6/03/2008

Urban residents in the basic medical insurance pilot scheme

Chapter I. General Provisions
First of all types of coverage for the establishment of sound urban residents in the multi-level social medical insurance system to protect urban residents in the basic medical needs, in accordance with "the State Council on urban residents carry out the basic medical insurance pilot guidance" (State of the [2007] 20) And "urban residents in Hunan Province basic medical insurance pilot implementation method (Trial)" (G Gordon, [2007] 22) the spirit of the document, the actual city of Zhuzhou, the enactment of this approach.
Article 2 of the basic medical insurance for urban residents adhere to the medical security level and the level of economic development to the principle of co-ordination mainly to ill health, focusing on protection of patient treatment. According to the branch in order to, a balanced budget, a slight raise and balance the principle of the use of medical insurance funds; adhere to the fee-based individuals and families, the principle of appropriate subsidies to raise funds.
Article 3 of the basic medical insurance for urban residents implementation of the municipal co-ordination, territorial management.
Article 4 of the basic medical insurance for urban residents object to the participants in Zhuzhou Shixia area for urban workers do not belong to the basic medical insurance system within the coverage of the following persons:
(A) primary and secondary stage of the students (including vocational high schools, secondary and technical schools), children (the children of students);
(B) over 18 years of age and above, the following 60 years of age, with urban household registration in Zhuzhou City of non-residents and business district exempted township (town) of rural residents (hereinafter referred to practitioners of non-residents);
(C) above the age of 60 years of age with urban household registration in Zhuzhou City residents, the district exempted township (town) of rural residents (hereinafter referred to the elderly residents).
Article 5 of Zhuzhou City, where the basic medical insurance urban residents in terms of enrollment, to the family as a unit to the street location of residence (township), community labor and social security services for participants registered.
Chapter II organizations and responsibilities
Article 6 of city, county (city) labor and social security administrative departments in charge of urban residents in the basic medical insurance administration. Its main duties are:
(A) is responsible for the basic medical insurance for urban residents of the organization and implementation;
(B) develop the basic medical insurance for urban residents of supporting policies;
(C) validation of basic medical insurance for urban residents designated medical institutions eligible;
(D) the preparation of the audited agencies the basic medical insurance for urban residents to pre-fund, the accounts of urban residents in the basic medical insurance fund management oversight;
(E) of urban residents in the basic medical insurance policy for the implementation of the inspection and supervision.
Article 7 of the city, county (city) medical insurance agencies in charge of handling the basic medical insurance for urban residents, whose main responsibilities are:
(A) The medical insurance agencies in charge of urban residents in the urban basic medical insurance fund raising, management and payment;
(B) of counties (cities) of medical insurance agencies in charge of the county (city) area within the urban residents in the basic medical insurance fund raising, management and payment;
(C) responsible for the preparation of urban residents in the basic medical insurance fund PWC, the accounts;
(D) is responsible for urban residents and the basic medical insurance designated medical institutions signed a service agreement;
(5) is responsible for the development of urban residents in the basic medical insurance business management methods.
Article 8 of the District labor and social security administrative departments in charge of the area in the basic medical insurance for urban residents of the organization and implementation work.
Article 9 of the District medical insurance agencies in charge of the area in the basic medical insurance for urban residents registered participants of the audit summary, reporting and work to raise medical insurance premiums.
10th streets (township) labor and social security services contractor in this specific area in the basic medical insurance for urban residents of the participants registered for review, and change, the information recorded, summarized and reported to the collection of medical insurance and so on.
Article 11 of the financial departments in charge of urban residents in the basic medical insurance fund-raising part of the financial assistance and disbursed; responsible for urban residents in the basic medical insurance fund accounting of financial accounts, audited the Budget and Final Accounts; responsible for the medical insurance agencies working budget for the organization of work.
Article 12 of the health sector responsible for the formulation and implementation of urban residents for medical treatment of preferential policies to standardize the designated medical institutions of medical services.
Article 13 of the education sector to help students do a good job in the basic medical insurance enrollment work.
Article 14 of price, auditing, civil affairs, food and drug supervision, CDPF and other departments and perform their duties to the basic medical insurance for urban residents in the related work.
Chapter III of the basic medical insurance fund raising and management
Article 15 of urban residents in the basic medical insurance fund sources:
(A) individual residents to pay the basic medical insurance;
(B) The Government grants the basic medical insurance for urban residents;
(C) of the Fund's interest income;
(D) other income.
Article 16 of Zhuzhou City of urban residents and the district exempted township (town) of rural residents in accordance with the basic medical insurance premiums to raise the following criteria: students 80 yuan per person per year for children; non-elderly residents and business people 280 yuan per person per year.
Article 17 grants the Government and individuals pay the standard:
(A) Student grants children 40 yuan per person per year, individuals paid 40 yuan; non-resident business grant 80 yuan per person per year, individuals paid 200 yuan; elderly residents of 180 yuan per person per year for grants, individual pay 100 yuan.
(B) to enjoy the minimum living guarantee, holders of "Disabled People's Republic of China" and disability rating for the level of 1-2: Student children grant 65 yuan per person per year, individuals paid 15 yuan; practitioners of non-residents per person 220 yuan subsidy a year, individuals paid 60 yuan; elderly residents of 240 yuan per person per year for grants, individual pay 40 yuan.
(C) of urban residents without the ability to work, no source of life, can not be Shanguang (honestly, help) support obligations of staff and the district exempted township (town), "Wu Baohu" full subsidy from the Government.
Article 18 of conditional employing units or organizations can provide for immediate family members or employees of the Habitat (Village), the enrollment fee for subsidies, grants funds to enjoy preferential tax policies for the country.
Article 19 of the community to promote and encourage donors to support the development of urban residents and the basic medical insurance industry.
Article 20 established the basic medical insurance for urban residents risk reserve fund system. Risk reserve fund, the income of 3 percent from year to year, earmarked for special circumstances make up the fund risks. Risk reserves and the interest of all urban residents into the basic medical insurance fund special fiscal account unified management. The total cumulative risk from the reserve fund to co-ordinate the 15 percent annual income no longer extract.
Article 21 of urban residents in the basic medical insurance funds in addition to the central government grant, part of the financial assistance, the remainder of the municipal, county (city) District financial commitment grade. City, district financial commitment to a ratio of 6:4; cities and counties in accordance with the proportion of financial commitment.
Article 22 of the financial sector under the medical insurance agencies approved the actual number of participants, according to no less than two yuan per person per year the standard for the community and other units had allocated Daiban Fei. Dai Banfei included in the budget.
Article 23 of the basic medical insurance for urban residents pay an annual basis. The annual October 1 to November 30 next year for the basic medical insurance for urban residents of the participants, payment period. Participants in the payment period provided for in full and on time to pay medical insurance premiums, the following year from January 1 onwards to enjoy basic medical insurance benefits.
Article 24 of the participants when the residents were not in full payment of the basic medical insurance premiums from next year on January 1 cease to enjoy basic medical insurance benefits. Within three months back, from the back, with effect from 1 to enjoy basic medical insurance benefits; more than three months from the date back 90 days later to enjoy basic medical insurance benefits.
Article 25 of urban residents in the basic medical insurance funds into the financial accounts of social security funds unified management, separate accounts, earmarking. No unit or individual shall not be misappropriated, embezzled. Medical insurance agencies for funding and staff from the budget for, shall not be extracted from the Fund.
Article 26 of urban residents in the basic medical insurance fund the implementation of national reunification of the Budget and Final Accounts system of social insurance funds, financial accounting systems and internal audit system.
Article 27 of urban residents in the basic medical insurance fund income and expenditure management, should be periodic report of Social Insurance Fund Oversight Committee, and regularly to the public and accept supervision by society.
Chapter IV of the basic medical insurance benefits
Article 28 of the basic medical insurance for urban residents each year from January 1 to December 31 for an annual settlement.
Article 29 of the basic medical insurance urban residents in major medical and hospital out-patient protection ill health.
Article 30 of the participants in the basic medical insurance for urban residents designated medical institutions (hereinafter referred to designated medical institutions) in the required hospitalization expenses for urban residents from the basic medical insurance funds and personal burden on the common.
Article 31 of the basic medical insurance for urban residents of the medication, treatment, services and facilities of the reference to the basic medical insurance for urban workers, the implementation of relevant provisions.
Article 32 of urban residents in the basic medical insurance fund set up hospital Qifubiaozhun settlement and the highest limit.
Qifubiaozhun hospitalized for: community health service center 100 yuan, 450 yuan a hospital; two hospitals 650 yuan, 800 yuan three hospitals.
A clearing house for clearing the highest level: for the children of students 70,000 yuan; non-residents and elderly residents of employment for 30,000 yuan.
Article 33 of the hospital medical insurance for urban residents from the basic medical insurance funds and patients were provided by the following commitments:
(A) The following hospitalization Qifubiaozhun part, by an individual own.
(B) Qifubiaozhun above, the maximum limit of clearing the following components: community health service agencies, funds to pay 65%, individuals own 35 percent of a hospital, the fund paid 60%, individuals own 40 percent; two hospitals, the fund paid 50 %, Individuals own 50 percent; three hospitals, the Fund paid 40 percent, individuals own 60 percent.
(C) above the maximum limit of the settlement by individuals own.
Article 34 of urban residents for participating in the basic medical insurance for more than five years, each additional year, raising funds to pay proportion of 2%. The highest percentage increase of not more than 10 percent.
Article 35 of enrollment staff out-patient radiotherapy and chemotherapy cancer, renal failure dialysis treatment into the hospital out-patient management, according to the provisions of Article 33 of the proportion paid Kangpai Yi organ transplant recipients and immunosuppression out-patient treatment costs the highest settlement below the limit Part of the fund to pay 50%, individuals own 50 percent above the maximum limit of the settlement by individuals own.
Article 36 of the students children without third-party liability in the accident, the designated medical institutions in the door, emergency medical expenses, medical insurance fund by 50 percent.
Article 37 staff participants in the following cases, their medical expenses for urban residents are not included in the basic medical insurance fund to pay:
(A) due to traffic accidents, medical accidents medical treatment;
(B) because of delinquency, alcohol abuse, assault, suicide, self-mutilation (except for mental illness) for medical treatment;
(C) in foreign countries or Hong Kong, Macao and Taiwan region for medical treatment;
(4) in non-designated medical institutions for medical treatment (emergency rescue);
(E) other than the one provided for hospital procedures, without authorization to other medical institutions for medical treatment;
(6) of industrial injury insurance (including occupational disease) or maternity insurance coverage; (7) the other provisions not paid.
Chapter 5 of the basic medical insurance service management
Article 38 of the basic medical insurance for urban residents designated medical institutions practice management, staff should be insured to the designated medical institutions for medical treatment. Designated medical institutions for by the labor security department confirmed in health administration departments.
Article 39 of the basic medical insurance for urban residents implementation of the first consultation and referral system. Participants in the registration procedures for participants, to the family as a unit with a choice of hospital conditions of medical institutions designated as my doctor first diagnosed medical institutions. First of all insured persons sick in my choice of attending designated medical institutions, the need for referral of the disease, medical institutions should first diagnosed in time for referral of patients registered.
The first medical consultation, without a referral agency for the registration procedures and hospital medical costs, the basic medical insurance fund is not paid. Emergency, the rescue directly with the exception of hospital treatment.
Article 40 of the participants to designated medical staff for hospital procedures, I should Jiaoyan "Zhuzhou City of basic medical insurance for urban residents Handbook" and residents proof of identity and personal Precrosslinked pay. The end of discharge for medical procedures, should be the individual pays the medical expenses incurred by individuals and medical institutions settlement; urban residents should be the basic medical insurance fund to pay part of the medical insurance agencies and medical institutions settlement.
Article 41 should be designated medical institutions for the hospital's medical insurance costs of hospital staff to provide daily lists, strict control at their own expense, drugs, medical supplies, the use of project clinics, must be used and should be informed prior written consent of patients or their relatives Consent. Without a staff or their families authorized participants, the participants or the right of families to dishonour the medical expenses.
Article 42 designated medical institutions should conscientiously implement the relevant policies and regulations, standardize medical services and consciously act in ensuring basic medical care under the premise adhere to reasonable inspection, rational drug use, reasonable treatment, reasonable fees.
Article 43 of the participants and staff for referral to visit relatives, vacation and other reasons in remote medical institutions for medical treatment management methods, labor and social security departments provided otherwise.
Chapter VI.
Article 44 of the financing for the standard approach, treatment of payments, in the implementation process, according to the city socio-economic development and basic medical insurance for urban residents practical operation of timely adjustment.
Article 45 because of a major outbreak of urban residents in the disaster-patient medical expenses, arranged by the Government to solve the capital.
Article 46 of Labor and Social Security Bureau in accordance with the relevant departments to formulate the implementation details.
Article 47 of this approach since January 1, 2008 will go into effect. Urban Labor and Social Security Bureau is responsible for the interpretation.

No comments: