2018 Medical Insurance Regulations Full Text New Workers' Compensation Insurance Regulations Full Rules
Chapter I General Provisions
Article 1 In order to protect the basic medical care of urban employees, and rationally utilize the medical resources, according to the relevant provisions of the state, combined with the actual situation of the province, to formulate the Regulations.
Article 2 of the province's cities and towns of the following units and their employees must participate in the basic medical insurance in accordance with these regulations:
(a) enterprises and their employees;
(b) agencies, institutions, intermediary organizations, social organizations, non-enterprise private units and their employees;
(c) units belonging to the army and their employees without military status.
The retirees of the above units are subject to these Regulations.
Article 3 establishes the basic medical insurance fund for urban employees, and implements a system combining individual medical accounts (hereinafter referred to as individual accounts) and payments from the basic medical coordinating fund (hereinafter referred to as the coordinating fund).
The ownership of the individual account belongs to the individual. The ownership of the integrated fund belongs to all those who participate in basic medical insurance.
Article 4 of the basic medical insurance premiums shall be borne by both the employer and the employee **** the same burden.
Article 5 of the basic medical insurance in principle to the city, county, autonomous county as a coordinating unit, the implementation of localized management.
Article 6 of the basic medical insurance premiums by the local tax authorities (hereinafter referred to as the collection authority).
Chapter II of the basic medical insurance premiums
Article 7 of the basic medical insurance premiums by the employer and employees **** the same payment. Where the employer unit according to the unit employees pay 5% -7% of the total monthly wages, employees to pay the basic medical insurance premium rate of not less than 2% of their total monthly wages.
Article VIII of the practitioners of the monthly contribution to the amount of wages according to my actual gross salary, but shall not be less than 60% of the average monthly salary of the practitioners of the city, county, autonomous county in the previous year, less than part of the medical insurance premiums that should be paid by the person to be paid by the employer.
Article IX practitioners of the total monthly salary over the city, county, autonomous county practitioners of the previous year, the average monthly social wage of more than 300% of the part, do not pay the basic medical insurance premiums, and not as the base of the approved personal account quota.
Article 10 of the employer in obtaining a business license or approved the establishment of 30 days, must be to the social insurance agency for basic medical insurance registration. Changes in registration matters or terminate the obligation to pay in accordance with the law, shall promptly apply for registration of changes or deregistration. The social insurance agency should notify the collection agency of the registration in a timely manner.
The employer shall, within 10 days after the registration of basic medical insurance, register the payment of basic medical insurance premiums with the collection agency in accordance with the relevant provisions.
Article 11: The amount of basic medical insurance premiums to be paid by the employer and employees shall be declared by the employer to the collection agency on a monthly basis and approved by the collection agency.
If the employer does not declare the amount of basic medical insurance premiums to be paid according to the regulations, the collection agency shall temporarily determine the amount to be paid by 110% of the amount paid by the employer in the previous month; if there is no amount of premiums paid in the previous month, the collection agency shall determine the number of persons and the amount of premiums to be paid by the employer according to the economic status of the employer, the number of employees, and other relevant circumstances. After the contributing unit completes the declaration procedures and pays the basic medical insurance premiums according to the stipulated amount, the levying authority will settle the bill accordingly.
Article 12 of the basic medical insurance premiums are levied on a monthly basis, employers and employees should pay the basic medical insurance premiums to the collection agency within the specified period. The portion of the premiums to be paid by the individual practitioner shall be withheld by the employer from his salary.
Basic medical insurance premiums shall not be reduced or exempted.
Article 13 of the basic medical insurance premiums to pay the composition of the total wages, calculated in accordance with the relevant provisions of the State.
The basic medical insurance premiums paid by the employer shall be charged in accordance with the relevant state financial regulations.
The basic medical insurance premiums are not included in the current wage income of individuals and are exempt from personal income tax.
Employers are not allowed to reduce the wages of employees on the grounds that they have paid the basic medical insurance premiums.
Article 14 of the basic medical insurance contributions to implement the annual inspection system. Any employer who has not gone through the annual inspection of basic medical insurance premiums by the collection agency will not be subject to the annual inspection by the administrative department for industry and commerce.
Employers in the business license cancellation procedures, the administration for industry and commerce shall first review the social insurance agency issued by the end of the basic medical insurance relationship.
Article 15 After the retirement of employees, I no longer pay the basic medical insurance premiums, the unit will no longer pay the basic medical insurance premiums for them.
Article 16 of the employer's legal bankruptcy, closure and termination for other reasons, or restructuring and reduction of more than 2/3 of its retirees in the retirement of the actual payment of basic medical insurance premiums for less than 10 years before retirement, should pay the basic medical insurance fund compensation. The fund indemnity shall be calculated on the basis of the number of years that each retiree is now up to the age of 75 multiplied by the standard of the average basic medical insurance premiums of retirees in the same period, and shall be paid in a lump sum from the assets realized after liquidation, and the treatment of those who are indeed incapable of paying the indemnity shall be stipulated separately by the provincial people's government. If the state has other provisions, the provisions shall apply.
Article 17 of the employer due to bankruptcy, abolition, dissolution or other reasons for the termination, in accordance with the relevant state laws and regulations, to settle its outstanding basic medical insurance premiums, interest, late fees, penalties.
When an employer merges, divides, or transfers an organization, the merged, divided, or transferred organization shall pay the outstanding basic medical insurance premiums, interest, late payment fees, and penalties. If the state provides otherwise, the provisions shall apply.
Article 18 of the implementation of this regulation before the medical fee arrears, still by the original channel to solve.
Chapter III of the basic medical insurance fund management
Article 19 of the basic medical insurance premiums paid by employees are all credited to their personal accounts.
25-35% of the basic medical insurance premiums paid by employers are used to establish individual accounts for retirees and employees, and the specific allocation method is formulated by the provincial people's government in accordance with the principle of taking care of the elderly; the remaining funds are used to establish a comprehensive fund.
Article 20 of the basic medical insurance fund to implement the two-line management of income and expenditure, into the financial account of the social insurance fund, earmarked for the exclusive use of all employees and retirees for basic medical care, shall not be diverted to other uses.
Article 21 of the basic medical insurance fund of interest-bearing methods in accordance with the relevant provisions of the State, the individual account and the integrated fund of the interest accrued were calculated and transferred separately.
Article 22 of the individual account shall not be withdrawn in cash, shall not be overdrawn, the overspending shall not be compensated, and the savings shall be rolled over for use. Practitioners, retirees, death, the balance of funds in their personal accounts can be inherited.
Article 23 The employer shall not violate the provisions of these regulations for its employees or other personnel to increase the funds in the personal account.
Article 24 The social insurance agency shall establish basic medical insurance files for employees and retirees, and issue basic medical insurance documents.
Article 25 to move out of the province or mobile within the province, the balance of funds in the individual account can be transferred to use; can not be transferred, shall be returned to the person.
The basic medical insurance premiums allocated to the integrated fund, the original integrated unit of all participants, not transferable, nor refundable.
Article 26 of the basic medical insurance fund of the annual budget, final accounts, shall be prepared and finalized in accordance with the relevant provisions of the State and the province.
Chapter IV basic medical insurance treatment
Article 27 of the basic medical insurance premiums paid in accordance with these regulations of the employer's personnel, enjoy the basic medical insurance treatment.
Article 28 of the individual account for the payment of medical expenses outside the scope of payment of the integrated fund; the individual account is not enough to pay, at their own expense.
Article 29 of the hospitalization of serious illnesses 'medical expenses, according to the following methods of payment:
(a) the starting standard in principle, controlled in the city, county, autonomous county employees in the previous year, the average annual social wage of 9% -11%. [page]
(b) The maximum payment limit is in principle controlled in the city, county, autonomous county practitioners of the previous year's annual average social wage of 3-5 times.
(c) Medical fees above the starting standard and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees is given appropriate care.
The scope of serious illnesses, the specific criteria for the starting standard and maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit shall be determined by the provincial people's government.
Article 30 of the starting standard below, above the maximum payment limit of medical expenses, the integrated fund will not pay.
Article 31 of the basic medical insurance fund to pay part of the cost of diagnostic and treatment items and Class B list of drugs, the proportion of individual out-of-pocket payments, determined by the provincial people's government.
Article 32 of the cholera, plague and other Class A infectious diseases of medical expenses shall be fully paid by the integrated fund. The medical expenses of the outbreaks and epidemics of infectious diseases recognized by the administrative department of health shall be settled by the people's government with special funds.
Article 33 The state civil servants and other persons who meet the regulations shall be provided with medical subsidies on the basis of their participation in basic medical insurance.
In order to solve the problem of medical expenses above the maximum payment limit for persons other than those stipulated in the preceding paragraph, the provincial people's government may organize and implement supplementary medical insurance.
Article 34 of the basic medical insurance where the age of 50 years old, and according to the state regulations to calculate the continuous service or less than five years of service, the basic medical insurance for one year before enjoying the integrated fund to pay medical expenses.
Article 35 of these Regulations provides that the contribution period includes the actual contribution period and the deemed contribution period.
The deemed contribution period referred to in the above paragraph refers to the number of consecutive years of service or years of work in accordance with national regulations before the implementation of these Regulations.
Article 36 of the revised implementation of the Regulations retired employees, the number of years of basic medical insurance premiums, men full 30 years, women full 25 years, after retirement, the standard of basic medical insurance benefits in accordance with the provisions of these Regulations.
If the practitioners have not paid the basic medical insurance premiums for as many years as stipulated in the preceding paragraph when they retired, the basic medical insurance benefits enjoyed by them after retirement shall be reduced by 5% on the stipulated treatment standard for each year of less contribution.
Article 37 of the retiree in the retirement of the actual payment of basic medical insurance premiums for 10 years before retirement, the original unit does not pay the basic medical insurance premiums after retirement, does not affect its enjoyment of the basic medical insurance treatment of retirees under these regulations.
Retirees who have actually paid basic medical insurance premiums for less than 10 years before retirement, and whose original units do not pay basic medical insurance premiums after retirement, shall not be entitled to the basic medical insurance benefits for retirees under these Regulations.
Article 38 of the practitioners and retirees due to alcoholism, suicide and self-injury, illegal and criminal expenditures of medical fees, the integrated fund shall not pay.
Medical expenses incurred as a result of traffic accidents and medical malpractice shall be handled in accordance with the relevant state regulations.
Article 39 of the Social Insurance Administration approved treatment in a foreign medical institution, retirees living in a foreign place for more than one year, the basic medical insurance treatment in accordance with the implementation of these Regulations.
Article 40 of the practitioners, retirees in foreign countries or Hong Kong, Macao, Taiwan during the medical expenses incurred in accordance with the implementation of these Regulations.
Chapter V of the basic medical insurance medical services management
Article 41 of the provincial labor security administrative departments in accordance with relevant state regulations, in conjunction with the planning, economic and trade, finance, health administration, drug supervision and management departments to determine the basic medical insurance drug list.
Provincial labor security administrative departments in accordance with relevant state regulations, in conjunction with planning, finance, health administration, drug supervision and management departments to determine the basic medical insurance catalog of diagnostic and therapeutic items, the scope of medical service facilities and payment standards.
The use of drugs, diagnostic and therapeutic items, medical service facilities not included in the scope of the basic medical insurance, the cost of the integrated fund shall not be paid.
Article 42 of the provincial labor security administrative departments in accordance with the relevant provisions of the State, in conjunction with the health administration, drug supervision and management departments to develop basic medical insurance designated medical institutions management methods.
Provincial labor security administrative departments in accordance with relevant state regulations, in conjunction with the drug supervision and management departments to develop basic medical insurance designated pharmacy management.
Labor security, health administration and drug supervision and management departments of the designated medical institutions and designated pharmacies of the qualification of dynamic management.
Article 43 of the labor security, health administration, drug supervision and management departments and social insurance agencies based on the management of designated medical institutions and designated pharmacies, in accordance with the Chinese and Western medicine, community, specialized and comprehensive medical institutions, the principle of convenience to the insured to seek medical treatment, to determine the designated medical institutions and designated pharmacies, and to the insured persons announced.
Article 44 patients using personal accounts, can be in any of the designated medical institutions and designated pharmacies for medical treatment, purchase of medicines.
If the medical expenses are required to be paid by the integrated fund, the patient should go to the designated designated medical institutions.
Article 45 of the integrated fund to pay for medical expenses, according to the principle of total control, can be implemented in the total prepaid settlement system.
The social insurance agency can regulate the amount of prepayment of the integrated fund based on the quantity and quality of medical services provided by the designated medical institutions and the protection of the legitimate medical rights and interests of the insured.
Article 46 of the designated medical institutions and designated pharmacies shall comply with the provisions of the state and the province of medicine and health and basic medical insurance, shall not in any way harm the legitimate medical rights and interests of the insured.
The fixed-point medical institutions must inform the patient about the medical services and charges detailed information.
Article 47 of the basic medical services fees by the provincial labor security and price management departments, in conjunction with health administration, finance and other departments to develop and revise, and reported to the provincial government for approval.
The price of basic medical insurance drugs, should be consistent with national regulations on drug pricing.
Violation of the basic medical service program fee standards and drug prices, the basic medical insurance fund accounts do not pay for excessive medical expenses.
Chapter VI of the basic medical insurance organization, management and supervision
Article 48 of the provincial labor security administrative department is the province's urban employees of the basic medical insurance of the administrative authority, its responsibilities are:
(a) the preparation of employees of the basic medical insurance development planning;
(b) in conjunction with the relevant departments to formulate the basic medical insurance fund Financial management system, statistical system and internal audit system;
(3) supervision and management of the province's basic medical insurance work, and exercise the right to administrative penalties in accordance with the law;
(4) annual public announcement of the work of the basic medical insurance to the community;
(5) other duties that should be carried out by the competent administrative organs.
Municipalities, counties and autonomous counties of labor security administrative departments in accordance with the provisions of the basic medical insurance work of urban workers in their administrative areas to manage and supervise.
Article 49 of the social insurance agency is responsible for the management of urban workers basic medical insurance business, its duties are:
(a) responsible for the registration of basic medical insurance;
(b) management of the basic medical insurance fund;
(c) supervision of basic medical insurance medical services;
(d) responsible for the payment of the basic medical insurance benefits;
(d) responsible for the payment of basic medical insurance;
(v) proposing the budget and final account of the basic medical insurance fund;
(vi) conducting inspections and investigations related to basic medical insurance as commissioned by the administrative department of labor security;
(vii) preserving and increasing the value of the basic medical insurance fund in accordance with the state's regulations;
(viii) providing policy advice and other services related to basic medical insurance;
(h) providing information on the basic medical insurance policy and other services;
(ix) providing information and advice on the basic medical insurance policy and other services;
(x) providing advice on the basic medical insurance policy and other services. Basic medical insurance policy advice and other services;
(ix) is responsible for other basic medical insurance matters provided by the state and the province. [page]
Article 50 of the collection authority is responsible for the basic medical insurance payment registration; the basic medical insurance fund income budget, final account preparation proposals; according to the law of the collection of the basic medical insurance premiums; the basic medical insurance premiums paid by the contributing units and individuals to supervise and inspect and irregularities in the treatment of the basic medical insurance premiums.
Article 51 of the administrative department of health and drug supervision and management departments shall strengthen the designated medical institutions and designated pharmacies management and supervision, to assist the social insurance agency to carry out basic medical insurance work.
The competent administrative department of health shall deal with the behavior of medical institutions that violate the relevant provisions of health care and basic medical insurance and harm the legitimate medical rights and interests of the insured.
Drug supervision and management departments should increase drug supervision and management efforts to ensure that medical institutions and designated pharmacies to provide patients with quality, safe and effective medicines; according to law on the designated medical institutions and designated pharmacies to deal with pharmaceutical accidents.
The price management department shall inspect and supervise the basic medical insurance fees and charges, strengthen the management of unauthorized increase in fees and charges and raise the standard of behavior shall be dealt with according to law.
Article 52 of the social insurance agency shall send a list of personal account records to the individual contributors at least once a year.
Employers should announce the payment of basic medical insurance premiums to their employees and retirees every year and accept their supervision.
Article 53 of the collection agency, the administrative department of labor security and social insurance agencies, have the right to verify the employer's roster of employees, payroll, financial accounting books and other relevant information, if necessary, the audit department shall cooperate. The departments or organizations involved in the verification should keep the commercial secrets of the employer.
Employers should truthfully provide a roster of employees, payroll, financial accounting books and other relevant information, shall not be forged, altered, misrepresented, concealed or hidden.
Article 54 of the labor security administrative departments and social insurance agencies have the right to check the designated medical institutions and designated pharmacies in the diagnosis, examination, treatment, supply of medicines and charges in the implementation of the basic medical insurance regulations; the right to pay medical expenses before the examination of the medical prescription (doctor's orders), diagnosis and treatment report form, medical records, receipts and other relevant information. When necessary, health administration, drug supervision and management and price management departments should be assisted.
The fixed-point medical institutions and fixed-point pharmacies or other parties should truthfully provide medical prescriptions (doctor's orders), diagnosis and treatment report form, case, cost receipts and other relevant information, shall not be forged, altered, misrepresented, concealed or hidden.
Article 55 of the designated medical institutions, designated pharmacies in violation of the relevant provisions of the basic medical insurance, the administrative department of labor security may, depending on the circumstances, ordered to make corrections within a specified period of time, and if it fails to make corrections after the expiration of the period of time, it can be canceled the designated qualification.
Article 56 of the financial, audit, supervision and other departments and social insurance fund supervisory board shall, in accordance with the law, the basic medical insurance fund collection, management and supervision, and strengthen the employers and employees to pay the basic medical insurance premiums in accordance with the law.
The annual revenues and expenditures of the basic medical insurance fund shall be audited by the auditing authority and announced to the public before June 30 of the following year for social supervision.
Article 57 Employers and individuals have the right to inquire about the payment of basic medical insurance premiums, individual account contribution records and enjoyment of basic medical insurance benefits, and the collection agency, social insurance agency or other relevant institutions shall provide services.
Employers and individuals have the right to supervise the collection of basic medical insurance premiums by the collection agency and the basic medical insurance work of the social insurance agency; and have the right to apply for administrative reconsideration or file a lawsuit for disputes related to basic medical insurance.
Article 58 employers and individuals have the right to report illegal acts in the collection of basic medical insurance premiums and the payment of basic medical insurance benefits. Labor security administration, supervision and other departments shall promptly investigate after receiving the report, in accordance with the relevant provisions of the handling, and for the confidentiality of the informant.
Article 59 of the social insurance agency to manage the basic medical insurance funds required, included in the financial budget at the same level.
Chapter VII Legal Liability
Article 60 of the employer fails to comply with the provisions of the Regulations for basic medical insurance registration, change of registration or deregistration, the administrative department of labor security ordered to make corrections within a specified period of time; the circumstances of the seriousness of the situation, the directly responsible officers in charge and other personnel directly responsible for may be sentenced to a fine of more than 1,000 yuan to 5,000 yuan; the circumstances are particularly serious. The directly responsible officer in charge and other personnel directly responsible can be imposed a fine of more than 5000 yuan 10000 yuan.
Article 61 of the employer fails to declare the amount of basic medical insurance premiums payable in accordance with the provisions of these Regulations, the collection agency shall order rectification within a specified period of time; if the circumstances are serious, the supervisors directly responsible for and other personnel directly responsible for a fine of more than 1,000 yuan and less than 5,000 yuan; the circumstances are particularly serious, the supervisors directly responsible for and other personnel directly responsible for a fine of more than 5,000 yuan and less than 10,000 yuan. 5000 yuan or more 10000 yuan fine.
Article 62 of the employer fails to pay and withhold the basic medical insurance premiums according to the amount and period stipulated in the Regulations, the collection authority shall order the payment of the outstanding amount and interest; overdue payment is still not paid, in addition to making up for the outstanding amount of money, from the date of non-payment of money, the amount of money owed to the day of the late payment of 2 per cent of the late payment fee, but not at the same time to pay the interest. Late payment fees are incorporated into the basic medical insurance fund.
Article 63 of the employer violates the relevant financial, accounting, statistical laws and regulations and the relevant provisions of the state, falsification, alteration, misreporting, concealment, concealment, intentional destruction of the roster of employees, payroll, financial and accounting books and other information, or does not set up books, resulting in the basic medical insurance premiums can not be determined by the base of the contributions, in addition to the provisions of the relevant laws and regulations shall be subject to administrative penalties, Disciplinary action, criminal penalties, in accordance with the provisions of Article 11 of these Regulations; delay in payment, the collection authority in accordance with the provisions of the preceding article decided to add late fees, and the directly responsible officer in charge and other personnel directly responsible for a fine of 5,000 yuan or more than 20,000 yuan.
Article 64 of the social insurance agency did not pay the basic medical insurance treatment, the administrative department of labor security shall order it to pay; refused to pay, the responsible personnel to give administrative sanctions.
The fixed-point medical institutions do not pay the basic medical insurance treatment, by the administrative department of labor security or social insurance agency ordered to pay; refused to pay, by the administrative department of labor security or social insurance agency in accordance with the relevant provisions of the corresponding treatment.
If the parties concerned are not satisfied with the decision, they may apply for administrative reconsideration or file a complaint or accusation in accordance with the law.
Article 65 of the labor security administrative departments, financial departments, collection agencies or social insurance agencies in violation of the provisions of these Regulations, one of the following acts, the higher administrative organ shall order it to make corrections within a specified period of time, to recover the misappropriation or loss of the basic medical insurance fund; there is unlawful income, the confiscation of the illegal income, and into the basic medical insurance fund; the unit of the main person in charge of the directly responsible person shall be held administratively responsible, directly responsible for the administrative responsibility; constitute a crime, be held criminally responsible:
(a) not in accordance with the provisions of the basic medical insurance premiums credited to the individual account, the integrated fund;
(b) not in accordance with the provisions of the basic medical insurance fund into the basic medical insurance fund financial account;
(c) embezzlement, misappropriation of the basic medical insurance fund;
(d) the basic medical insurance fund;
(d) the basic medical insurance fund;
(d) the basic medical insurance fund;
(d) the basic medical insurance fund;
(a) the basic medical insurance fund p>
(D) violation of the basic medical insurance fund value preservation and appreciation of the provisions of the fund, resulting in losses;
(E) unauthorized reduction, exemption or increase in the basic medical insurance premiums to be paid by employers and employees;
(F) unauthorized changes in the basic medical insurance benefits.
Article 66 of the labor security administrative departments, audit departments, collection agencies or social insurance agencies and their staff to disclose the employer's commercial secrets, in accordance with relevant state laws and regulations to pursue legal responsibility. [page]
Article 67 of the designated medical institutions, designated pharmacies or other parties to use one of the following acts, fraudulent basic medical insurance costs, the social insurance agency shall refuse to pay the basic medical insurance costs or recover the paid basic medical insurance costs and interest; the circumstances are serious, by the administrative department of labor security or other administrative departments of the relevant Medical institutions and pharmacies or other parties to impose a fine of two times the amount incurred; constitutes a crime, shall be investigated for criminal responsibility:
(a) forgery, alteration of health insurance documents, medical advice, medical bills vouchers;
(b) misrepresentation, false lists of medical personnel, diagnostic and therapeutic items, treatment time, medical materials, medicines;
(c) violation of the government's Price regulations, misrepresentation of diagnostic and treatment programs, medical materials and drug prices.
Article 68 of the employer or other parties to the collection authority or the administrative department of labor security of the collection of basic medical insurance premiums and interest, late payment, penalties and other decisions, may apply for reconsideration, bring an administrative lawsuit in accordance with the law. Late application for reconsideration, do not bring a lawsuit, and do not fulfill the decision, the collection agency or the administrative department of labor security can apply to the people's court for compulsory execution.
Chapter VIII Supplementary Provisions
Article 69 of the retirees, the Old Red Army, the second class B disabled retired revolutionary soldiers of medical treatment in accordance with the relevant provisions of the State.
Article 70 The provincial people's government shall decide whether employees of urban individual economic organizations and township enterprises shall participate in basic medical insurance.
Article 71 The provincial people's government may formulate implementation rules in accordance with these Regulations.
Article 72 These Regulations shall come into force on the date of promulgation.