Article 1 regulates the management of social health insurance and promotes sustainable economic and social development, in accordance with the laws and regulations of the People's Republic of China Social Insurance Act, to develop this approach in the light of the actual practice of this city.

Article 2

The scheme refers to social health insurance, including the health insurance of workers, the basic health insurance of the population and the provision of high-risk insurance for rural and urban residents.

Article 3. Social health insurance upholds the principle of full coverage, basic, multi-tier and sustainableness, establishes and improves the multi-tier social health safeguards system that supplements health insurance and the combination of large-scale disease insurance for rural and urban residents, and that the level of security is commensurate with the level of economic and social development.

Article IV, city, city (zone), the territorial Government should incorporate the cause of social health insurance into national economic and social development planning, mobilize funds for social health insurance, integrate health-related monitoring systems, identify health costs control targets, control medical costs and improve the level of medical safety for insured persons.

Article 5 Social Insurance Administration is responsible for the management of social health insurance within the city's administration.

The social health insurance management established by the Government of the District is responsible for the management of social insurance within the Territory.

The social health insurance institutions in the city, the city (the district) are responsible for the management of specific social health insurance in the integrated area.

The sectors such as health, finance, public safety, food medicine regulation and price should be jointly managed in accordance with their respective responsibilities.

Article 6. The Government of the Integrated Region has established a Social Insurance Monitoring Committee consisting of representatives of the user unit, representatives of the insured person, trade union representatives and experts to oversee the management and policy implementation of social health insurance.

Chapter II

Article 7. Staff health insurance includes basic health insurance for workers, supplementary health insurance for workers.

Article 8

Individuals of unemployed businesses, non-time practitioners who do not take part in the basic health insurance of the workforce and other flexible employed persons (hereinafter referred to as flexible employed persons) may participate in the health insurance of their workers in accordance with the State's provisions.

Article 9

The number of health insurance payments for flexible employed persons is determined by the municipal social security administration.

Adjustments to the payment rate of the employee's health insurance are made by the Municipal Social Insurance Administration to comment with the city's financial sector, which, with the consent of the Government of the city, is determined or submitted to the Government of the province.

Article 10 Employees have reached their age retirement and, according to the monthly entitlement to basic old-age insurance treatment, the cumulative pay rate for the employee's health insurance (considence the same-payment period) shall be 25 years, the female worker shall be up to 20 years and the actual pay period shall be paid for 10 years, with the benefit of the pension health insurance.

The accumulated annual rate of contributions or the period of actual contributions should be paid in accordance with the average annual social salary issued by the municipal social insurance administration and the pension health insurance pension entitlements for the previous year after the annual payment rate of the medical insurance of the annual unit.

Article 11. Employers' participation in health insurance benefits from payment of health insurance payments.

Flexible employed persons participate in the treatment waiting period for the health insurance; the treatment of personal accounts funds that may be used during the waiting period to receive medical insurance-related treatment upon completion of the waiting period.

Article 12

Article 13

(i) The cost of inpatient medical care, which is higher than the payment rate;

(ii) The cost of medical treatment for special illnesses, which exceeds the payment rate;

(iii) Emerging costs;

(iv) Other costs to be paid by the Integrated Fund.

The scope of special illnesses is made public by the Municipal Social Insurance Administration following the determination of the relevant sectors.

Article 14. Individual accounts are taken into account by the Social Insurance Agency, and early warning, end-of-removal liquidation and interest, and the balance can be traced, inherited.

Individual accounts cover medical costs incurred in targeted medical institutions and medical expenses incurred in non-scheduled medical institutions; and health-related insurance, health-related costs, etc.

Article 15. Risk adjustments are extracted from the Integrated Fund for medical costs that are required for the integrated fund collection or for the occurrence of large-scale emergency relief interventions.

The proportion and use of the Risk Adjustment Fund is provided by the Municipal Social Insurance Administration, which is reviewed by the municipal financial sector and reported to be implemented after the approval of the Government.

Article 16 supplements the health insurance fund to cover the highest cost of medical expenses paid by the Integrated Fund and other expenses to be paid by the Employer Supplementary Fund.

Chapter III Basic health insurance for the population

Article 17

The resident's basic health insurance is combined with the payment of personal contributions and Government financial assistance.

The personal contributions required for the enjoyment of the minimum living guarantees, for persons with disabilities who have lost their labour capacity, for the elderly and minors aged 60 years of low-income households, are subsidized by the integrated territorial Government.

Sources of the basic health insurance fund for the population include:

(i) Medical insurance payments paid by residents;

(ii) Government financial assistance;

(iii) Social donations;

(iv) Other social health insurance funds used by law;

(v) Fund interest and other income.

Article 19 standards such as personal contributions for basic health insurance for the population, the Government's financial support rate should be adapted to the incomes at the disposal of the population, and the introduction of dynamic adjustments, which are proposed by the Integrated Regional Social Health Insurance Administration in conjunction with the financial sector, to be followed up with the consent of the Government of the population.

Article 20 shall be paid by the insured person within the prescribed period for the benefit of the basic health insurance treatment of the population for the corresponding year, and the payment shall not be returned within that year.

The insured person did not receive the payment for a period of time, for a period of three months for the period of time, and for the treatment of the population's basic health insurance.

Article 21, the basic health insurance of the population is the first system of community medical institutions, with the participation of the insured persons to agree with the first community medical institutions.

In the case of community medical institutions, the proportion of payments to the basic health insurance fund for the population should be higher than other targeted medical institutions.

The basic health insurance for the population does not have a personal account; the fees for the treatment of the medical treatment of the insured person in compliance with the prescribed medical treatment, inpatient and special illnesses, are paid in proportion to the standard of payment and the maximum payment limit.

Article 23. The Government of the people of the region should develop a system of supplementary health insurance for the population.

The population supplements the health insurance to cover medical costs that are paid at the highest rates of the basic health insurance fund for the population and other expenses that should be paid by the residents.

Chapter IV

Article 24 protects the population of rural and urban areas for the basic health insurance and basic health insurance of the population.

Article 25

Article 26

In accordance with the prescribed medical expenses for hospitalization and special medical treatment during the year of the insured person, the personal burden is paid in proportion to more than 50 per cent of the per capita income of the previous year's urban population and is paid by the proportion of the funds paid by the urban and rural residents.

Chapter V Social Health Insurance Fund

Article 28 of the Social Health Insurance Fund follows the principle of payment, balance of payments and a slight balance.

The Social Health Insurance Fund should be incorporated into the financial specialization, with the introduction of two line managements of income and expenditure, respectively, with separate accounts, independent accounts, earmarked funds, and no units and individuals shall be excluded from diversion.

Article 29 should be subject to the supervision of the employee by making a periodic publication of the payment of the social health insurance expenses of the Unit, through a marked manner of posting a notice in this unit, making it available to the General Assembly.

Article 33, under the overall control of the Social Health Insurance Fund, is based on a combination of payments, such as illnesses, headpersons and service modules, which are developed by the Social Health Insurance Administration with the financial, health sector.

Social health insurance management should strengthen the management of social health insurance costs and effectively utilize and allocate health resources.

Article 31 Medical establishments should provide comprehensive, timely, accurate and normative information in accordance with the requirements of social health insurance coverage and surveillance; according to the provisions, the social health insurance institutions should pay the related costs to the targeted medical institutions by the end of the month of the completion of the review process.

In one of the following cases, the Social Health Insurance Fund does not cover medical costs:

(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, Taiwan area or abroad;

(v) Other circumstances that are not covered by the law.

The Social Insurance Monitoring Committee should strengthen the supervision of the Social Health Insurance Fund and identify income and expenditure, management and investment operations of the Social Health Insurance Fund and have the right to make corrections recommendations.

Encourage and support the participation of the public in the supervision of the Social Health Insurance Fund and the safe and effective functioning of the Social Health Insurance Fund.

Chapter VI Oversight management

Article 34, Social Health Insurance Management shall perform the following duties:

(i) Develop and open targeted medical institutions should have the conditions, assessment rules and assessment procedures, in accordance with the needs of management services such as urban development planning, the allocation of medical resources and the distribution of insured persons;

(ii) Examination of the implementation of social health insurance laws, regulations, review of the draft Social Health Insurance Fund, prepared by the Social Health Insurance Institute, conduct a review of the income and expenditure, management and investment operation of the Social Health Insurance Fund, and correct problems by law;

(iii) The establishment and improvement of social health insurance coverage, monitoring systems, and the regulation of the social health insurance coverage of targeted medical institutions;

(iv) To organize a security assessment of the social health insurance fund by relevant departments and agencies, and to promote the timely elimination of the safety hiddenness of the social health insurance fund;

(v) To receive reports of violations committed by the Social Health Insurance Fund in accordance with the law and to identify violations committed by the Social Health Insurance Fund;

(vi) Legal regulations and other responsibilities under municipal governments.

Article XV shall perform the following duties:

(i) The establishment of the pre-accounting system of the Fund, the financial accounting system and the internal audit system to report regularly to the social health insurance management and the financial sector on the income and expenditure of the social health insurance fund and the performance analysis;

(ii) An assessment of medical institutions, in accordance with the provisions of the assessment, of service agreements with eligible medical institutions based on the assessment findings and reporting on the Social Health Insurance Administration;

(iii) Establish agreements to regulate targeted medical institutions and conduct monitoring inspections in accordance with the agreement;

(iv) Establish a public system of sound information to receive social oversight, through its network of units, service windows, public columns, etc., on the basis of the law's initiative, regular public social health insurance fees and the use of the Integrated Fund for Social Health Insurance;

(v) Legal regulations and other responsibilities under municipal governments.

Article XVI: The targeted medical institutions shall provide medical services to the insured person in accordance with medical insurance provisions and service agreements and shall not have the following acts:

(i) The use of tools such as fraud, forfeiture of material, to deceive the social health insurance fund;

(ii) Concrete receipt of the Social Security Cardage Fund;

(iii) Reimbursement of non-scheduled medical institutions;

(iv) The number of financial and pharmaceutical entry stocks is incompatible with actual sales;

(v) Other violations of the management of social health insurance.

In accordance with the provisions of the health insurance and services agreement, the following shall not be done:

(i) Distinguished and detained inpatient medical care, unserviceable medical expenses, and deceived the Social Health Insurance Fund;

(ii) Removal of projects outside the coverage of medical insurance into medical coverage or settlement projects incompatible with actual projects;

(iii) In violation of the principle of ill-treatment and ill-treatment, there is no reasonable fee;

(iv) Exclusiveness, refusal of patients, or the imposition of patients who do not meet the standards of the school;

(v) Reduce standard treatment of patients, de-patient hospitalization and intentional extension of hospitalization;

(vi) Discuss medical costs for non-contingent medical records;

(vii) Other violations of the management of social health insurance.

Article 338 retail pharmacies should provide buy-in services to the insured person in accordance with medical insurance provisions and service agreements without receiving multiple card purchases.

Article 39 Medical Doctors in Social Health Insurance (hereinafter referred to as medical doctors) shall provide reasonable and normative medical services to the insured person in accordance with the provisions, without:

(i) Discussing social health insurance funds for medical institutions;

(ii) The use of tools such as the use of falsification, alteration, concealment and false testimony to extract social health insurance funds;

(iii) Reduce access standards for patients, reduce diagnostic standards from disease certificates, misuse or use of social health insurance funds;

(iv) Provision of repetitive, excessive, unjustifiable or separated medical services;

(v) Other violations of the management of social health insurance.

Article 40 provides that a person's unit shall not forfeiture the labour relationship or take other inappropriate means to facilitate personal fraud in social health insurance, access to social health insurance.

Article 40

(i) Fraud, forgery or forfeiture of social insurance material from others;

(ii) borrowing social security cards for use by others or the transfer of social health insurance treatment;

(iii) Costs outside the scope of the social health insurance fund;

(iv) Removal of medicines and treatment services paid by the Social Health Insurance Fund;

(v) To deliberately conceal medical costs that are not paid by the Social Health Insurance Fund and to extract social health insurance funds;

(vi) Funding for a medical insurance personal account;

(vii) Other violations of the management of social health insurance.

Article 42

Article 43 thirteenth social health insurance institutions should establish a regulatory system of good faith in the health insurance of targeted medical institutions, medical doctors, practitioners and insured persons, regulate the integrity of the relevant institutions and personnel of social health insurance and incorporate into the public credit information management system, as required.

Chapter VII Legal responsibility

Article 44 quantify medical institutions violate articles 36, paragraphs 1 to 4, 37, paragraphs 1 to 6 and 38 of this scheme, which are recovered by social health insurance institutions; in exceptional circumstances, the suspension of medical insurance settlement relations and the imposition of a fine of more than five times the social health insurance administration.

Article 48 fractures of medical insurance in violation of article 39, paragraphs 1 to 4, of this scheme are recovered by social health insurance institutions; in exceptional circumstances, the suspension of medical insurance settlement relations, which is fined by more than 1,000 yen by the social health insurance administration and the release of its operational qualifications by law.

Article 46 provides that, in violation of article 40 of this scheme, a person is forged or otherwise unjustifiable to facilitate personal fraud in social health insurance, access to social health insurance, recovery of related costs by social health insurance institutions and fined by social health insurance management for more than five times.

Article 47, in violation of article 41, paragraphs 1 to 6, of the scheme, shall be recovered by the social health insurance agency and may change the manner in which the insured person is to be charged with a fine of more than 5,000 by the social health insurance administration.

Article 48 of the Social Health Insurance Administration, the Social Health Insurance Service and the relevant departments and their staff play a role in the management of social health insurance, abuse of their duties, provocative fraud, and are subject to administrative disposition by their units or superior administrative authorities, the inspection authority is governed by law.

Article 49, in violation of this approach, constitutes an offence and is criminalized by law.

Chapter VIII

Article 50

Integrated areas refer to the integration of basic health insurance, in principle, in accordance with national, provincial provisions, in accordance with the city's administrative area, or the integration of the urban (zone) administrative area.

Medical institutions are known as medical institutions and retail pharmacies.

Medical costs refer to costs consistent with the Basic Health Insurance, Work injury Insurance and Maternity Insurance Section of the Province of Susang, the Medical ITS project, the scope of medical services and the payment criteria.

The standard of payment for the Integrated Fund is that, prior to the payment of medical expenses for insured workers by the Integrated Fund, the individual of the employee is required to pay a certain amount of medical expenses in accordance with the provisions.

The maximum payment limit for the Integrated Fund refers to the maximum amount of basic medical costs that would be paid by the Integrated Fund within a medical year.

Article 50 defines and adjusts the Integrated Fund, the Basic Health Insurance of the Resident, the criteria for the payment of major illnesses for rural and urban residents, the maximum payment limits and the proportion of payments, and is presented by the Integrated Regional Social Health Insurance Administration in conjunction with the financial sectors, to the extent approved by the same Government.

Article 52 states, provincial adjustments to the types of social health insurance are provided.

Article 53 of this approach is implemented effective 15 November 2016.