Beijing Municipal People's Government On The Amendment Of The Decision Of The Regulations On The Basic Medical Insurance In Beijing

Original Language Title: 北京市人民政府关于修改《北京市基本医疗保险规定》的决定

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.
(On November 25, 2003 Beijing City Government 17th times Executive Conference considered through on December 1, 2003 Beijing City Government makes 141th, announced) City Government decided on Beijing city basic medical insurance provides for following modified: 40th article first paragraph subsection (ii) items modified for: "retired personnel in a annual within outpatient, and emergency medical with cumulative over 1300 Yuan of part, discontent 70 age of retired personnel, large medical with mutual funds paid 70%, Personal payment 30%; retirees aged 70, large medical expenses assistance funds to cover 80%, personal payment 20%. "One paragraph is added as a second paragraph:" the big medical expense assistance funding to pay standards, pay scale, when high limit needs to be adjusted, by the administrative departments of labor security in conjunction with the Municipal Finance Department, submitted to the municipal people's Government. "This decision shall enter into force on January 1, 2004.

    On February 20, 2001, basic medical insurance, issued by the Beijing Municipal People's Government regulations in accordance with this decision revised and republished.
    Appendix: basic medical insurance in Beijing (revised 2003) (68th order issued on February 20, 2001, the Beijing Municipal People's Government on December 1, 2003, Beijing Municipal People's Government, the 141th modified) contents chapter I General provisions chapter II chapter III of the basic medical insurance fund basic medical insurance individual account the fourth chapter of basic medical insurance treatment fifth supplementary health insurance in the sixth chapter of medical management the seventh chapter organization, management and supervision
    Eighth chapter legal liability the Nineth chapter by-laws chapter I General provisions article in order to protect employees and retirees of basic medical care when they fall sick, health insurance benefits, according to the relevant regulations of the State, considering the actual situation in the city, these provisions are formulated.
    Second town within the administrative area of the city for all employers, including enterprises, Government organs, institutions, social organizations, private non-enterprise units (hereinafter referred to as the employer) and its employees and retirees to apply this provision.
    Employers and workers and retirees participating in basic medical insurance of time by the municipal labor and social security administrative departments (hereinafter the municipal labor and social security administration departments).
    Third municipal labor and social security administrative departments in charge of the city health insurance work, organizing and implementing medical insurance system, is responsible for the management and supervision of medical insurance.
    District and county administrative departments of labor security in charge of the administrative areas of medical insurance management and supervision and inspection.
    The municipal, district and county administrative departments of labor security established by the social insurance agency, handling insurance. Implemented article basic medical insurance premiums employers and employees both principle and common payment, the city's overall burden. The basic medical insurance fund to implement the principle of combining social pool and personal accounts.
    Basic medical insurance protection level with the social productivity development as well as financial, Enterprise and personal affordability.
    The fifth article of the city on the basis of basic medical insurance, establishment of high medical cost assistance system, the implementation of civil service medical subsidies, companies and institutions can establish supplementary medical insurance to encourage employers and individuals to participate in the commercial health insurance.
    Sixth article combined with the establishment of a basic medical insurance system, and actively promoting the reform of medical care system in town, with lower costs, provide better medical services for workers and retirees, the need to meet the people's basic medical services.
    Chapter seventh basic medical insurance funds of basic medical insurance funds should be to achieve a balanced budget.
    Article the basic medical insurance fund consists of the following components: (a) basic medical insurance premiums paid by employer, (ii) workers ' basic medical insurance premiums paid by individuals, (iii) interest on basic medical insurance premiums (iv) late payment of basic medical insurance premiums (v) other funds covered by basic medical insurance fund in accordance with law. Ninth basic medical insurance premiums paid by employers and employees together. Employers and workers ' basic medical insurance premiums shall be paid in full and on time.
    Not paid in full and on time, regardless of the personal account, the basic medical insurance does not pay their medical expenses.
    Tenth article by himself on a full 2% of the average pay of workers basic medical insurance premiums.
    Worker himself previous years average salary is lower than the city's average monthly wage of employees 60% for the previous year, 60% monthly wage of staff and workers, not more than one year base salary, pay medical insurance premiums.
    Himself previous years higher than the average wage of workers for a year more than the city's average monthly wage of employees 300% parts, not as a salary base, non-payment of basic medical insurance premiums.
    Unable to determine himself previous year average wage of staff and workers, not more than one year of the workers ' monthly salaries to pay the wage base to pay basic medical insurance premiums.
    11th before the implementation of these provisions has been retirees don't pay basic medical insurance premiums.
    After these provisions are implemented to work today to pay basic medical insurance premiums men under 25 years, women 20 years of age, in accordance with the national provisions of the retirement procedures, receiving a monthly pension or pension officer, enjoy basic medical insurance benefits for retirees, stopped paying the basic medical insurance premiums. Retired after going to work prior to the implementation of the purposes of these provisions, payment of basic medical insurance premiums of less than prescribed in the preceding paragraph, of which I am a one-time supplement should be determined by the employing units and after the basic medical insurance premiums paid by individuals, enjoy basic medical insurance benefits for retirees, stopped paying the basic medical insurance premiums.
    Designated by the administrative departments of labor security, employee's uninterrupted service or work experience in accordance with the national provisions, considered as basic medical insurance payment period.
    12th employers and workers pay wage base and 9% to pay basic medical insurance premiums.
    13th when basic medical insurance payment ratio needs to be adjusted by the municipal labor and social security administration departments, financial departments, and submitted to the municipal people's Government.
    14th the employer should be on time to the social insurance agency truthfully a year on the average wage of workers, social insurance agencies approved pursuant to the provisions of basic medical insurance payment wage base.
    15th basic medical insurance premiums paid by an employer should, commissioned by the social insurance agency the employer's Bank "authorizes the Bank to collect (without payment)" settlement on a monthly deduction.
    Employee basic medical insurance premiums payable, the employer withheld from wages paid by the month.
    Basic medical insurance fund the city's 16th overall, management at different levels, all of the social security fund accounts, the two lines of income and expenditure management.
    Basic medical insurance funds to be earmarked, not diverted or misappropriated, must not be used to balance the budget.
    The 17th year to raise part of the basic medical insurance fund, according to the bank deposits carry interest at a rate; the previous year's carry-over funds and repay the lump-sum deposit at 3-month interest rate; settling funds on deposit in accounts of the Social Security Fund, compared with 3-year installment savings deposits carry interest at a rate not below the grade level of interest rates.
    18th basic medical insurance fund implementation of the unified social security budget system, accounting and internal audit systems.
    19th chapter III basic medical insurance individual account social insurance agencies shall provide employees and retirees to establish basic medical insurance individual account (hereinafter referred to as personal account).
    20th personal account consists of the following components: (a) the workers ' basic medical insurance premiums paid by individuals, (ii) in accordance with the provisions included in the personal account of the basic medical insurance premiums paid by employers and (iii) personal accounts interest on deposit; (d) into the personal accounts of other funds in accordance with law.
    21st article employing units paid of basic medical premium of part according to following standard designated into personal account: (a) discontent 35 age of workers by I months payment wage base of 0.8% designated into personal account; (ii) 35 age above discontent 45 age of workers by I months payment wage base of 1% designated into personal account; (three) 45 age above of workers by I months payment wage base of 2% designated into personal account;
    (D) age of 70 per cent in the previous year of retired persons 4.3% of the workers ' monthly salary into personal accounts; (v) pensioners aged 70 per cent in the previous year 4.8% of the workers ' monthly salary into personal accounts.
    22nd personal account amounts refer to residents of bank deposits carry interest at a rate per year.
    23rd personal account of principal and interest for the individual, can only be used for basic medical insurance, but can be carried forward for use and inheritance.
    Death for workers and retirees whose personal accounts stored into personal accounts of their heirs; heirs not participating in basic medical insurance, personal account deposit can be paid to heirs without heirs, basic medical insurance fund for deposit into personal account. 24th the unemployed not to pay basic medical insurance premiums, personal accounts stopped into account, balances continue to be used.
    The unemployed during the period of receiving unemployment insurance compensation, in accordance with the unemployment insurance under Medicaid benefits.
    25th personnel participating in basic medical insurance in the insurance area, counties within the flow, the only basic medical insurance relationship transfer and not to transfer personal account deposit; area across districts, counties or across and manpower flow, the basic medical insurance relationship transfer and transfer individuals account deposit. Fourth chapter of basic medical insurance treatment 26th basic medical insurance funds and personal accounts delineation of the scope of the respective payment, accounting, not crowding out each other.
    Meets the basic scope of the health insurance fund to pay medical expenses by basic medical insurance funds and personal accounts have to pay.
    27th basic medical insurance fund workers and retirees to pay health-care costs, shall comply with the provisions of this city basic medical insurance drug list, medical directories and services scope of the project and pay standards.
    Diagnosis and treatment of basic medical insurance drug list, project directory and scope of medical services and payment of specific measures formulated by the municipal labor and social security administration departments, in conjunction with relevant departments separately.
    28th personal account to pay the following costs: (a) the medical expenses of outpatient, emergency, (ii) to the designated retail pharmacy drug purchase costs; (c) the funds of basic medical insurance to pay medical expenses below the standard, (iv) standard of pay above the basic medical insurance fund, in accordance with the proportion of medical costs should be borne by the individual.
    Personal account is not enough to pay for part of which I pay.
    29th basic medical insurance funds pay the following costs: (a) the medical cost of hospitalization, (ii) concept and emergency hospital treatment of income, within view of their hospital stay before 7th medical costs, (iii) radiation and chemical therapy of malignant tumors, kidney dialysis and kidney transplant anti-rejection medicine outpatient medical costs.
    30th article basic medical insurance fund not paid following medical with: (a) in non-I Sentinel medical institutions visits of, but emergency except; (ii) in non-Sentinel retail pharmacy purchased drug of; (three) for traffic accident, and medical accident or other accident caused hurt of; (four) for I drug, and fight fights or for other violations caused hurt of; (five) for suicide, and self-mutilation, and alcohol, reasons for treatment of; (six) in abroad or Hong Kong, and Macau S.A.R. and Taiwan treatment of;
    (VII) in accordance with the State and this municipality should be paid by individuals. 31st enterprise employees for work-related injuries and occupational diseases medical expenses, in accordance with the relevant provisions of the workers ' compensation insurance.
    Women reproductive health-care costs, in accordance with the relevant provisions of the State and this municipality. 32nd basic standard of pay paid by the health insurance fund by the previous annual average wage of staff and workers in the city of 10% is set at about.
    In a year in medical expenses for the second and subsequent hospitalization, pay standards for basic medical insurance fund according to the previous annual average wage of staff and workers in the city of 5% is set at about.
    Article 33rd in the basic medical insurance fund in a fiscal year to pay employee and retiree medical expenses total maximum limit in previous years about 4 times times the city's average wage of staff and OK.
    34th basic medical insurance fund pay standards and maximum payment limit needs to be adjusted when, by the administrative departments of labor security in conjunction with the Municipal Finance Department, reported to the municipal people's Government for approval, issued by the administrative departments of labor security.
    35th set for basic medical insurance fund to pay for the settlement period.
    Settlement period hospitalization time for employees and retirees, radiotherapy and chemical therapy of malignant tumors, kidney dialysis and kidney transplant anti-rejection medicine outpatient treatment settings. 36th article in a settlement period within workers and retired personnel occurred of medical costs, by hospital grade and costs amounts take segment calculation, and cumulative paid of approach, by basic medical insurance and manpower Fund and personal according to following proportion share: (a) in three level hospital occurred of medical with: 1. up pay standard to 10,000 yuan of part, and manpower Fund paid 80%, workers paid 20%; 2. over 10,000 yuan to 30,000 yuan of part, and manpower Fund paid 85%, workers paid 15%; 3.
    Part of the more than 30,000 to 40,000 yuan, and fund 90%, 10% employees; 4. portion of more than 40,000 yuan, funds pay 95% employees 5%.
    (Ii) in II level hospital occurred of medical with: 1. up pay standard to 10,000 yuan of part, and manpower Fund paid 82%, workers paid 18%; 2. over 10,000 yuan to 30,000 yuan of part, and manpower Fund paid 87%, workers paid 13%; 3. over 30,000 yuan to 40,000 yuan of part, and manpower Fund paid 92%, workers paid 8%; 4. over 40,000 yuan of part, and manpower Fund paid 97%, workers paid 3%.
    (Three) in a level hospital and family bed occurred of medical with: 1. up pay standard to 10,000 yuan of part, and manpower Fund paid 85%, workers paid 15%; 2. over 10,000 yuan to 30,000 yuan of part, and manpower Fund paid 90%, workers paid 10%; 3. over 30,000 yuan to 40,000 yuan of part, and manpower Fund paid 95%, workers paid 5%; 4. over 40,000 yuan of part, and manpower Fund paid 97%, workers paid 3%.
    (D) the proportion of retirees pay scale for employees of 60%.
    But the basic medical insurance fund according to the proportion of the maximum amount paid shall not exceed the maximum limit stipulated in this article 33rd. Fifth supplementary health insurance in the 37th chapter establishment of high medical cost assistance system. Large medical expenses assistance funds prorated for employees and retirees in a year in more than a certain amount of outpatient, emergency medical costs and exceed the payment limits of basic medical insurance funds (excluding payment standards and personal burdens of the following part) of medical costs.
    The basic medical insurance for employers and their workers and retirees should take part in large medical expenses assistance, but civil servants medical subsidies for employers and their workers and retirees, except.
    Large medical expenses assistance formulated by the municipal labor and social security administration departments, financial departments. Article 38th of large medical expenses assistance funds jointly paid by employers and individuals. Employers and workers pay 1% pay of salary base, by 3 Yuan per month pay for workers and retirees.
    Large medical expenses assistance funds to pay basic medical insurance premiums each month when I pay.
    When the large mutual funds to pay medical costs, the financial suitable subsidies.
    Large medical expenses when mutual fund fees, payment amount needs to be adjusted by the municipal labor and social security administration departments, financial departments, and submitted to the municipal people's Government.
    39th large medical expenses assistance funds and manpower in the city, separate accounts, accounts of the Social Security Fund, in accordance with the basic medical insurance fund for interest calculation interest.
    Large medical expenses assistance financed by the social insurance agency is responsible for the standardized collection, management and use.
    40th big medical expense assistance funding to meet the requirements of basic medical insurance for large medical expenses in accordance with the following payments: (I) workers in a year in outpatient, emergency medical expenses more than 2000 of their large medical expenses assistance funds to cover 50%, personal payment 50%.
    (B) retirees a year in outpatient, emergency portion of medical expenses more than 1300 Yuan, retirees under the age of 70 years, large medical expenses assistance funds to cover 70%, personal payment 30%; retirees aged 70, large medical expenses assistance funds to cover 80%, personal payment 20%.
    (C) large medical expenses of mutual funds in an annual payment over employees and retirees of outpatient, emergency medical expenses maximum amount of 20,000 yuan. (D) employees and retirees in a given year exceed the limit of funds of basic medical insurance (excluding payment standards and personal burdens of the following part) hospitalization costs, radiotherapy and chemical therapy of malignant tumors, kidney dialysis and kidney transplant anti-rejection medicine outpatient medical costs, large medical expenses assistance funds to cover 70%, personal payment 30%.
    But large medical expenses of mutual funds in a cumulative maximum amount is 100,000 Yuan within one year.
    Large medical expenses mutual funds pay standards, pay scale, when high limit needs to be adjusted, by the administrative departments of labor security in conjunction with the Municipal Finance Department, submitted to the municipal people's Government. 41st participating in basic medical insurance of enterprises and public institutions may establish supplementary medical insurance.
    Enterprise complementary medical insurance in the total wages for employees of enterprises within 4% of the part, included in the cost.
    Supplementary health insurance schemes formulated by the administrative departments of labor security in conjunction with the municipal finance department.
    42nd civil servants participating in basic medical insurance system on the basis of article, enjoy the benefits of Medicaid, and, together with the municipal labor and social security administration departments, specific measures for the financial sector, submitted to the municipal people's Government for approval before implementation.
    Article 43rd for the enjoyment of family minimum living guarantee for urban residents in the city's workers and retirees, on the personal burden of medical expenses and provide for their care.
    The city's established poverty medical aid, departments concerned should take measures to raise funds to solve personnel difficulties due to medical spending is too large. The 44th article of the sixth chapter of medical management, medical healthcare system. According to "the nearest doctor, ease of management" principle, workers and retirees can choose 3 to 5 designated medical institutions, by the unit, after reported to the unit area, County social insurance agencies, established by the social insurance agency and manpower.
    Designated agencies and specialist medical care fixed-point medical institutions of traditional Chinese medicine for all insured employees and retired personnel to designated medical institutions.
    Sick employees and retirees, according to require health insurance vouchers to designated medical institutions for treatment, can also be issued by the designated medical institutions by the attending doctor's prescription to the designated retail pharmacy to buy drugs. 45th point willing to take basic medical insurance services medical institutions and retail pharmacies, you can apply to the administrative departments of labor security, meet the requirements by the municipal labor and social security administration identified as designated medical institutions and appointed retail drugstores, issuance of certificates, and to the public.
    Achieve targeted qualification and are identified as designated medical institutions, appointed retail drugstores, signed an agreement with the social insurance agency.
    Designated medical institutions, the management of appointed retail drugstores and by the administrative departments of labor security in conjunction with the municipal finance, health, traditional Chinese medicine practitioners and drug supervision departments. Article 46th authorities contracted medical institutions and dynamic management of appointed retail drugstores.
    Designated medical institutions, appointed retail drugstores to strictly implement national and municipal policies and standards for a set price, implementing relevant provisions of the basic medical insurance system, adapted to the establishment and management of basic medical insurance system.
    47th medical institutions should set up specialized agencies or to set up a full-time staff responsible for the specific work of the basic medical insurance, strictly implement the State and the municipality of regulations and standards relating to medical services, development and implementation of routine diagnosis and treatment of common diseases, establishing criteria for evaluating the quality of medical benefits, provide basic health insurance outpatient, emergency, hospitalization, and disease-specific and other relevant information.
    48th appointed retail drugstores should be equipped with staff responsible for the specific work of the basic medical insurance, comply with the provisions of the State and the municipality on management, establishment of a pharmaceutical quality assurance system, so for the drug is safe and effective. 49th outpatient, emergency medical expenses and hospitalization expenses paid by the individual parts, as well as fixed-point retail pharmacy drug purchase costs from the individual settlement directly with the designated medical institution, appointed retail drugstores; funds of basic medical insurance to pay medical expenses, after review by the social insurance agency and designated medical institutions for settlement.
    Specific measures by the administrative departments of labor security in conjunction with the municipal finance, the health sector separately. 50th article reform of the urban medical service system, vigorously develop community health services to facilitate people hospitalized. By introducing a competitive mechanism, inhibit the growth of medical costs, and reduce the burden on people and society.
    Establishment of a new system of classified management of medical institutions, carry out separate accounting and expenditure on medical management and centralized drug tender procurement system, strengthen supervision of the prices of medical services and medicines.
    Seventh chapter organization, management and supervision of the 51st article of the municipal medical insurance administration, fund management and transaction handling management system.
    52nd article labor guarantees administrative sector of duties is: (a) implementation medical insurance of legal, and regulations and about provides; (ii) organization implementation medical insurance system; (three) research developed medical insurance of policy and development planning; (four) guide social insurance handling institutions of work; (five) supervision check medical premium of levy paid and medical insurance fund of paid; (six) supervision check Sentinel medical institutions, and Sentinel retail pharmacy implementation basic medical insurance provides of situation. 53rd article social security handling institutions of duties is: (a) according to provides is responsible for medical premium of collection and medical insurance fund of paid and management; (ii) prepared medical insurance fund budget, and accounts; (three) according to provides established and management basic medical insurance personal account; (four) according to provides and Sentinel medical institutions, and Sentinel retail pharmacy signed agreement, audit paid medical insurance costs, on Sentinel medical institutions, and Sentinel retail pharmacy of medical insurance work for Guide; (five) provides medical insurance query, and
    Advisory services, (vi) other functions stipulated in the State and this municipality.
    54th requirements for social insurance agencies, included in the budget, by the financial allocation.
    55th labor and social security, health, traditional Chinese medicine practitioners, drug, price and other administrative departments should strengthen the designated medical institutions, the management, supervision and inspection of appointed retail drugstores.
    56th financial and auditing departments shall be responsible for the health insurance fund of the social insurance agencies and monitor the management.
    57th social security Supervisory Committee in accordance with the relevant provisions of article is responsible for overseeing relevant laws and regulations and the implementation of policies and management of the health insurance fund.
    58th eighth chapter legal liability the employer not complying the provisions to pay basic medical insurance premiums or large medical expenses of mutual funds, which failed to comply with the requirements of the basic medical insurance fund into personal accounts, not covered by the medical insurance benefits for employees and retirees, the employer shall compensate for the resulting losses for workers and retirees.
    59th article employing units not according to provides paid basic medical premium or not according to provides declared basic medical insurance payment wage base, led basic medical premium leak paid, and less paid, or not according to provides generation buckle generation paid basic medical premium of, by labor guarantees administrative sector ordered deadline paid; late still not paid of, except Fill paid owes paid amounts outside, from owes paid of day up, by day added received 2 per thousand of late fees.
    60th an employer does not comply with the requirements to participate in the basic medical insurance and basic medical insurance premiums paid, the administrative departments of labor security in accordance with the provisions of the State Council provisional regulations on collection and payment of social insurance for punishment.
    Article 61st of defrauding Medicare, the social insurance agency is responsible for the recovery and the administrative departments of labor security fined 1000 Yuan fine.
    62nd article Sentinel medical institutions has following behavior one of, caused medical insurance fund loss of, should compensation loss, and can by labor guarantees administrative sector sentenced 5000 Yuan above 20,000 yuan following of fine; plot serious of, canceled its Sentinel medical institutions qualification: (a) will not participate in medical insurance personnel of medical costs by basic medical insurance and manpower Fund or large medical with mutual funds paid of;
    (Ii) will should by personal burden of medical costs by basic medical insurance and manpower Fund or large medical with mutual funds paid of; (three) will non-emergency, and rescue patients of costs included emergency, and rescue project paid of; (four) will not meet hospital standard of patients for hospital treatment, or deliberately extended patients hospital time, or titular hospital, and false records of; (five) misappropriated others personal account of; (six) fraud, and replacement drug of; (seven) take other means cheat medical insurance of.
    63rd appointed retail drugstores have one of the following acts, the administrative departments of labor security fined 1000 Yuan and 20,000 yuan fine; the circumstances are serious, canceled its appointed retail drugstores qualifications: (a) do not follow the outside sell prescription drugs; (b) not in accordance with the external dose dispensing prescriptions; (c) outside of prescription drugs into other articles.
    64th designated medical institutions, appointed retail drugstores under medical care, medicines, price regulations, labor and social security administrative departments should ask the relevant departments to address serious, cancel the targeted qualifications.
    The 65th who violate health insurance provisions of the social insurance agency, resulting in loss of medical insurance fund, the labor Security Administration Department be ordered to recover; the circumstances are serious, shall be given administrative sanctions.
    66th social insurance agency's staff failed to perform their duties, does not pay for health insurance benefits pursuant to the provisions of, the administrative departments of labor security to criticize it and ordered to correct causing serious consequences, shall be given administrative sanctions.
    67th labor and social security administration, social insurance agencies of personnel who abuse their power, malpractice, negligence, loss of health insurance fund, the labor security administration departments to recover the loss of health insurance fund constitutes a crime, criminal responsibility shall be investigated according to law; do not constitute a crime, administrative sanctions according to law.
    68th unit or individual diversion of medical insurance fund, in accordance with State Council 28th article of the interim regulations on the collection and payment of social security provisions. Nineth chapter supplementary articles article 69th retired personnel, army, second class b unchanged above disabled revolutionary medical treatment, medical expenses according to the original funding channels.
    Specific measures formulated by the municipal labor and social security administration departments, in conjunction with relevant departments, and submitted to the municipal people's Government.
    70th urban self-employed and employees in the light of the regulations.
                                                                                71st these provisions come into force on April 1, 2001.

Related Laws