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(Summit No. 141 of the Beijing People's Government Order of 25 November 2003) The Government of the city decides to amend the basic health insurance provisions in Beijing as follows: Article 40, paragraph 1 (b), was amended to read: “A retired person has paid 80 per cent of the total medical expenses for a year-old diagnosis, emergency medical expenses for more than 1,300 dollars, retired under the age of 70, 70 years of age, 70 per cent for mutual medical expenses, 30 per cent for a person, and 80 per cent for retirees above 70 years of age, and 20 per cent for individuals”. In addition, paragraph 2 reads as follows: “The payment criteria for mutual assistance for medical expenses, the proportion of payments, the maximum payment thresholds are adjusted, and the executive branch of the city's labour guarantees submits to the city's financial sector for approval by the Government.” This decision has been implemented effective 1 January 2004. The Basic Health Insurance provisions of the Beijing Municipalities, enacted by the Government of the people on 20 February 2001, were released in accordance with this decision. Annex: Basic health insurance provisions in Beijing City (Amendments of 2003) (Act No. 68 of the Government of the People of Beijing, 20 February 2001 and amended by Order No. 141 of the Beijing People's Government of 1 December 2003) Contents Chapter I General Chapter II Basic Medical Insurance Fund Chapter III Individual accounts for basic health insurance Chapter IV Basic health insurance treatment Supplementary health insurance Chapter VI Medical management Organizational management and oversight Chapter VIII Legal responsibility Chapter IX Chapter I General Article 1, in order to ensure that workers and retirees receive basic medical care and receive health insurance treatment, establishes this provision in line with the relevant provisions of the State. Article II applies to all units of the town within the city's administration, including businesses, agencies, business units, social groups, non-commercial units (hereinafter referred to as a user unit) and their employees and retirees. Specific time for the participation of the user units and their employees and retirees in the basic health insurance is provided by the municipal labour and social security administration (hereinafter referred to as the municipal labour security administration). Article 3 Labour guarantees the executive heads of the city-wide health insurance system by organizing a health insurance system responsible for the management and supervision of health insurance work. The district, district labour security administration is responsible for the management and supervision of health insurance in the current administration. Social insurance institutions established by the municipal and district, district labour security administrations are specifically administered with health insurance. Article IV Basic health insurance costs are subject to the burden of both the user unit and the individual worker, the principle of joint payment and integration throughout the city. The basic health insurance fund is guided by the principles of social integration and personal accounts. The level of safeguards for basic health insurance should be tailored to the level of social productivity development in the city and the affordability of financial, user units and individuals. Article 5 Article 6, in conjunction with the establishment of the basic health insurance system, actively promotes the reform of the urban medicine system and provides more costly medical services for workers and retirees to meet the needs of the general population for basic health services. Chapter II Basic Medical Insurance Fund Article 7. The basic health insurance fund shall be paid and the balance of payments. Article 8 (i) Basic medical insurance fees paid by a person's unit; (ii) Basic health insurance payments paid by the individual worker; (iii) Interest on basic health insurance fees; (iv) Flags for basic health insurance fees; (v) Other funds included in the Basic Health Insurance Fund under the law. Article 9. Basic health insurance expenses are paid jointly by the user unit and the individual worker. The user unit and the worker shall pay the basic medical insurance expenses in full. Unless paid in full on time, no individual accounts are paid, the Integrated Fund for Basic Health Insurance does not pay its medical expenses. Article 10 Employers pay basic health insurance fees by 2 per cent of their average monthly salary. The average monthly salary of the employee was 60 per cent lower than the previous year's average monthly salary, and 60 per cent of the average monthly salary of the employees in the current city was paid at the pay base for the payment of basic health insurance. The average monthly salary of the employee was higher than that of the previous year's average monthly salary of more than 30 per cent of the previous year's employees, without paying the basic health insurance fee as a pay base. It was not possible to determine the average monthly salary of the employee himself for the previous year, and the average monthly salary of the employee for the previous year had been paid to the basic health insurance. Article 11 provides that persons who have been retired prior to the operation of this provision do not pay basic medical insurance expenses. After the operation of this provision, a cumulative payment of basic health insurance expenses was 25 years for males and 20 years for women, and, according to the State's provisions, the retirement process was held to receive basic pension or retirement expenses for the benefit of the basic health insurance treatment of retirees and no payment of basic medical insurance expenses. The provision provides for retirement prior to the operation and pays the basic medical insurance fee for a period not exceeding the previous period, and a one-time supplement shall be paid by the user's unit and the individual after the payment of the basic medical insurance expenses. According to the Labour Safety Administration, the continuing working age of the employee or the duration of the work is in accordance with the State's provisions, depending on the date of the contribution to the basic health insurance. Article 12 Article 13. The proportion of payments for basic health insurance payments needs to be adjusted by the municipal labour security administration and the municipal financial sector, which is approved by the Government. Article 14. Article 15. The basic medical insurance fees to be paid by the user unit shall be paid by the start-up bank, which is entrusted by the social insurance agencies, in the form of the payment “to entrust the bank receipt (no payment period). Employers shall pay their basic health insurance expenses, which shall be paid by the user's unit from their own salary in the month. Article 16 provides for the integration of the basic health insurance fund across the city, the management of sub-sectors, the full incorporation of the financial exclusives of the social security fund and the introduction of two line managements. The basic health insurance fund shall not be excluded or misappropriated or shall not be used to balance income and expenditure. The basic health insurance fund, which was raised in the year, is paid at the bank's life-saving interest rate; the last year's reproduced funds have been relocated to the bank deposit interest rate for three months; the deposit fund deposited with the financial special occupants of the Social Security Fund, which is not at the level of interest in the file. Article 18 of the Basic Health Insurance Fund implements a unified social insurance predetermined system, the financial accounting system and the internal audit system. Chapter III Individual accounts for basic health insurance Article 19 The Social Insurance Service should establish a personal account for basic health insurance for workers and retirees (hereinafter referred to as a personal account). Article 20 (i) Basic medical insurance payments paid by the individual worker; (ii) The payment of basic medical insurance fees to the user units designated to the individual accounts in accordance with the provisions; (iii) Interests stored in the personal accounts; (iv) Other funds included in the personal accounts in accordance with the law. Part of the basic medical insurance expenses paid by a person's unit is classified in the personal accounts according to the following criteria: (i) Employees under 35 years of age who have been sentenced to a personal account by 0.8 per cent of their monthly salary base; (ii) A worker who is less than 45 years of age than 35 years of age is transferred to a personal account by 1 per cent of the monthly salary base; (iii) Employers aged 45 years and above are transferred to the personal accounts by 2 per cent of the monthly salary base; (iv) Retires under the age of 70 years are classified into the personal accounts by 4.3 per cent of the average monthly salary of employees in the previous year; (v) Retirements over 70 years of age are transferred to the personal accounts by 4.8 per cent of the average monthly salary of employees in the previous year. Article 2 Article 23. The principal and interest of the individual account is owned by the individual and only for basic health insurance, but may be transferred and inherited. When workers and retirees die, their personal accounts are stored in the personal accounts of their successors; the successors do not participate in the basic health insurance, and the personal accounts are stored in a one-time payment to the successor; and the personal accounts are stored in the integrated health insurance fund. Article 24 does not pay basic medical insurance expenses for the unemployed, and the personal accounts are closed and the balance may continue to be used. During the receipt of unemployment insurance payments, the unemployed receive medical benefits under unemployment insurance. Article 25 Persons participating in the basic health insurance were transferred only to the basic health insurance relationship when they were involved in the movement of the protected area, where they were not transferred to the personal accounts; the transfer of basic health insurance relations in the cross-sectoral, district or cross-cutting area; and the transfer of personal accounts storage. Chapter IV Basic health insurance treatment Article 26 Integrated Funds and individual accounts for basic health insurance delineate their scope of payment, accounting separately, and cannot be convicted. Medical expenses incurred in line with the basic health insurance fund are paid separately from the Integrated Fund and the individual accounts. Article 27 pays medical expenses for workers and retirees under the Basic Medical Insurance Fund, which shall be in line with the basic medical insurance medicine directory set out in this city, the directory of the medical treatment project and the scope and payment criteria for the service facility. The directory of basic health insurance medicines, the directory of therapeutic project and the specific approach to the scope and payment of medical services are developed separately by the municipal labour security administration. Article 28 (i) Medical costs for referral and emergency medical treatment; (ii) The cost of buying medicines at the point of order; (iii) Medical costs below the standard of payment for the Integrated Fund for Basic Health Insurance; (iv) In addition to the standard of payment for the Integrated Fund for Basic Health Insurance, the proportion should be borne by the individual. Inadequate accounts are paid by themselves. Article 29 (i) Medical costs for hospitalization; (ii) Urgent medical care for retention and income inpatient treatment, with a pre-patched medical fee of 7 days; (iii) Distinguished medical treatment and chemical treatment, kidney syllabus, kidney explanatory resistants. Article 33 (i) In the case of non-sidential medical institutions, with the exception of emergency treatment; (ii) To purchase medicines at non-specified retail shops; (iii) Damage caused by traffic accidents, medical accidents or other liability accidents; (iv) Be harm caused by drug abuse, fighting or other violations; (v) Treatment for reasons such as suicide, maiming and alcohol abuse; (vi) Treatment abroad or in Hong Kong, Macao Special Administrative Region and Taiwan; (vii) Individual self-payment, in accordance with national and present municipal provisions. Article 31 Medical costs for industrial workers for injury and occupational illnesses are implemented in accordance with the relevant provisions of the insurance. Medical costs for female workers are carried out in accordance with the relevant provisions of the State and the city. The payment rate paid by the Integrated Fund for Basic Health Insurance was determined by about 10 per cent of the average salary of workers in the previous year. In the second year and subsequent hospitalizations, the standard of payment paid by the Integrated Fund for Basic Health Insurance was determined by about 5 per cent of the average salary of employees in the previous year. Article XXIII of the Integrated Fund for Basic Health Insurance establishes a maximum payment limit for medical expenses paid to workers and retirees within one year, at about 4 times the average salary of employees in the previous year. In the case of adjustments to the payment criteria and the maximum payment thresholds paid by the Integrated Health Insurance Fund, the municipal labour security administration, together with the municipal financial sector, was issued by the municipal labour security administration after the approval of the Government. Article XV of the Integrated Fund for Basic Health Insurance provides a settlement period for medical expenses. During the settlement period, inpatient care is provided by staff members and retirees, the time period for the treatment of maloxinology and chemical treatment, the kidney syllabus, the kidney transplantation, and the time period for the treatment of pharmacies. Article XVI provides for medical expenses incurred by workers and retirees during a settlement period, calculated in accordance with subparagraphs of the level and cost of the hospital, and paid by the Integrated Fund and the individuals of the Basic Medical Insurance according to the following proportion: (i) Medical costs incurred at three hospitals: An amount of €10,000 is paid by the Integrated Fund for 80 per cent and 20 per cent by workers; More than 1,000 to $30,000, the Integrated Fund paid 85 per cent and 15 per cent for workers; More than 3,000 to 40,000 dollars, the Integrated Fund paid 90 per cent and 10 per cent for workers; More than 40,000 dollars, the Integrated Fund paid 95 per cent and 5 per cent for workers. (ii) Medical costs incurred at secondary hospitals: In part of the payment standard to US$ 1 million, the Integrated Fund paid 82 per cent and the employee paid 18 per cent; More than 1 million yen, the Integrated Fund paid 87 per cent and 13 per cent for workers; More than 3,000 to 40,000 dollars, the Integrated Fund paid 92 per cent and the workforce paid 8 per cent; More than 40,000 dollars, the Integrated Fund paid 97 per cent and the workforce paid 3 per cent. (iii) Medical costs at the level of hospitals and at the family beds: An amount of €10,000 was paid by the Integrated Fund of 85 per cent and 15 per cent by the employee; More than 1 million yen, 90 per cent of the Integrated Fund and 10 per cent for employees; More than $30,000 to $40,000, the Integrated Fund paid 95 per cent and 5 per cent for workers; More than 40,000 dollars, the Integrated Fund paid 97 per cent and the workforce paid 3 per cent. (iv) The proportion of payments paid by a retired person is 60 per cent of the proportion of employees. However, the maximum amount paid by the Integrated Fund for Basic Health Insurance shall not exceed the maximum payment limit set out in article 33 of this provision. Supplementary health insurance Article 37 establishes a system of mutual assistance for major medical costs. Funds for mutual assistance in the amount of medical expenses are paid in proportion to the medical costs incurred by workers and retirees in a given year in excess of a certain amount, emergency medical expenses and the maximum payment limits for the Integrated Fund for Basic Health Insurance (subject to payment criteria and part of the personal burden). The user units and their employees and retirees participating in the basic health insurance should participate in the mutual assistance of the major medical costs, except for the use of the National Civil Service Medical Benefit scheme and its employees and retirees. The Greater Medical Cost Mutual Assistance scheme was developed by the Municipal Labour Guarantee Administration with the municipal financial sector. Funds for mutual assistance for medical expenses of the thirty-eighth largest amount are paid jointly by the user units and individuals. The user unit pays the salary base and 1 per cent of the total employee's contributions, and the individual worker and retirees are paid at a monthly rate of 3,000. Funds for mutual assistance for medical expenses are paid in conjunction with the monthly payment of basic medical insurance fees. In the event of insufficient funding for mutual assistance for medical expenses, adequate financial subsidies were granted. The proportion of contributions for mutual assistance for medical costs, the amount of contributions required to be adjusted, was submitted by the Municipal Labour Guarantee Administration with the city's financial sector and approved by the Government of the city. A total of 39 large-scale funding for mutual assistance for medical costs is integrated across the city and is included in the Social Security Fund's financial specials, with interest in the basic health insurance fund. Funds for mutual assistance for medical expenses are coordinated by the Social Insurance Agency. Article 40 Funds for mutual assistance for medical expenses are paid in accordance with the following methodology: (i) Employers have paid 50 per cent of the funds for mutual assistance for medical expenses, and 50 per cent for individuals, in a given year's medical clinic and emergency medical costs. (ii) The number of retirees in a year-old diagnosis and emergency medical costs exceeds €13 million, the retirements under the age of 70 years, the payment of 70 per cent for mutual assistance for medical expenses, 30 per cent for individuals, 80 per cent for retirees aged 70 years and 20 per cent for individuals. (iii) Funds for mutual assistance for major medical costs amount to a maximum of $20,000 in the year for payment of staff and retirees, emergency medical expenses. (iv) In-patient medical expenses incurred by workers and retirees in excess of the maximum payment threshold for the Integrated Fund for Basic Health Insurance (unless paying the criteria below and the personal burden), inpatient medical fees for the treatment and chemical treatment of maloxinology, kidney morphology, kidney transplant, and veterinary veterans, and 70 per cent for mutual medical costs and 30 per cent for individuals. However, the largest amount of money for mutual assistance for medical costs has been accumulated over a year. When funds for mutual assistance for medical expenses are paid, the proportion of payments and the maximum payment thresholds need to be adjusted, the executive branch of the municipal labour security administration, together with the municipal finance sector, is approved by the Government. Article 40. Business and cause units participating in basic health insurance may establish supplementary health insurance. Complementary health insurance payments for enterprises are included in part within 4 per cent of the total salary of the enterprise worker. The supplementary health insurance scheme was developed by the municipal labour security administration with the municipal financial sector. Article 42 provides for treatment of medical assistance on the basis of participation in the basic health insurance, specifically by the Municipal Labour Guarantees Administration and the municipal financial sector, after the approval of the Government. Article 43 provides care for workers and retirees who enjoy the minimum living security of their families in the city's town. In this city, special hardship relief funds should be established, and the authorities concerned should take measures to raise funds to address the difficulties of special hardships due to the high cost of medical expenses. Chapter VI Medical management Article 44 provides for a targeted medical system. In accordance with the principle of near-term medical, user-friendly management, workers and retirees may choose to select 3 to 5 targeted medical institutions, which are summarized by the unit, are identified in the area of the reporting unit, in the district social insurance agency. The medical institutions of the Unit and the targeted medical institutions are all involved in the targeted medical institutions for all insured workers and retirees. In the case of sickness of workers and retirees, a medical insurance certificate is granted to a medical facility in his or her choice, or a medical agency with a medical clinic from a medical facility to purchase a medicine at a targeted retail shop. Article 42 is open to medical institutions and retail pharmacies that are willing to assume basic health insurance orders, which can apply to the labour security administration to meet conditions, and are determined by the municipal labour security administration as a targeted medical institution and a terminal retail pharmacies, a certificate of eligibility and a social publication. Access to targeted positions and is identified as targeted medical institutions, targeted retail pharmacies, and agreements with social insurance agencies. The management of targeted medical institutions, targeted retail pharmacies is developed by the Municipal Labour Security Administration in conjunction with sectors such as the city's finance, health, adolescent health management and drug surveillance. Article 46 related sectors are subject to dynamic management of targeted medical institutions and targeted retail pharmacies. Structural medical institutions, targeted retail pharmacies are required to strictly implement price policies and standards established by the State and the city, implement the relevant provisions of the basic health insurance system and establish an internal management system adapted to basic health insurance management. Article 47 medical institutions should establish specialized agencies or set up specialised personnel responsible for the specific work of basic health insurance, strictly enforcing regulations and standards relating to medical services in the country and in the city, develop and implement common medical treatment standards, establish comprehensive assessment standards for the quality of medical care, and provide accurate information on access to basic health insurance personnel, emergency, hospitalization and single diseases. Article 48 should be equipped with specific work on basic health insurance, compliance with national and present market-related drug management provisions, the establishment of a drug quality assurance system, which is safe and effective. Article 49 provides for medical treatment, emergency medical expenses and inpatient medical expenses, as well as for the purchase of medicines at targeted retail stores, which are directly settled by individuals and targeted medical institutions, customary retail shops; medical costs paid by the Integrated Fund for Basic Health Insurance, which are settled by social insurance agencies after clearance. Specific approaches are developed by the municipal labour security administration with the city's finance and health sector. Article 50 Reforms the urban health service system, with a strong development of community health services and accessibility to people. Through the introduction of competition mechanisms to curb the rapid growth of medical costs and reduce the burden of people and society. The establishment of a new system of classification of medical institutions, separate accounting for medicines, management and pooling of tendering procurement systems, and strengthening the regulation of medical services and pharmaceutical prices. Organizational management and oversight Article 50 provides for the administration of health insurance, the management of funds and the administration of services. Article 52 guarantees the functions of the executive branch: (i) Follow-up to the laws, regulations and related provisions of health insurance; (ii) Organizing the implementation of the health insurance system; (iii) Research on policies and development planning for health insurance; (iv) Guidance for the work of the Social Insurance Agency; (v) Supervision of payment of medical insurance payments and medical insurance funds; (vi) Monitoring of the implementation of basic health insurance provisions by targeted medical institutions, targeted retail pharmacies. Article 53 responsibilities of the Social Insurance Agency are: (i) The collection and management of health insurance funds in accordance with the provisions; (ii) The preparation of the budget and accounts of the Fund; (iii) Establish and manage the personal accounts of the basic health insurance, in accordance with the provisions; (iv) Under the terms of the agreement with the targeted medical institutions and the customized retail pharmacies, the payment of medical insurance expenses, the guidance on medical insurance for targeted medical institutions, targeted retail pharmacies; (v) Provide health insurance access, counselling services; (vi) Other responsibilities under the State and the city. Article 54 of the Social Insurance Agency's requirements are included in the financial budget and are financed by financial resources. Article 55 should strengthen the management and supervision of targeted medical institutions, targeted retail pharmacies, etc. Article 56 Financial, auditing services are governed by law with respect to payments and management of the Medical Insurance Fund of the Social Insurance Agency. In accordance with the relevant provisions, the Social Insurance Monitoring Committee oversees the implementation of laws, regulations and policies and the management of the health insurance fund. Chapter VIII Legal responsibility Article 588 does not provide for the payment of basic health insurance fees or for mutual assistance for major medical expenses, resulting in the failure of the basic health insurance fund to be converted into an individual account in accordance with the provisions and that the employee and retirees are not entitled to the treatment of the relevant health insurance and that the unit of the agent shall compensate the worker and the retirees for the resulting losses. Article 599 does not pay the basic medical insurance fee or the salary base for the release of the basic medical insurance payments under the provision of the required medical insurance, resulting in a failure to pay the basic medical insurance fee or the non-payment of the payment of the basic medical insurance expenses in accordance with the provisions, which are paid by the Labour Security Administration for a period of time; the overdue payments remain unmet, with the result that, from the date of the contributory payment, the amount of the payment has been added to the sum of the excess. Article sixtieth does not participate in the basic health insurance and pay the basic medical insurance expenses, and is punished by the Labour Security Administration in accordance with the provisions of the State Department's provisional Social Insurance Scheme. Article sixtieth deceiving medical insurance funds by social insurance agencies and may impose a fine of up to 1,000 dollars for the labour security administration. Article 62 contains one of the following acts, resulting in the loss of the health insurance fund, which should be compensated for losses and may be fined by the labour security administration for more than 50 million dollars; and, in the event of a serious abolition of the qualifications of its targeted medical institutions: (i) Medical costs for persons not participating in health insurance will be paid by the Integrated Fund for Basic Health Insurance or by the Fund for Mutual Assistance in Medical Costs; (ii) The medical costs to be borne by individuals are to be paid by the Integrated Fund for Basic Health Insurance or the Fund for Mutual Assistance in Medical Costs; (iii) The inclusion of costs for non-repatient care and for patients in emergency care and rescue projects; (iv) Inpatient treatment for patients who do not meet the standards of hospitalization or the intentional extension of the duration of the patient's hospitalization, or the place of a hospitalization and a breakthrough; (v) Transmovation of personal accounts of others; (vi) Resistance and the transfer of medicines; (vii) Other means to deceive medical insurance funds. Article 63 contains one of the following acts in the fixed-point retail pharmacies, which are fined by the Labour Security Administration for more than 1000 yen; in the case of severe circumstances, the dismissal of its fixed-point retail pharmacies: (i) No sale of medicines in accordance with the external distribution; (ii) No dose of dose in dose in dose in dose; (iii) Emissions for other items. Article 63 quantified medical institutions, customized retail pharmacies, in violation of the regulations governing medical, pharmaceutical, material and etc., should be addressed by the executive branch concerned; in the event of serious dismissal of their eligibility. Article 62XV Staff of the Social Insurance Agency violates the health insurance provisions, resulting in the loss of the health insurance fund, which is charged by the labour security administration for its recovery; in the case of serious circumstances, administrative disposition is provided by law. Article 46 staff members of the Social Insurance Agency do not carry out their duties, do not pay for the treatment of health insurance in accordance with the provisions, are criticized by the labour security administration and responsible for its transformation; and, with serious consequences, are given administrative treatment by law. Article 67 guarantees the misuse of authority, provocative fraud, sterilization and neglect of the staff of the executive branch, social insurance agencies, resulting in the loss of the health insurance fund, which is guaranteed by the labour security administration to recover the loss of the health insurance fund, which constitutes a criminal offence, and has not been a criminal offence, and has been granted administrative treatment by law. Article 68 of the Convention on the Elimination of All Forms of Discrimination against Women Chapter IX The medical treatment of persons with disabilities in the above-mentioned revolution at the end of the twenty-ninth period has been unchanged, and medical costs are addressed by the source of funds. The specific approach was developed by the municipal labour security administration with the relevant departments and was approved by the Government. Article 76 is implemented in the light of the provisions of this article by the individual business and business of the town. Article 76 of the present provision is implemented effective 1 April 2001. |
