Key Benefits:
(Summit No. 70th ordinary meeting of the People's Government of New York, 9 March 2006 to consider the adoption of Decree No. 138 of 23 March 2006 of the People's Government Order No. 138 of 23 March 2006 on 1 May 2006) Chapter I General Article 1 establishes and improves the basic health insurance system for workers in towns, in line with the relevant provisions of the State, the establishment of this provision, in conjunction with the current city. Article 2. This provision applies to all types of enterprises, State agencies, business units, social groups, non-commercial units, self-employed persons (hereinafter referred to as personal units) and their employees (injured workers) and retirees within the city's administration. The user units should participate in the basic health insurance in accordance with this provision, in which external workers and presenters participating in the low-standard old-age pension insurance may participate separately in the inpatient health insurance. Unemployment workers, flexibilities in towns may participate in basic health insurance or inpatient health insurance, as prescribed. Article 3 establishes the basic health insurance system for workers must uphold the following principles: (i) The level of funding and security of basic health insurance should be tailored to the level of local economic and social development; (ii) All personnel units in the town and their employees should participate in the basic health insurance and be administered on the ground; (iii) Basic health insurance costs are jointly burdened by both user units and in-service workers; (iv) The basic health insurance fund combines social integration and personal accounts. Article IV The Health Insurance Unit under the Labour Security Administration is specifically responsible for the day-to-day management of basic health insurance. Sectors such as health, finance, taxes, prices, drug surveillance should be implemented in line with their respective responsibilities. Article 5 Chapter II The health insurance funds should be established in all integrated areas of Article 6. The Medical Insurance Fund consists of the following projects: (i) Basic health insurance payments and major illness relief payments paid by a person's unit and by individuals (hereinafter referred to as the Sickness Relief); (ii) Value-added income such as interest in the health insurance fund; (iii) lag income; (iv) Government subsidies; (v) Other funds of the Medical Insurance Fund should be incorporated by law. The Health Insurance Fund is integrated into the financial exclusive and administered in accordance with the management approach of the Social Security Fund. Article 7 (i) On-the-job basis of the average monthly salary of the employee in the previous year, the basic health insurance fee was paid by a 2 per cent of his/her contribution base, which was paid by the user's unit in his salary in the month, and the base for the basic health insurance was approved by 30 per cent of the average monthly salary of the employee in the city at least 30 per cent, with no less than 60 per cent of the average monthly salary in the current city. (ii) The rate of payment of basic health insurance fees by the user unit and the standard for the payment of major illnesses are provided in the integrated areas. Within the area of integration, a person's unit pays a basic health insurance fee of 11 per cent of the employee's paying base and pays a major medical insurance payment in accordance with a standard of 5 per person per person per month; the individual business and industry pays basic health insurance payments at a rate of 13 per cent and pays royalties at a standard of 5 per person per person per month, the individual business worker with an employment agent, paying a basic health insurance fee at a rate of 2 per cent, and the remainder paid by the employer in accordance with paragraph 1 of this article. (iii) The criteria for the payment of basic health insurance fees and major illness relief for unemployed persons, flexibilities in the town are provided in the integrated areas. The number of unemployed persons who received unemployment insurance payments during or after the expiry of the municipal level is 60 per cent of the average monthly salary of the employee in this city, while other unemployed and urban flexibilities pay the average monthly salary of the employee in this city, at 13 per cent rate, and pay major illnesses at the standard of $5 per person per month. (iv) Governments in the integrated areas are subsidized by the contributions of insured persons and by 0.5 per cent in the current year. The basic health insurance fee shall not be paid, and the basic medical insurance expenses and major illnesses are not charged. Article 8 Removal (remobilization) military, out-of-the-court municipalities are redirected into the city, new participation and re-employment, which are declared by the user unit in real terms; no year-old payment base is determined by the user unit in accordance with the terms of the employee's salary. Article 9. Basic health insurance payments and major illness relief payments are used by a user unit to process basic health insurance in the health insurance system. The basic health insurance payments paid by the user unit and the major illnesses are charged on the basis of the financial sector. Article 10. The user unit shall pay the basic medical insurance expenses and major illnesses in full and on time. The user unit has not been paid according to the prescribed deadline, which has been paid by the tax authorities for a period of time and has been outstanding or donated, from the date of non-contributory or small contributions, with the amount of 2 per 1,000 per 1,000 per 1,000 per 1,000 per 1,000 per 1,000 per day, and the lag has been incorporated into the basic health insurance fund. The basic health insurance fees and major illnesses are collected by the local tax authorities at all levels on a monthly basis, with a specific payment scheme developed by local tax authorities in the integrated areas. Article 11. The Social Insurance Fund Oversight Committee shall oversee the payment and expenditure management of the Fund in accordance with the laws, regulations and related provisions. Article 12. The Medical Insurance Fund calculates interest on the basis of the portion raised in the year, on the basis of the life-saving interest rate; the last year's deposit interest on the basis of the three-month period; the deposit of the bank deposits; and the deposit of the deposit funds deposited with the social security finance vested in the treasury, which is not less than the level of interest. Article 13 restructured, insolvency, and in the public sector, its subjects are no longer present, and the medical expenses of retired persons have been recovered under the relevant provisions shall be transferred to an integrated regional health insurance institution and incorporated into the health insurance fund. Chapter III Individual accounts and integrated funds Article 14. The personal accounts of the insured person are taken into account by the Basic Health Insurance Fund in a proportional manner, with a specific proportion and management approach being developed by the people's governments in the integrated regions. The proportion of monthly personal accounts of insured persons in the area of integration is: (i) Under the age of 35 years, 3 per cent of the base salary paid to him; (ii) The age of 35 years (concluded) to 45 years, which is 3.2 per cent of their contributions; (iii) The age of 45 (concluded) to retirement, which is 4 per cent of the base of contributions for himself; (iv) Retirement (including) to 70 years of age, 4.2 per cent of the average monthly salary for workers in the current city; (v) More than 70 years of age (including) and 4.8 per cent of the average monthly salary for workers in the current city. Article 15. Personal accounts are mainly used for medical expenses incurred in the case of a medical examination. The principals and interest in the personal accounts are owned by the individual, and the balance of the individual accounts may be transferred, removed and used in the event of the death of the insured person, which may be inherited by law. Article 16 provides primarily for hospitalization in the year of the insured person, with medical fees paid above the standard for the integrated fund and the medical fees incurred for special treatment. The Sickness Relief is mainly used to cover hospitalizations in the year of the insured person, with medical fees paid at the Integrated Fund for up-to-date medical expenses. Article 17 provides for the scope and integration of some of the medical fees paid by the Integrated Fund, and the maximum payment of the Sickness Relief. Chapter IV Basic health insurance treatment The treatment of basic health insurance is determined in accordance with the principle of payment, balance of payments, and is gradually linked to the pay-for-year limit, with a specific approach being developed separately in the integrated areas. After the payment of basic health insurance fees and major illnesses by the user unit, the active worker enjoyed basic medical treatment since the month. The user unit interrupted the payment, and its staff members ceased to enjoy basic health insurance treatment for the second month of the interruption of the payment. After a lump-sum payment is made in full, the active worker has recovered from the month of the basic medical insurance treatment; the medical expenses incurred by the employee during the interruption of the payment period are paid by the user's unit in the light of the basic medical treatment standards. Individuals and their employees, unemployed persons and flexibilities in the town began access to basic health insurance benefits after their first participation in basic health insurance or the suspension of basic health insurance relations. Article 19 The insured person may choose to receive basic health insurance treatment or inpatient health insurance after retirement. The insured persons shall enjoy the basic health insurance treatment, with the following conditions: (i) The process of retirement and the benefits of old-age treatment in accordance with the relevant provisions; (ii) The cumulative payment rate for basic health insurance (including contributions and actual contributions) and the actual annual amount of the payment required. Inpatient health insurance payments for insured persons may be converted to the actual pay for basic health insurance. The cumulative payment rate for basic health insurance is not in accordance with the prescribed conditions, and after a lump-sum payment of basic health insurance payments and major illness relief payments are provided, the basic health insurance treatment of retirees is available. Article 20 After the retirement of the insured person within the area of the city, the cumulative pay for the basic health insurance amounted to 15 years and to five years after the actual payment period was due, and the basic medical insurance treatment of the retired person could be enjoyed. In arriving at the age of retirement, the insured person does not have the conditions for retirement and the monthly benefits of old-age treatment, or the cumulative annual payment of the basic health insurance is not in accordance with the conditions of the provision and is not willing to pay as a result of the termination of the basic health insurance relationship since the month. The standard for payment of medical expenses incurred by the insured person is set out in the integrated areas. Medical fees incurred by the insured persons in the area of integration are paid by the personal accounts for the year when the funds are taken into account; personal accounts are self-sufficient by the insured person after the year's funding is completed; under 45 years of age, 45 years of age (including) to retirement, the cumulative self-worthiness of the retired person are determined by 9 per cent, 6 per cent and 3 per cent of the average annual salary of the employee in the city, respectively. On a cumulative basis, beyond the amount specified in the preceding paragraph, the medical fee is paid by the Integrated Fund, at 75 per cent (three-tier medical agencies), 85 per cent (communication health services) and 80 per cent (other medical institutions) respectively, and the remainder by individuals. The standard of medical expenses incurred by the insured person in the treatment of special illnesses is set out in the integrated areas. Medical fees for special treatment of insured persons within the area of urban integration, 15 per cent for active workers, 10 per cent for retirees and 10 per cent for the remainder paid by the Integrated Fund. Article 23 standards for the payment of inpatient medical expenses incurred by insured persons are set out in the integrated areas by the establishment of the standard for the payment of integrated funds at different levels of the medical institution (hereinafter referred to as payment criteria): at the level and in the following medical institutions, amounting to $80; at the secondary medical institution, 1000; and at the third level of medical institutions, 1,200 dollars. The medical expenses incurred in hospitalization in the year of the insured person have been accumulated under the standard of payment (concluding) to be borne by the individual; and payments are made in part of the payment standard: (i) Two times the average annual wage of workers in this city, with 20 per cent for active workers, 15 per cent for retirees and the remainder paid by the Integrated Fund; (ii) More than two to four times the average annual wage of workers in this city, 15 per cent of active workers, 10 per cent for retirees, and the remainder paid by the Integrated Fund; (iii) More than 4 to 8 times the average annual wage of workers in this city, with 10 per cent of the insured person, and the remainder paid by the major illnesses; (iv) More than eight times the average annual wage of workers in this city, and through social medical treatment. In one year, inpatient health-care institutions at the same level, the payment rate is calculated at the standard of the medical facility at that level; in one year, inpatient hospitals at different levels of medical institutions, the payment rate is calculated on the basis of the standards of the highest-level medical institution. Article 24 provides for medical expenses incurred by the insured person for the treatment of medical expenses incurred in the medical treatment of essential medical insurance types of medicines, types of medical services, prior to the payment of part-time medical expenses by the individual. The management approach, such as the specific payment criteria, would be developed separately by the executive branch of the integrated areas of labour security. Article 25 Article 26, on the basis of participation in the basic health insurance, enterprises may establish additional health insurance for workers, mainly for medical expenses paid by the insured person and may also be used to participate in the medical assistance of the employee, commercial health insurance. A total of 4 per cent of the total salary for enterprises can be charged directly from the cost. Article 27 provides for medical assistance in accordance with the relevant provisions of the State after the participation of public servants in the basic health insurance. Article XXVIII affects basic life due to the excessive burden of health-care workers, and the units should provide appropriate assistance. There are difficulties in the medical fees for the above-mentioned labour model, which are helped by the user unit and the local people's Government. Article 29 does not apply to the medical treatment of the recuperation, the old-age army, which is settled on the basis of the original channels, makes it difficult to pay and is helped by the local people's Government. The medical treatment of persons with disabilities, such as grade II, and above, has remained unchanged, with funding being addressed on the basis of the original channels and when payments are not paid by the local people's Government. The old-age worker who had previously participated in the revolution had been reduced by half of his personal self-critical and paid medical expenses on the basis of access to basic health insurance. The following medical expenses are not covered by the Medical Insurance Fund: (i) Medical fees other than those covered by the basic health insurance medicine catalogue, the directory of the medical services project and the payment of the standard; (ii) Medical fees for medical treatment and purchase of medicines, as prescribed; (iii) Medical fees incurred as a result of offences committed, maiming or suicide, fighting, alcohol abuse and drug abuse; (iv) Medical expenses incurred as a result of motor vehicle traffic accidents, medical accidents, poisoning of large-scale foods and other liability; (v) Medical fees incurred during the departure period; (vi) The suspension of the insured person and the cessation of medical expenses incurred during the treatment of health insurance; (vii) Other medical fees that are not paid as prescribed. The work injury of the insured person and the cost of maternity medical care are treated in accordance with the relevant provisions. Chapter V Article 31 Medical services for basic health insurance are covered by targeted medical institutions and targeted retail pharmacies. Medical institutions authorized by the health administration at all levels to obtain permission to do so may be granted to the integrated area of labour security administration to apply for entry-point medical institutions and the restricted retail shops, with the approval by the relevant authorities of the medical institutions that are eligible for external services and are registered with the local health administration. The targeted medical institutions and targeted retail pharmacies have been identified by the Integrated Regional Labour Guarantee Administration, which has issued a certificate of eligibility for targeted medical institutions and targeted retail pharmacies and published to society. The targeted medical institutions and the fixed-point retail pharmacies should enter into agreements with health insurance agencies to clarify their respective rights and obligations. The targeted medical institutions and the targeted retail shop management approach are developed separately by the municipal labour security administration. Article 32 regulates the classification of targeted medical institutions, introduces a system of separate accounting for medicines, separate management systems, create competition mechanisms for medical services and the flow of medicines; manages the level of medical services, regulates medical services and improves the quality of medical services. In the case of the purchase of medicines by targeted medical institutions for medical care, targeted retail pharmacies, a medical certificate should be presented; inpatient care is required to pay a certain amount of advance payments to medical institutions for medical expenses that are subject to personal burden. The targeted medical institutions and the pharmacies should check the medical insurance certificate of the insured person. Article 344 Medical fees incurred by insured persons in targeted medical institutions, customized retail pharmacies, a portion of the personal burden, medical institutions and retail pharmacies should be charged to the insured person, and the medical agencies and retail pharmacies should be accounted for in real terms. Article XV Medical establishments, customary retail pharmacies should communicate the medical insurance agencies in a timely manner with material such as a medical cost settlement and a costly checklist. Medical fees should be reviewed in accordance with the coverage of payments under basic health insurance and the payment criteria, and the remaining medical fees are allocated to medical institutions and retail medicine stores after deduction of medical fees that are not in compliance with the prescribed medical expenses. The health insurance cost-recovery approach was developed by the various integrated regional labour security administrations with the relevant sectors. Article XVI provides for medical expenses incurred by the Participating in medical treatment outside the integrated district-based medical institution, with personal mattress payments, to be settled by a user unit or individual under the relevant provisions. Chapter VI Legal responsibility Article 37 consists of one of the following acts by the Medical Insurance Agency for the recovery of the health insurance fund; and the penalties imposed by the Labour Guarantee Administration in accordance with the State Department's Labour Guarantee Monitoring Regulations: (i) To conceal the total salary or the number of workers; (ii) Those suffering from severe illnesses are temporarily placed on their health insurance procedures; (iii) The use of means such as deception, the misconception of facts, the falsification of documents (contest) to the treatment of health insurance or the expenditure of the health insurance fund; (iv) Other violations of basic health insurance provisions. Article 338 is one of the following acts by the Medical Insurance Agency for the recovery of the medical insurance fund losses; fines for the violation of subparagraphs (iii), (iv) of the Labour Security Administration of more than 500 dollars; in violation of subparagraphs (i), (ii) (v) are suspended by the Labour Security Administration for the basic treatment of its health insurance for the period from 3 to 6 months, and are punished in accordance with the Labour Safety Monitoring Regulations of the State; and criminal liability is lawful: (i) The medical insurance certificate of the person for medical treatment and purchase of medicines; (ii) The use of other health insurance vouchers for medical treatment and purchase of medicines; (iii) In accordance with the conditions of the school, the medical institution was denied the institution's notice; (iv) The failure of the medical insurance voucher to proceed without delay, resulting in the loss of the health insurance fund; (v) Concept medical treatment by means such as deceasing, misconstitutional facts, false testimony (documented). During the investigation and treatment of the above-mentioned conduct by the health insurance agencies against the insured person, with the approval of the Labour Security Administration, the Medical Insurance Service may change the manner in which its health insurance costs are settled; the denial of the investigation may be suspended, and the specific approach has been developed by the executive branch of labour security in the integrated areas. Article 39 Medical establishments, targeted retail pharmacies are one of the following acts, which are incurred by the Medical Insurance Agency for the recovery of the health insurance fund and are subject to a cessation of the cost of medical insurance services for the following six months, and by the Labour Security Administration to give warning, responsibly to the suspension or removal of its qualification and to impose penalties in accordance with the Labour Safety Monitoring Regulations of the Department of State: (i) Recurrent increases in the rate of fees or increased charges, including undefined charges and medical fees not covered by the Medical Insurance Fund; (ii) The use of a registered hospital or the transfer of a patient to other medical institutions by reason of his or her imprisonment; (iii) Non-recognition or recourse to probationary means of treatment or the inclusion of medical fees for non-insecution personnel in fund expenditure; (iv) In the absence of treatment of illness, ultra pharmacies, diagnosing or inpatients, collusion of medicines, medical services projects; (v) The provision of medical insurance costs for non-scheduled medical institutions, non-sidental retail pharmacies without approval; (vi) Other violations of health insurance provisions. Article 40 is one of the following acts by the Medical Insurance Agency and its staff, whose period of time is to be changed by the Labour Security Administration, resulting in the loss of the health insurance fund, which is recovered by the labour security administration and administratively disposed of in accordance with the law; constitutes an offence punishable by law. (i) The loss of the health insurance fund resulting from a violation of the financial regulations; (ii) Removal of the standard of treatment for health insurance; (iii) No provision for the implementation of the coverage of the health insurance fund; (iv) To take advantage of its mandate and work in favour of private fraud, bribes and profitability; (v) Other violations of health insurance provisions. Any unit of article 40, the personal misappropriation of the health insurance fund shall be recovered; the confiscation of proceeds of the offence is incorporated into the health insurance fund and the administrative disposition of the person directly responsible, in accordance with the law; and the criminal responsibility of the law. Article 42 provides appropriate incentives for units and individuals reporting on the treatment of medical insurance or for the receipt of the expenses of the health insurance fund, which are separate from the same financial sector, with specific incentives being developed separately. Chapter VII Article 43 thirteenth rates and treatment standards for basic health insurance require adjustments based on the balance of income and expenditure of the Fund for Economic and Social Affairs, to be determined by the Government of the Integrated Region. Article 44 quantifications for health insurance institutions, approved by the Government of the Integrated Region, are included in the financial budget and are financed by the same-level finance. Article 42 Medical expenses incurred by the insured person prior to the enjoyment of the basic health insurance are processed by the source. The medical costs resulting from sudden-onset diseases or non-resistance factors have resulted in a wide range of acute risky patients, which are coordinated by the integrated people's governments. Article 46 flexibilities in the towns referred to in this Article refer to persons who have non-agricultural origin in the city and who have participated in the old-age insurance of the worker, in a flexible form of employment or self-employment, such as full-time, temporary, etc. The external workers referred to in this provision refer to non-nationals who have established labour relations within the age of labour under the State. Article 47 provides for external workers in units and those who participate in the lower-standard old-age insurance for their workers, and for unemployed persons, flexibilities in the town, to participate separately in the hospitalization health insurance scheme. Article 48 states that the year referred to in this Article is 1 May to 30 April. Article 49 provides that the average wage of the worker is based on the data published by the Ministry of Statistics. Article 50 The provisional provision on basic health insurance for workers in the city of Nimbo, issued by the Government of the people on 30 May 2003, was also repealed. |
