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Guangzhou Social Medical Insurance

Original Language Title: 广州市社会医疗保险办法

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Chapter I

Article 1 establishes this approach in accordance with the Social Insurance Act of the People's Republic of China, the Social Insurance Insurance Regulations of the State of the Republic of China.

Article II applies to activities such as social health insurance coverage, services and oversight management in the city's administration.

Article 3 establishes social health insurance for workers, medical assistance for major illnesses for workers, supplementary health insurance for workers, and meets the health-care security needs at multiple levels of insured workers.

The establishment of social health insurance for rural and urban residents, and the provision of health insurance coverage to the extent of the health-care needs of the insured population.

Article IV. The implementation of social health insurance laws, regulations and related provisions; organization of social health insurance systems; research on policies, development planning and related standards for the development of social health insurance; guidance on the work of the social insurance institutions; and supervision of the implementation of social health insurance policies, regulations and regulations by the inspection units, the insured person and the social health insurance services.

The human resources and the social security administration sector are responsible for the management of social health insurance within the jurisdiction.

The Social Insurance Agency is specifically responsible for the day-to-day management and service of the social health insurance in the city within its mandate.

Sectors such as urban development reform, education, civil affairs, finance, hygienic, audit, food medicine regulation, levies, trade unions and disability should be responsible, within their respective responsibilities, for the coordinated implementation of the scheme.

Street offices, the Town People's Government, schools should assist social insurance agencies and social insurance agencies in the processing of related services related to the social health insurance for rural and urban residents of the Territory.

Chapter II Social health insurance treatment

Article 5

The unemployed persons (hereinafter referred to as unemployed) during the period of unemployment insurance payments in this city participate in the social health insurance of the employee.

Flexible employment personnel, including those who do not have a job within the age of employment, non-time practitioners who do not participate in the social health insurance of the employee and other flexible employment personnel, may participate in the social health insurance of the employee.

The following persons participated in social health insurance for rural and urban residents:

(i) In-school students at all levels of secondary schools, higher schools, secondary vocational technical schools, technic schools and scientific colleges in the current city's administration.

(ii) The urban and rural residents who do not belong to the social health insurance for their families, including minors, flexible employment, non- practitioners and older residents.

Article 7. When the mandatory retirement age is reached, the following persons whose social health insurance payments have not reached the required period of time (hereinafter referred to as the retired contributor) may continue to participate in the social health insurance of the employee:

(i) The social insurance agencies in the present city's administrative area receive retirements for the basic pension for the old-age insurance or for the benefit of the pensionable pension for the benefit of the unit of the person;

(ii) Flexibility of employed persons in the home of the worker's social health insurance;

(iii) Persons who have paid basic old-age premiums in social insurance agencies within the current municipal administration;

(iv) In line with the transfer of health insurance relations between national and provincial mobile workers, the provision may be made for the payment of social health insurance payments in the city.

The retirement of the occupants of the city, who do not pay the social health insurance fee, may participate in the social health insurance of the urban and rural residents.

Article 8. Staff members receive inpatient hospitals, the designation of single diseases, the specific patient projects, the appointment of chronic illnesses, the general clinic and the treatment of personal accounts.

The social health insurance for rural and urban residents is granted in accordance with the provisions of the hospitalization, the designation of single diseases, the specific patient projects, the appointment of chronic illnesses, the general clinic and maternity-related treatment consistent with family planning policies.

Article 9. The Integrated Fund for Social Health Insurance pays for basic hospitalization costs, which should be in line with national and provincial basic health insurance coverage, the scope of medical treatment projects, the scope of medical services facilities and the payment standards.

The Integrated Fund for Social Health Insurance pays for the designation of single illnesses, a specific patient project, the designation of chronic illnesses by the clinic, the basic medical costs of the general clinic, which should be in line with the designation of single diseases by social health insurance, the specific projects for diagnosis, the directory of the generic clinic, the directory of medicines, the directory of therapeutic projects and the relevant provisions of the social health insurance. The specific catalogue is determined separately by the urban human resources and the social security administration.

The Social Health Insurance Fund for Rural and Rural Residents pays for maternity-related treatment and should be in line with family planning policy provisions, the directory of national and provincial reproductive insurance medicines, the coverage of the medical treatment project and the relevant provisions of the social health insurance for rural and urban residents.

Article 10

(i) It should be paid from the work injury insurance fund;

(ii) Transport accidents, accidents, medical accidents, etc., should be clearly burdened by third parties;

(iii) Plans to be covered by public health, immunization, maternal and child health, first aid, blood collection and epidemics, chronic diseases and local disease prevention;

(iv) Medical care in Hong Kong, Macao Special Administrative Region and Taiwan areas, or abroad.

Medical expenses should be borne by third parties in accordance with the law, and third parties are not paid or unable to determine third parties, and are paid by the Social Health Insurance Fund. The Social Health Insurance Fund had the right to seek compensation to third parties once payments were made.

Article 11 Staff members are involved in the use of basic health insurance types of medicines, special treatment projects and special medical material, and the proportion of the individual's self-payment rate is as follows:

(i) The use of generic medicines in the scope of the basic health insurance drugs, with a proportion of 5 per cent of the individual's self-payment rate;

(ii) To use a medical treatment project in the scope of the basic health insurance treatment project to pay a portion of the costs incurred by the Fund, with an individual paying rate of 10 per cent for treatment projects, 15 per cent for inspection projects, 10 per cent for a single-cost medical material and 20 per cent for the installation of various organs and bodies.

Article 12 pays workers' social health insurance payments in full and on time, with the payment of the corresponding social health insurance benefits from the paying month.

The unemployed persons have been treated with the corresponding social health insurance scheme in the event of unemployment insurance payments.

Persons who have participated in the social health insurance of the urban and rural residents, who participated in the annual health insurance for the social health insurance of their workers, began to receive the corresponding social health insurance treatment from the employee's social health insurance payments in the month of the receipt of the social health insurance for their workers and who are no longer entitled to social health insurance treatment for rural and urban residents.

Article 13 establishes an individual account for persons participating in the social health insurance of workers. Individual accounts are classified as monthly criteria:

(i) A 2 per cent of the monthly contributions to the social health insurance for its employees for the current year;

(ii) Between 35 and 45 years of age, 3 per cent of the monthly social health insurance rate of his or her employee;

(iii) A total of 38 per cent of the monthly contribution base for the social health insurance of its employees during the year, up to 45 years until retirement (including retirement);

(iv) Approximately 41 per cent of the average monthly salary for retirees in the previous year.

Article 14. Persons participating in the social health insurance of the employee may pay the following expenses for personal accounts or their immediate family members:

(i) Medical costs incurred on medical treatment by targeted medical institutions, which are a personal burden;

(ii) Prevention of vaccinations and medical examinations in targeted medical institutions;

(iii) Costs for the purchase of medicines and medical supplies at targeted retail shops;

(iv) Social health insurance payments to be paid by individuals, supplementary health insurance payments;

(v) Other costs that are consistent with national, provincial and municipal provisions.

Article 15. Individual accounts shall not be financed by cash, or by misappropriation, which may be transferred and inherited.

After the death of the insured person, the personal accounts remain in balance after the clearance of the related medical costs, which are converted into the personal accounts of their successors or cash received by their successors on a one-time basis, and the successor has not been present within two years of the date of the death of the insured person and the balance of the personal accounts is included in the Social Health Insurance Fund.

The insured person has been working on a long-term basis for medical recognition or settlement, and the balance of the personal accounts can be earned on cash and retain its personal accounts.

The individual account balances may be transferred or cashed on the basis of information.

Article 16

The insured person has processed the registration process for the social health insurance of workers in the city by 31 December 2013 and pays by 31 January 2014, and its contribution to the social health insurance for its employees is still carried out by 10 years.

The contributory period of the basic health insurance rate for employed persons in the city's town was calculated at the time of the contribution of the employee's social health insurance.

The transfer or veterans are accommodated in the city, in accordance with the relevant provisions of the State and the province, and their military service is subject to the annual payment of social health insurance payments for workers in this city.

Article 17 reached the mandatory retirement age of the worker's social health insurance rate, which was granted by the social insurance agencies, was treated with the social health insurance of the employee who had been granted a retirement pension in accordance with the provisions of the mandatory retirement age for the following month.

The number of persons who have not reached the required period of payment for social health insurance at the time of the mandatory retirement age is in accordance with Article 7. The social health insurance treatment of workers is provided for during the payment of social health insurance expenses.

The standard of payment for each of the basic medical expenses of the insured person under article 18 is determined in accordance with the following criteria:

(i) Employers: 40 at the level of targeted medical institutions, up to 800 at the secondary level, and 1600 at three-point medical institutions;

(ii) Retirement: 280 medical institutions at the level, 560 at the secondary level and 1120 at the third level;

(iii) Inpatients pay a lump-sum standard for each inpatient inpatient hospital, with a continuing hospitalization rate of more than 90 days to repayment once;

(iv) In-patient treatment of tuberculosis at specialized hospitals, the incumbent will need to repay a payment standard for more than 180 days. As a result of the medical institutions of the Psychiatric Psychia or the designation of comprehensive medical institutions for hospitalization, no payment is required.

The basic medical costs of the social health insurance for the insured person in Article 19 are paid in proportion to the following:

(i) Employers: 90 per cent of targeted medical institutions at the level, 85 per cent for secondary-level medical institutions and 80 per cent for three-tier medical institutions;

(ii) Retirement: 93 per cent of targeted medical institutions at the level, 895 per cent for secondary-level medical institutions and 86 per cent for three-tier medical institutions.

Article 20 Staff members are covered by the Integrated Fund in accordance with the provisions for the designation of single diseases, specific projects for referral and the designation of chronic medical expenses for medical care.

Specific diseases and scope of projects, access standards, payment standards and approaches are developed separately by the urban human resources and social security administration and made available to society.

Article 21 Staff members in social health insurance are paid by the Integrated Fund in proportion to the general medical expenses incurred in connection with medical treatment, as prescribed.

In the period of inpatient treatment of illnesses, the custodians may not be treated with a general patrioritization; the custodians have access to specific projects, the patrioritization of chronic diseases, and the Integrated Fund will no longer duplicate the payment of integrated treatment for general clinics.

Specific payment standards and approaches are developed by the urban human resources and the social security administration with the financial, health-care-based administration.

Article 2 General medical treatment fees, national basic drugs and provincial supplements basic drugs are fully covered by the Integrated Fund for Social Health Insurance, which harmonizes basic drug-based pharmaceutical management.

In the health-care sector, staff members have approved the implementation of the basic drug system and the introduction of a targeted medical agency for the sale of basic drug-severance rates, the general medical fee is paid by the Integrated Fund for the Social Insurance of Employees, which is less than 70 per cent; the costs incurred in the use of basic medicines, the proportion of payments of the Fund's Social Health Insurance Fund has increased by 10 per cent on the basis of the corresponding criteria, but the highest proportion of payments to the latter fund should not exceed 95 per cent.

Article 23 provides for medical expenses within a year of medical care for workers, with a cumulative maximum payment limit of six times the average annual salary of the insured person in the previous year's current city for the year of the employee's pay.

Medical expenses incurred by members of the social health insurance in the home, after the annual payment of the Integrated Fund for the Social Health Insurance of the Employer exceeds the maximum payment limit, are paid by the Fund for Major Diseases of the employee according to the following criteria:

(i) The basic medical costs of the hospitalization, the referral of specific projects, which are paid by 95 per cent of the Fund's major illnesses;

(ii) The appointment of chronic illnesses and the general medical fee, which is paid by the Fund for the Medical Aid for Major Diseases, in accordance with the applicable standards;

(iii) Other costs that are consistent with national, provincial and municipal provisions.

Within a worker health insurance year, the employee's major sickness benefits fund paid a cumulative maximum of three times the average annual salary of the insured person for medical medical care.

Article 25 pays full-fledged workers' supplemental health insurance payments, which began to receive supplementary health insurance treatment for workers from the contributory month.

In a year of health insurance for workers, the medical expenses incurred by workers in connection with hospitalization or the treatment of specific projects are covered by the provision for medical treatment, which is the highest payment of medical expenses for individuals who are covered by the Integrated Fund for Social Health Insurance, amounting to 70 per cent of the total amount paid by the employee for supplementary medical insurance payments.

Article 26 Social health insurance for rural and urban residents, and specific treatment standards and approaches for the health insurance for the population of the urban and rural areas.

Social health insurance payments

The new user unit established in article 27 should be registered in accordance with a licence of business, registration certificate or unit of residence, within 30 days of the date of its establishment, for social health insurance payments in the designated tax sector, and for the social health insurance registration process by the Social Insurance Agency.

A person's unit shall terminate by law or change in the registration of a social health insurance, and shall, within 30 days of the date of the termination or change, proceed with the write-off or modification of registration procedures in the tax sector and the social insurance agency.

Article 28 Employees who participate in the social health insurance of their workers shall be subject to the registration of social health insurance payments by a user unit within 30 days of the date of the use of the worker's work.

Flexible Employment and Retirement Persons participating in the Social Insurance of Employers shall be subject to registration procedures for social health insurance payments in accordance with the provisions of the tax authorities.

There is a need to change access to health care or to stop participating in the social health insurance of workers, to conduct a change in registration or write-off procedure in the tax sector.

Twenty-ninth persons participating in social health insurance for rural and urban residents should be registered in accordance with the provisions of the street offices, the Government of the town or institutions.

Article 33 Social health insurance expenses for workers, major sickness benefits for workers, and supplementary health insurance expenses for workers are charged by the tax sector.

Social health insurance payments for rural and urban residents are charged by social insurance agencies.

The full payment of the social health insurance expenses of the employee shall be made in accordance with article 31 of the Acting Persons and Individuals participating in the Social Insurance of the Employees.

This approach has been followed by flexible employment workers who have participated in the basic health insurance for flexible employment workers in the town, which should take place within three months of the implementation of the scheme for changes in the social health insurance for workers or for the social health insurance of rural and urban residents; and the harmonization of changes to the social health insurance for workers.

Article 32 participates in the social health insurance of the urban and rural population, and shall be subject to payment of social insurance expenses for the residents of rural and urban areas in full accordance with the provisions of the insurance year prior to the start-up.

In the previous year, persons who participated in the social health insurance for rural and urban residents did not need to be re-registered in the new residential health insurance year, and the insurance relationship was automatically continued after the payment of the annual social health insurance rate for the new resident population.

In the year of health care for the population, urban and rural residents with the following conditions may participate in the payment during the year:

(i) The termination of the social health insurance relationship of workers;

(ii) In addition to the city's administrative region, students who attend full-time education in various schools;

(iii) Newborn babies;

(iv) Newly displaced persons;

(v) Additional medical assistance targets;

(vi) Other personnel who are required to participate in the payment of contributions during the year, subject to review by the Social Insurance Agency.

Article 33 governs the socialization of retirees administered by the district pensioner's social service administration, and the related social health insurance services are governed by the responsibilities of the retired social service administration in the area under which the retirement pension is managed.

The contribution base for article 34 employees is the monthly average of the personal income tax salary, salary income, and the contribution base for the new unit's employees is the sum of the personal income tax and salary income reported on to him in the month of the social health insurance. The average monthly salary of personal income, the average monthly salary income exceeds 30 per cent of the average monthly salary in the previous year's pensioner and exceeds the amount of the contribution base, 60 per cent below the average monthly salary of the previous year's pensioner and 60 per cent of the average monthly salary in the current city of the year.

The number of contributions from the user unit is based on the number of contributions paid by the employee of the unit.

The number of unemployed persons, flexibilities employed persons and retired persons was 60 per cent of the average monthly salary of the previous occupier.

Individuals of the third fifier shall pay their social health insurance expenses in full by 2 per cent of their contribution base. The user unit shall pay the social health insurance expenses of the employee in full in accordance with 8 per cent of its contribution base and shall pay the social health insurance expenses of the employee to which he or she shall pay.

The unemployed should be paid by the Unemployment Insurance Fund at 10 per cent of its contribution base.

Flexible employment and retired persons shall pay their social health insurance payments in full by 10 per cent of their contributions base.

In the last month of the suspension of the payment of the social health insurance for the third XVI workers, the personal accounts balance could continue.

In the absence of the provision for the participation of the worker in the social health insurance, the payment of the dues, interest and lags, the social health insurance rate of the employee is paid for the period of the payment of the social health insurance treatment of the employee, and the treatment of the social health insurance of the insured person shall be covered by the agent of the paid obligation.

In the absence of the payment of the social health insurance expenses of the employee on time from the contributory month, the insured person shall not be entitled to the treatment of the social health insurance of the employee; within three months of the date of the contributory service (from the beginning of the month of payment to the end of the month of payment to the payment of the payment, interest and lag payments shall be paid at the expense of the insured person and the payment of the social insurance shall be paid to the insured person for the period up to three months.

The individual of the insured person did not pay the social health insurance expenses of the employee on time and did not receive the payment, and the treatment of the social health insurance for the insured person should be borne by the individual with the obligation to pay.

Interests are calculated in accordance with the rate of interest rates for the resident deposit announced by the People's Bank of China at the time of payment.

(a) A total amount of contributory expenses for the social health insurance of 37 employees who have not been paid for the prescribed year; At the end of the period at which the old-age insurance payments were calculated to start the implementation of the health insurance scheme in the former independent integrated area in which they received basic pension procedures, as determined by the end of December 2005, the city's current level was as at November 2001, the area of banditry as at February 2006 and donated as at April 2003, from the area of integration as at December 2005, the area of the increase in the town area as at November 2005, the State rail (group) company as at September 2004.

Within the city's home, 50-year-old-old males, those who were employed after the unemployment of women aged 40 years and retired in the new unit, the social health insurance expenses of the employee who were paid by the individual should be funded by the specific funding reference established by the Government at all levels.

Those who have been transferred to the city by the municipal organization, human resources and the social security administration have been granted permission to accommodate the military expediencies of the city, the Ministry of Demobilization, the veterans, mediators, the FDWs and the families of the FDW, who have been transferred from different locations to the contributory period of the old-age insurance (concluding the contributory period) for the Government's funding period.

The insured person participates in government funding funds for the social health insurance of the employee, which is assumed in full by the same level of finance, in accordance with the affiliation of the insured person to the maximum number of units working within the city's administration.

Article 338 takes part in the social health insurance of workers and participates in major sickness benefits for workers.

The payment rate for major health-care benefits for workers is based on the average monthly salary for the above-year occupancy workers and 06% per person per month.

Employers' major sickness benefits are fully covered by the user unit.

In order to receive government-specific funds to fund workers' social health insurance payments, the Government's earmarked funds should be accompanied by funding for major sickness benefits for the corresponding year.

The unemployed should be paid by the Unemployment Insurance Fund for major sickness benefits for their workers.

Article 39 includes units and individuals on the basis of their participation in the social health insurance of the employee, which may participate in the supplementary health insurance. A person's unit participates in the supplementary health insurance for the worker and should be insured in full by all employees.

Employers supplement the payment rate of medical insurance payments, which is based on average monthly salary in the occupancy pay for the above-year-old workers and 05% per person per month.

Employers' supplemental health insurance fees may be fully burdened by the user unit or by the user unit, in accordance with the procedures or modalities set forth in the relevant provisions, to determine the proportion of co-sharing between the user and the individual. Employers' supplemental health insurance payments are received by the user unit, which is part of the personal burden of the employee, and by the user's unit.

Retirements who have participated in the social health insurance of workers in the city and are in line with the conditions for the treatment of the social health insurance of their workers, who should pay the supplementary health insurance fee paid by the Fund for the Medical Insurance of the Major Diseases of the Employer.

The unemployed persons participating in the supplementary health insurance should pay additional health insurance expenses for the workers in accordance with the prescribed standards and be distributed from the paid unemployment insurance.

Article 40 Social health insurance for rural and urban residents, specific funding standards and approaches for health insurance for urban and rural residents are set up separately.

Funding at all levels of government and social medical assistance should be transferred in full and on time to the Fund's funds.

Specific fiscal-sharing approaches, allocation options are developed by the municipal financial administration, in conjunction with urban human resources and social security, and by the civil administration.

Article 42 does not meet the mandatory retirement age of the insured person, whose employment is transferred from other integrated areas within the province to the city, and in accordance with the relevant provisions of the province, this city recognizes and calculates the number of contributions paid by the insured person in other integrated areas within the province and paid in full.

The social health insurance relationship has been transferred from this city to an integrated area outside the city, and the social insurance agencies should maintain their attendance information on the basis of a personal request for accreditation or the processing of social health insurance relations.

The social health insurance relationship has been transferred to the city by uniformed occupants in the province, in accordance with the relevant provisions of the State and the province.

Chapter IV Social health insurance management

Article 43

(i) Social health insurance in the city;

(ii) The payment, management and inspection of the Social Health Insurance Fund;

(iii) The preparation of the Social Health Insurance Fund for predetermined accounts and the review of the payment of social health insurance costs;

(iv) Establish and manage the personal accounts of social health insurance and manage the application of medical certificates in the area of social health insurance;

(v) A social health insurance service agreement with targeted medical institutions and a terminal retail pharmacies;

(vi) Regular supervision of the implementation of social health insurance policies, regulations and performance of service agreements for targeted medical institutions, targeted retailers, and processing in accordance with the agreement of the social health insurance-related provisions and service agreements;

(vii) Provide regular social information on the incidence of medical and pharmaceutical costs incurred by insured persons in targeted medical institutions, targeted retail pharmacies;

(viii) The management of individual rights and interests, the promotion of social health insurance policies to user units and insured persons and the provision of social health insurance access, counselling services;

(ix) Management of the application of the social health insurance information system;

(x) Other responsibilities under national, provincial and present municipalities.

Article 44

(i) Provide information on the procedures relating to social health insurance;

(ii) Payment of social health insurance payments in full and on time;

(iii) The use of social health insurance funds or personal accounts in accordance with the relevant provisions of the social health insurance, to meet medical costs in accordance with the provisions;

(iv) Compliance with the regulations governing medical institutions and retail pharmacies established by the administration;

(v) Compliance with other provisions of national, provincial and municipal social health insurance.

Article 42 holds medical institutions and retail pharmacies with effective operating documents issued by the health-care administration sector or the food drug control administration, as well as military medical institutions authorized by the military authorities for external services, which can submit applications to the urban human resources and the social security administration authorities for the assumption of the social health insurance scheme service, which are reviewed by the urban human resources and the social security administration. In line with the qualification, the Social Health Insurance Services Agreement, which was established by the Social Insurance Agency after the signing of the Social Insurance Services Agreement with the Social Insurance Agency, was made available to society by the urban human resources and the social security administration.

Medical institutions with special illnesses, treatment subjects, basic medical services such as pharmacies or retail pharmacies are determined by the urban human resources and the social security administration in the context of access to the social health insurance scheme, and signed agreements with social insurance agencies.

Article 46 quantify the following conditions:

(i) To adhere to national, provincial and present laws, regulations and standards relating to medical services and price management, with sound and improved health-care management systems;

(ii) The time frame for obtaining licences for the operation, the right to use and area of medical services, the number of physicians in the registrar;

(iii) Medical treatment subjects, sections, staffing, equipment staffing, technical level, service facilities, availability of medicines and quality and management levels are in line with the requirements of the relevant legal regulations in the health-care administration sector to meet the medical needs of social health insurance personnel;

(iv) The conditions, such as information systems, can meet the needs of social health insurance personnel for medical management and cost-saving;

(v) Medical institutions and their employees have participated in social insurance in the city as prescribed and paid social insurance in full and on time;

(vi) The heads of medical institutions and associated personnel are familiar with the provisions of social health insurance in the city and are familiar with health-care policies, regulations and regulations.

The priority should be given to the urban human resources and social security administration in order to meet the conditions of the town's health facility, community health services institutions, medical institutions of medical care, village health stations and health-care institutions.

The targeted medical institutions were dismissed by the social security agencies because of their violation by the social insurance agencies, by the dismissal of the conditionality by the urban human resources and the social security administration, and the non-declarability of the post-release position within three years.

The retail pharmacies of Article 47 should have the following conditions:

(i) To adhere to legal regulations such as drug management and price management, strictly regulating access to medicines, computer management of drug purchases, sale, stockpiling, and sound and sound drug quality assurance systems and facilities;

(ii) The right to use, area and burial in the operation is in compliance with the relevant provisions of the social health insurance and is officially operating and there are no violations in the administration, such as the regulation of food medicine in recent years;

(iii) In line with the requirements of the relevant legal regulations of the food medicine regulatory administration, the sale of pharmaceutical services and information management systems to meet the requirements for the sale of pharmaceutical services, the settlement of drug costs and the supervision of regulatory requirements;

(iv) The retail pharmacies and their employees have participated in social insurance in the city as prescribed and paid social insurance in full and on time;

(v) The heads of retail pharmacies and associated personnel are aware of the provisions and basic operations of social health insurance and are familiar with the policies, regulations and regulations governing and marketing of medicines;

(vi) The establishment of a specialized health insurance fee system in the area of operation and connected to the health insurance surveillance system of the social insurance agencies to eliminate the cost of non-medical supplies such as daily supplies, foods, or cash collection.

The existing customized retail pharmacies should establish a specialized health insurance fee system by 31 December 2015 and be connected to the health insurance surveillance system of the social insurance agencies. Until such time, the services agreement was lifted by the Social Insurance Agency.

The targeted retail pharmacies were removed by the municipal human resources and the social security administration because of violations by social insurance agencies. The retail pharmacies, which have been cancelled, are not declared to be eligible within three years after the retail pharmacies and other retail pharmacies run by their corporate heads.

Article 48-point medical institutions, targeted retail pharmacies are commissioned by the urban human resources and the social security administration to harmonize production, management, issuance, targeted medical institutions, custom-based retail shops should be properly maintained, preserve, not to be replicated, forged, transferred or destroyed, and the loss or accidental damage should be reported to the social insurance agencies in a timely manner and be treated accordingly.

After the termination or lifting of the agreement by the Social Insurance Agency, the medical institutions, the retail pharmacies should return the mark to the Social Insurance Agency.

Article 49 Social Insurance Agencys should conduct annual integrated examinations of targeted medical institutions, targeted retail pharmacies, including:

(i) The management of the social health insurance base;

(ii) Provision of social health insurance services for insured persons;

(iii) The management of the quality of the operation of the targeted retail pharmacies;

(iv) Control of medical expenses of targeted medical institutions;

(v) Construction and management of the social health insurance information system;

(vi) Other circumstances that fall within the scope of social health insurance services.

Article 50 is governed by a uniform social health insurance certificate for medical treatment.

In order to obtain medicines, pharmacies for medical treatment or for the customary retail store, the attendance officer must present an effective social health insurance certificate, in collaboration with targeted medical institutions, the pharmacies; and all costs incurred in connection with medical, buying and pharmacies prior to the presentation of an effective social health insurance voucher are borne by the insured person themselves.

In cases of acute admission or lack of awareness, such as compression, cannot be presented at the site, the relevant formalities should be filled within 3 days of entry, or the family or other escorts should cooperate with the process.

A medical doctor of a targeted medical institution diagnostics of those who require inpatient treatment may have an autonomous choice of a hospitalization medical institution in the city.

The insured persons should cooperate with the targeted medical institutions in implementing the provisions of the entry, school standards and inpatient management in the health-care sector. Inpatient treatment is in accordance with the standards of the school, the cost incurred by the medical directory of the self-determined medical institution has not been paid.

In-patient medical institutions are subject to the consent and signature of the insured person or family members by using medicines, medical treatment projects, medical facilities and expensive special medical materials.

At the time of the arrival of the occupier medical institution, the number and quantity of the pharmacies should be in line with this requirement for the diagnosis of illnesses, and generally not exceed 7 days. The medical treatment project and the cost of medical care facilities at the medical clinic is not paid by the Integrated Social Health Insurance Fund.

Article 52 occupants have been inter-annual inpatient care for specific projects, and the medical costs incurred during the previous year have been transferred in principle to the new annual settlement; the insured person is required to carry out the application of the sub-paragraphs to the SSAS. The standard of payment for the Integrated Fund is calculated in accordance with the criteria for the year at the time of entry or start of the treatment.

The standard cost of payment is calculated at one inpatient rate in accordance with article 53 of the Activist's medical treatment during the hospital. The criteria for the transfer of hospitals were higher than the referral of hospitals, and the number of participants was required to pay the standard cost difference at the time they were transferred to hospitals; the cost of paying the hospital was not required.

Article 54 Participating in the annual changes in social health insurance risks, is calculated on the basis of medical costs incurred during the various periods of risk, and the maximum annual payment limits are accumulated.

The change in the treatment of social health insurance risks during the hospitalization period is subject to a sub-item for medical treatment, which shall be calculated according to the relevant criteria to be enjoyed in the course of the settlement, and the cost of payment is calculated at a hospital level to calculate the number of inpatient medical institutions.

Article 55, which has been identified by the designated medical institution, is in compliance with the designation of a single disease, a specific project for a diagnosis, the appointment of a standard of access to chronic diseases, may be medically provided in accordance with the provisions to the appropriate specialist sections of the designated medical institution.

Article 56 occupants should conduct general medical treatment according to the provision for the selection of targeted medical institutions or the designation of specialized medical institutions.

In the case of a medical clinic in the targeted medical institution, medical care is available on a medical basis for a medical clinic: it is generally not possible for the user to exceed 7 days; for emergency patients, it is generally not more than 3 days; for the identified chronic, old-age or special circumstances, the user's use can be properly prolonged, but the doctor should indicate the reasons.

Article 57 Participating in the medical service is paid by the social insurance agencies in accordance with the provisions of the medical expenses incurred by the various medical agencies in the context of the Integrated Fund for Social Health Insurance in the city.

The Integrated Fund for the Social Health Insurance of Employers is implementing standards for the payment of medical expenses on the basis of the standards of the same-level medical institutions in this city.

The Integrated Fund for Social Health Insurance for Rural and Rural Residents differs from the standard of payment for medical care to the insured person and is implemented in accordance with the relevant provisions of the social health insurance for rural and urban residents.

The medical costs incurred by the custodial officer in the targeted medical institution are settled by the Social Insurance Agency in accordance with the relevant standards and the manner of payment of the fees established by the urban human resources and the social security administration.

In accordance with the level of economic and social development, changes in the prices of medical services, levels of medical technology development and social health insurance fund balances, the urban human resources and social security administration sector adjusts, as appropriate, the standards for medical costs for social insurance agencies and targeted medical institutions.

Article 59 relates to the treatment of medical management, the manner and approach to medical costs, which are developed separately by the urban human resources and the social security administration.

Chapter V Social Insurance Fund

The sixtieth health insurance fund includes the Employer Health Insurance Fund and the Urban and Rural Residential Health Insurance Fund, which is included in the Social Security Fund's financial specials.

The employee's health insurance fund covers the social health insurance of the workforce, the medical assistance for major illnesses and the supplementary health insurance for workers, including the Integrated Fund and the Personal Account.

The coverage of the urban and rural population health insurance fund covers the social health insurance of urban and rural residents, and the health insurance for rural and urban residents.

The Medical Insurance Fund is based on separate accounts for the health insurance of workers, urban and rural residents, accounting for income and expenditure lines management, dedicated funds, and no unit or individual shall be excluded.

Bank accounts of the sixtieth health insurance fund are carried out in accordance with the relevant national provisions and the health insurance fund is exempted from taxation, fees.

Article 62 of the Social Insurance Agency should seriously implement the financial system of the Social Insurance Fund, which is based on the annual budget of the Fund.

The health insurance fund budget prepared by the Social Insurance Agency was reported in accordance with the procedure, following the review of the urban human resources and the social security and financial administration.

Article 63 of the Social Insurance Agency should be prepared for the accounting and financial statistical analysis of the Health Insurance Fund, with serious implementation of the Social Insurance Fund accounting system and strengthening the accounting of the Fund.

Article 64, in order to guarantee the security of the Fund, would be implemented by the municipal financial administration with the urban human resources and social security administration, in accordance with the State's provision for the development of the value-added plan for the health insurance fund.

The human resources and social security administration sector in Article 65 should establish a social integrity management system for the management of the health insurance fund management system, with the participation of the user units, the insured person, the targeted medical agency, the firm retail pharmacies and their compliance with the law and the integrity of the integrity of the society.

The urban human resources and the social security administration should be made public by targeted medical institutions, targeted retail pharmacies, which are administratively sanctioned by violations of the health insurance fund management provisions.

Annex VI

Participants referred to in article 46 of the scheme refer to persons participating in the social health insurance in the city and paid in full on time.

The basic medical costs referred to in this approach refer to the extent of medical treatment, the scope of the medical treatment project, the scope of the medical facility and the standard of medical expenses paid, but do not include the costs incurred by the individual in accordance with the prescribed proportion and the cost of the excess limit.

The employee's health insurance year referred to in this approach refers to 1 July to 30 June each year.

The resident health insurance year referred to in this approach refers to 1 January to 31 December each year.

The scheme referred to retired persons, which are non-in-service staff members participating in the old-age insurance scheme, and after the mandatory retirement age, the social insurance agencies in the present municipal administration have been approved to receive retirement pension for the basic pension of the old-age pension for the pension insurance.

The medical treatment of persons who leave the age of 67, the old-age army and persons with disabilities at the first to sixth levels is unchanged, and the medical costs are resolved in accordance with the source of funds.

Article 68 units may establish units to supplement the health insurance system.

The total annual salary of enterprises or self-contributors to supplement the health insurance scheme is 5 per cent of the total annual salary in this unit, which is covered by financial regulations, and the supplementary health insurance provision for the financial nuclear supplemental units is 5 per cent of the total annual salary for the current unit and is covered by social security payments for expenditure or operating expenses. Financial treatment is inconsistent with tax provisions, and tax adjustments are treated in the calculation of enterprise income tax.

Other user units complement the provision of health insurance by reference to implementation.

Article 69, in accordance with the law, has obtained relevant employment documents and foreign nationals' residence documents and legally employed foreigners in the present city, shall participate in the social health insurance of the employee and receive the treatment of the social health insurance.

The ports of lawful employment in this city, Macao, Cohesion, are implemented in accordance with the preceding paragraph.

The State also provides for implementation in accordance with national provisions.

Article 76 is implemented effective 1 July 2015. Prior to the implementation of this approach, the criteria for the collection and treatment of social health insurance remain in line with the original criteria.