus treatment, organ transplanatory treatment, clamation, maloxinology and stereopathy are not established separately. Article 18 Article 19 provides for the treatment of young children with sole-born children who are inpatient medical care, medical care for the sick, emergency medical treatment, and an increase of 5 percentage points on the basis of the above-mentioned proportion of payments. Article 20, medical expenses incurred by the insured person for accidental injury, which are paid by the basic health insurance fund in accordance with the corresponding standards; the responsibility of the person shall be compensated by the responsible person, and the medical fees paid for compensation are less than the payment criteria for the basic health insurance fund and are filled by the basic health insurance fund. The responsible person does not have the capacity to compensate or cannot determine the responsible person, whose medical expenses are paid by the basic health insurance fund in accordance with the corresponding criteria. Article 21 requires the referral of the insured person to the hospitalization in the field for the condition of the illnesses, which is subject to referral of referrals by more than three targeted hospitals in this city, or by the municipality-specific hospital, and approval by the Social Insurance Agency. Inpatient medical fees in the context of basic health insurance in the field are paid by the Basic Medical Insurance Fund in accordance with article 14, article 16 of the scheme and by 5 percentage points. Article 22 provides for emergency medical expenses incurred by the insured person for reasons such as visits to relatives, leave, etc., which may be included in the coverage of the basic health insurance fund. The specific management approach is implemented in accordance with the relevant provisions of the basic health insurance for urban workers. Chapter IV Article 23 regulates the basic health insurance of the urban population, with the participation of the insured person to the targeted medical institution. The scope and management of the targeted medical institutions are implemented in accordance with the relevant provisions of the basic health insurance for the urban workers. Article 24 provides for community orientations and agreement management systems for old-age residents, persons with heavy disabilities. The targeted community health services should enter into a health-care agreement with the insured person to clarify both rights obligations. Participating persons are encouraged to enter into health-care agreements with targeted community health services institutions. A family-based agreement is concluded with the unit, whose family members are entitled to the health insurance-related policy. Article 25. The basic health insurance system for elderly residents, persons with heavy disabilities is introduced in the community's first and referral system. The custodians should select a community-based health service agency as their own targeted community health services. In the first instance, at the community-based health service agency in his own choice, the community-based health service institutions should conduct referrals for patients in a timely manner. Inpatient medical expenses incurred without the processing of referrals by community health services, the basic health insurance fund is not paid. Exceptions in emergency, inpatient care, and inpatient care. The insured person can freely change the targeted community health services institutions. The insured person needs to change the targeted community health service institutions, which should be synchronized and not interfered. Article 26 establishes a family doctor's system. The custodians may choose a doctor with a corresponding qualifications as a family doctor in the targeted community health service institutions to enter into service agreements that clarify both rights obligations. The family physicians provide medical services on behalf of the Community Health Services Agency to the signatories and family members. Article 27 Community health services institutions and family doctors should prevent health care for insured persons and their family members, implement chronic disease interventions, establish family beds, provide access to other community health services such as referrals, visits, bi referrals and old-age health care. Article 28 assigns 20000,000 dollars per year from the special fund for the benefit-based public service, dedicated to compensating the expenses of health-care services provided by targeted community health services for the insured person, the prevention of health care, the intervention of chronic diseases. Chapter V Management and oversight of the Fund Article 29 of the Basic Medical Insurance Fund for Urban Residents introduces two income and expenditure lines to be integrated into the management of the Principality of Finance, dedicated to funds, and no units and individuals shall be excluded and diverted. Article 33 Implementation of the Unified Social Insurance Fund, the financial accounting system and the internal audit system. Article 31 of the Social Insurance Agency is responsible for the preparation of the draft predetermined accounts for the basic health insurance for the urban population, the mobilization of funds and the payment of medical expenses, and the accounting of funds. The Social Insurance Agency should establish a sound internal management system, strengthen the income and expenditure management of the basic health insurance fund for the urban population and receive oversight inspections by the executive branch, such as audit, finance, labour guarantees. The requirements for the cause of the social insurance agencies are financed by financial budgetary arrangements and cannot be drawn from the Fund. Article 32 of the Labour Guarantees Administration is responsible for overseeing the mobilization, management and use of the basic health insurance fund for urban residents, and for the review of the draft predetermined accounts of the basic health insurance fund for urban residents prepared by the Social Insurance Agency. Article 33 Financial services are responsible for the accounting of the funds of the Royal Medical Insurance Fund for Urban Residents and for the finalization of the Fund. The audit department is responsible for the audit of the payment and management of the basic health insurance fund for urban residents, in accordance with the law. Article 34, Income and expenditure management of the basic health insurance fund for the urban population, should be reported regularly to the Standing Committee of the Social Insurance Fund and be made available to society on a regular basis to receive social oversight. Chapter VI Legal responsibility The collection of basic medical insurance fees for the urban population is one of the following acts, which are being responsibly corrected by the municipal labour security administration; the denial of correction and the imposition of a fine of up to 500,000 dollars for the principal and direct responsibilities, respectively; and the criminal liability of the law. (i) No collection of basic health insurance fees as prescribed; (ii) Not subject to the provision of registration, change or information recognition by the insured person; (iii) Separate retention and diversion of basic health insurance fees. Article XVI establishes one of the following acts by the Community Health Services Agency and its staff, which is fined by the municipal labour security administration for the fixed-point community health service agency by more than 5,000 dollars, and imposes a fine of up to €50 million for the direct responsibilities; in the event of a severe suspension or removal of its eligibility. (i) Failing medical instruments to deceive the health insurance fund; (ii) The referral of patients who are not eligible for referral; (iii) Inadequate referral procedures for insured persons; (iv) Incidence with hospitals; (v) Other violations of the basic health insurance regulations of the urban population. Article 37 devolved in the basic health insurance fund, returned by the municipal labour security administration and charged a fine of more than three times the amount of one year's basic health insurance treatment; constituted a crime and prosecuted criminally by law. The legal responsibilities of the basic medical establishment, the Social Insurance Agency, the Labour Guarantee Administration and its staff are implemented in accordance with articles 53, 54, 56, 55 and 57 of the Basic Health Insurance for Workers in the City of Blue Island. Article 39 of the decision of the parties to impose administrative penalties on the labour security administration may apply to administrative review or administrative proceedings in accordance with the law. The parties had failed to comply with administrative sanctions decisions and the executive organs that had made administrative sanctions decisions had applied to the People's Court for enforcement by law. Chapter VII Article 40 Standards for the mobilization and treatment of the basic health insurance fund for the urban population, in accordance with the principle of balance of payments and progressive treatment, are adjusted by the municipal labour security administration, as appropriate, in the city's financial sector, to be submitted to the municipalities for approval. Article 40. Other matters that are not covered by this approach are implemented in the light of the Basic Health Insurance Scheme for Youth Town Employers and related provisions. In the city of Metropolitan, the city of Popp South, the city of Pin and the city of Leci, the relevant provisions of the basic health insurance for the inhabitants of the city should be developed in the light of this approach and reported to the municipal authorities. The basic health insurance costs for the urban population are raised and managed by local social insurance agencies and are integrated throughout the city. Article 42 |
