Interim Measures For The Basic Medical Insurance For Urban Residents In Chengdu City

Original Language Title: 成都市城镇居民基本医疗保险暂行办法

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
(December 30, 2006, Chengdu municipal people's Government of the 94th General meeting by January 1, 2007, Chengdu municipal people's Government, the 134th announced come into force on the date of promulgation) first (objective basis) in order to further improve the basic medical insurance system for urban and rural areas, protection of urban resident basic medical, progressive realization of the right to health care, according to the provisions of the relevant laws and regulations, Chengdu practice, these measures are formulated.
    The second (insurance principle) of basic medical insurance for urban residents to follow the following principles: (a) the levels commensurate with the level of socio-economic development, the implementation of district (municipal), county-level co-ordination.
    (B) insurance system links up with urban workers ' basic medical insurance.
    (C) implement the medical community overall plan, serious illness, hospitalization, or not having personal accounts.
    (D) rights and obligations of reciprocity.
    (E) to individual contributions, supplemented by Government subsidies, financing.
    (F) Solidarity Fund so as to achieve a balanced budget, a balanced budget with a small surplus. Article III (authorities) municipal labor and social security administrative departments in charge of the city basic medical insurance for urban residents. District (municipal), county administrative departments of labor security in charge of the administrative areas of basic medical insurance for urban residents.
    District (municipal), County Social Insurance Agency (hereinafter referred to as social security institutions) in accordance with these regulations, in particular undertake co-ordination of basic medical insurance for urban residents.
    Fourth (scope of insurance) the town within the administrative area of the city residence of the following persons shall participate in the basic medical insurance for urban residents: (a) more than 18 years of age working age within the urban residents of establishing labour relations with the employer, (ii) males reaching the age of 60 and women 50 years of age do not participate in urban workers ' basic medical insurance for urban residents.
    Old Red Army men, retired cadres, two or more b disabled revolutionary soldiers, in the administrative area of the city of foreigners and Hong Kong, Macao and Taiwan people, these procedures do not apply.
    Fifth (payment standard) (a) of Jinjiang District, Jinniu District, wuhou district, and Chenghua district as well, and qingyang district development zones (hereinafter referred to as the five urban areas) earn base pay of employees, Chengdu, not more than one year, payment is 5%. (B) other areas (City) County employees for the contribution base, Chengdu, not more than one year, divided into three grades, namely: 100% of average wages in Chengdu in the previous year; last year the average wage of staff and workers in Chengdu 80%; last year of average wages in Chengdu, 60%, payment ratio is 4%.
    District (municipal), County Government under the co-ordination of economic income of the urban residents in determining specific pay grades.
    Covered by the basic medical insurance for urban residents last year, Chengdu city employees, city employees subject released by the municipal Statistics Bureau. The sixth section (insurance subsidy) enjoy the urban minimum living guarantee insurance of urban residents, the Government subsidy is not lower than 300 yuan per person per year; insurance of urban residents in the low-income families, males reaching the age of 60 and women over the age of 50 the Government subsidy of not less than 50 Yuan per person per year. Specific allowance, by co-ordinating regional (City) County Government determined in accordance with local conditions.
    The funds needed, according to the principle of territorial management, by District (City) County Government commitment.
    Seventh (payment period) insured persons should be continuous uninterrupted payment of basic medical insurance for urban residents, interrupted for more than 2 months to renew as a re-insurance.
    (A) insured persons 70 years of age when for the first time, more than 10 years ' continuous payment, according to the comprehensive index of average pay, lifelong enjoyment of basic medical insurance for urban residents.
    (B) when they first join the age of 60, the age of 70 personnel, continuous contributions over 15 years of age, according to the comprehensive index of average pay, lifelong enjoyment of basic medical insurance for urban residents.
    (C) during the initial insured persons 50 years of age, the age of 60, for payment over 20 years, according to the comprehensive index of average pay, lifelong enjoyment of basic medical insurance for urban residents.
    (D) the insured persons under 50 years of age when for the first time, more than 25 years ' continuous payment, according to the comprehensive index of average pay, lifelong enjoyment of basic medical insurance for urban residents.
    (Five) participate in town residents basic medical insurance Hou into town workers basic medical insurance of personnel, original town residents basic medical insurance payment conversion years and town workers basic medical insurance continuous payment years total full 15 years above, and insurance relationship transfer Hou reached statutory retired age Qian continuous paid town workers basic medical premium not below 10, reached statutory retired age Shi, lifelong enjoy town workers basic medical insurance treatment.
    Eighth (payment) of basic medical insurance for urban residents monthly or annual collection, insurance premiums will not be returned.
    Nineth (insurance convergence) basic medical insurance for urban residents and the employer establishes labor relationship after participating in basic medical insurance for urban workers, its original period of contributions by a certain percentage conversion, conversion of five urban areas every 2 years 1 year in other districts (City) converting approach by the integrated parts of the County (City) County OK.
    Personnel participating in basic medical insurance for urban workers, in principle, cannot turn into basic medical insurance for urban residents, due to exceptional circumstances needed to insurance of urban residents, can only be transferred to the original social security institutions, and maternity insurance as is imposed by the basic old-age insurance.
    Tenth article (insurance treatment) town residents basic medical insurance parameter insurance personnel in town workers basic medical insurance Sentinel medical institutions occurred of meet town workers basic medical insurance provides of one-time hospital medical costs, its amounts in and manpower Fund up pay standard above, and highest paid limit following of part, personal first paid part should by personal paid of costs Hou, by and manpower Fund by following standard paid: (a) five city by town workers basic medical insurance and manpower Fund paid standard paid.
    (B) other areas (City) County to base pay 100% pay, paid by urban workers ' basic medical insurance fund pays; in base pay 80% pay, by urban workers ' basic medical insurance fund payment 80% payment; to base pay 60% pay, by urban workers ' basic medical insurance fund to pay the standard 60% to pay.
    11th (standard) standard of paying funds of basic medical insurance for urban residents, refer to integrated urban workers ' basic medical insurance funds pay standards.
    12th (high limit) payment ceiling on funds of basic medical insurance for urban residents: a natural year in cumulative funds to pay medical expenses for insured workers had been admitted the previous year 4 times times the contribution base.
    13th (period of payment for the treatment) participated in the basic medical insurance for urban residents and continuous uninterrupted payment, insurance payment as follows: (a) before December 31, 2007, the insurance payment, monthly medical expenses of insured enjoy medical insurance benefits as provided herein.
    (B) after December 31, 2007 payment of insured, insured medical expenses that occurred after 12 months from the date of admission to enjoy medical insurance benefits as provided herein.
    (C) more than 2-month renewal fee, self-renewal after 12 months from the date of admission of medical expenses under the present system of medical insurance benefits.
    (D) participating in basic medical insurance for urban residents and the employer establishes labor relationship after participating in basic medical insurance for urban workers, medical insurance treatment according to the relevant provisions of the basic medical insurance for urban workers.
    14th (not paying) urban resident basic medical insurance does not cover the cost of: (a) in addition to rescue the external non-designated medical institutions for treatment.
    (B) interrupt pay medical expenses for the period.
    (C) due to traffic accidents, medical accidents, or other incidents of harm.
    (D) because the harm caused by drugs, assault, illegal.
    (E) self-harm, self-mutilation, alcohol abuse, drug addiction, sexually transmitted diseases were treated.
    (F) treatment for cosmetic, orthopedic, physical defects, etc.
    (VII) without the social security agency referral referral for examination and approval.
    (VIII) other not specified in national and provincial medical insurance policy to pay the costs.
    Due to injuries caused by traffic accidents, to provide public security traffic management sector issued by the responsible party to escape proof, and verified by the social security bodies, at designated medical institutions for treatment of medical expenses can be included in the scope of funds of basic medical insurance for urban residents, but enjoy related compensation are excluded.
    15th (settlement) the medical expenses of insured persons during hospitalization, belongs to the scope of urban resident basic medical insurance fund, by the appointed medical institutions of social security institutions and settlements belonging to the insured person pays and at their own expense, by the appointed medical institutions of insured persons and the settlement. Admission to designated medical institutions should pay a certain amount of advance payment to cover the costs to be borne by the individual. Deposit the exact amount determined by the appointed medical institutions according to the illness, contracted medical institutions and individual settlement at discharge.
    Medical fees should issue a payment to contributors when credentials.
    16th (Fund management) funds of basic medical insurance for urban residents into urban workers ' basic medical insurance fund management, the implementation of special financial account, separate accounts, and no unit or individual shall misappropriate.
    Work funded by the social security institution for medical insurance business financial budget at the same level shall not be extracted from the health insurance fund. 17th (Fund supervision) labour and social security administrative departments, finance departments are responsible for supervision and management of funds of basic medical insurance for urban residents; auditing Department responsible for regularly auditing the funds of basic medical insurance for urban residents.
    Social Security Agency is responsible for collecting, managing funds of basic medical insurance for urban residents, provides timely payment of health insurance benefits, and establish a sound budget and accounting systems, accounting and internal audit systems.
    18th (Fund overexpenditure) funds of basic medical insurance for urban residents when cost overruns, labor and social security administrative departments should be promptly reported to the Government at the same level, and by similar measures taken by the Government to address them.
    19th (personnel protection) required for urban resident basic medical insurance agency staff, by District (City) County Government in accordance with the needs on its own. 20th (service management) appointed medical institutions of basic medical insurance for urban residents to implement management.
    Specific measures shall be in accordance with the labor and social security, published by the Administrative Department of Health appointed medical institutions of urban employee basic medical insurance management approach implementation.
    21st (designated medical institutions accountable for violating) designated medical institutions and his staff violated medical insurance policy, fraud, drug abuse, illegal charges, social security institutions have the right to according to the Protocol of treatment; different case where the labor Security Administration Department granting the education through criticism, or suspend basic medical insurance service, or cancel the qualification of contracted medical institutions. 22nd (cheating) for insured persons concealed, fraud, and other means of obtaining medical insurance funds, social security institutions have the right to refuse to pay.
    Have been paid, should be ordered to refund according to law; refusing to return, administrative departments of labor security in accordance with the provisions of the State Council provisional regulations on collection and payment of social insurance, fined 500 Yuan more than 1000 Yuan fine constitutes a crime, shall be investigated for criminal responsibility by judicial organs.
    23rd (managers accountable for violating) administrative departments of labor security staff abuse, malpractice, negligence, social security agencies, resulting in loss of funds of basic medical insurance for urban residents, by the social security agencies recovered the loss of health insurance funds, penalties constitute a crime, criminal responsibility shall be investigated according to law. 24th (implementing rules), district (municipal) Government should be based on the regulations, combined with the actual formulation and implementation details, reported that the municipal government for the record.
    Its basic principles, standards of coverage, payment, salary, fund management system should be consistent with these measures.
    25th (supplementary medical insurance) personnel participating in basic medical insurance for urban residents, may voluntarily participate in the Chengdu city hospitalization complementary medical insurance.
    26th (umbrella term) this approach is called the "above" or "below", are included in this figure.
    27th (explain) problems in the application of these measures by the Chengdu municipal labor and Social Security Bureau is responsible for the interpretation. 28th (effective date) this approach come into force on the date of promulgation.
                                                                        The city past the relevant provisions is inconsistent with this approach, is subject to this approach.