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Chapter I General Provisions
Article I According to the "State Council on the establishment of basic medical insurance system for urban workers decision" (Guo Fa [1998] No. 44) and "Hebei Provincial People's Government on the issuance of Hebei Province to establish a basic medical insurance system for urban workers of the overall planning of the notice" (Hebei Government [1999] No. 12), combined with the actual situation in the city, the formulation of this program.
The main task of the reform of the second medical insurance system is: to establish a basic medical insurance system for urban workers, that is, to adapt to the socialist market economic system, according to the financial, corporate and individual affordability, the establishment of a social medical insurance system to protect the basic medical needs of workers.
Article 3 to establish the basic medical insurance system for urban workers is the principle of: the basic level of medical insurance and the city's level of socio-economic development, and financial, employers and employees of the affordability of the city; all urban employers and their employees to participate in the basic medical insurance, the implementation of territorial management; the basic medical insurance premiums paid by the employer and the employee both **** the same to determine the cost of revenue and expenditure The basic medical insurance fee is paid by both the employer and the employee, and is based on income to determine expenditure and income to balance expenditure; the basic medical insurance fund is a combination of a social coordinator and an individual account.
Article 4 of this program applies to all urban employers within the jurisdiction of the city, including state organs, institutions, social organizations, private non-enterprise units and enterprises (state-owned enterprises, collective enterprises, joint-stock enterprises, foreign-invested enterprises, private enterprises) and their employees and retirees.
Township and village enterprises and their employees, urban individual economic owners and their employees do not participate in basic medical insurance for the time being.
Article 5 of the city's basic medical insurance for urban workers to implement the city, county (city) district two-level coordination, county (city) district implementation of the county (city) district by the county (city) district to develop, reported to the municipal people's government for approval. Employers and their employees in accordance with the principle of territorial management, to participate in the basic medical insurance in the coordinated area.
Chapter II of the medical insurance management and the responsibilities of the agency
Article 6 of the Municipal Bureau of Labor and Social Security is responsible for the city's urban workers medical insurance, the main duties are:
(a) to implement the national and provincial policy on urban workers medical insurance policy;
(b) the development of the city's health insurance policy;
(c) in conjunction with the health, medical insurance, health and social security, the city's health insurance, health and social security. >(3) to formulate, in conjunction with the departments of health and medicine, the qualifications of designated medical institutions and pharmacies, and to issue certificates to qualified medical institutions and retail pharmacies;
(4) to organize, in accordance with the relevant provisions of the State and the province, the departments concerned to formulate the relevant complementary policies of the city's medical insurance, the Catalogue of Medicines for Basic Medical Insurance, the Catalogue of Services for Basic Medical Insurance, the Administrative Measures for Designated Medical Institutions and Designated Pharmacies, and the Administrative Measures for Designated Medical Institutions and Designated Pharmacies. Management Measures of Designated Pharmacies, etc.
(v) Strengthening the organization, coordination, supervision and guidance of medical insurance work;
(vi) Accepting disputes concerning medical insurance;
(vii) Rewarding and punishing units and individuals for exemplary compliance with or violation of medical insurance policies and regulations;
(viii) Other work that should be taken charge of by the Municipal Labor Security Administration Department .
Article 7 establishes a medical insurance agency under the Municipal Bureau of Labor and Social Security to specifically handle the city's urban workers' medical insurance business, and its main responsibilities are:
(1) responsible for the collection, management and payment of the medical insurance fund;
(2) responsible for the preparation of the employees' basic medical insurance fund budget;
(3) responsible for determining the fixed-point medical institutions and designated pharmacies, signing medical insurance service contracts with designated medical institutions and pharmacies in accordance with the regulations, and giving guidance and management to their relevant business work;
(d) handling the relevant formalities for the enrollment of insured units and employees in the insurance scheme.
(e) To receive inquiries from the insured units and employees concerning medical insurance business;
(f) To put forward suggestions and opinions on improving and perfecting the work of medical insurance;
(g) To do the corresponding supporting services;
(h) To accept the supervision of the administrative departments of labor and social security, finance, audit and other departments as well as the insured.
Chapter III of the medical insurance fund
Article VIII of the basic medical insurance premiums for urban workers, by the employer and the individual employee **** the same payment. The employer shall pay 6.5% of the total wages and incomes of the employees in the previous year, and the employees shall pay 2% of their total wages in the previous year.
Retirees do not pay medical insurance premiums.
The standard of payment of medical insurance premiums shall be appropriately adjusted by the People's Government of the city in accordance with the regulations of the provincial government and the factors of economic development and wage increase of the city, and no department or unit shall raise or lower it without authorization.
Article IX employers must pay the full amount of medical insurance premiums to the insurance agency on a monthly or quarterly basis.
Article 10 the employer obtains a business license or permission to set up within 30 days, must apply for medical insurance registration procedures, not in accordance with the provisions of the medical insurance procedures, the employer and the individual shall bear the corresponding responsibility.
Article 11 of the employer must be in accordance with the provisions of the medical insurance agency to declare the number of participants and their previous year's total wages and income, approved by the medical insurance agency to implement. If the employer does not report to the medical insurance agency in accordance with the provisions of the report, the medical insurance agency shall temporarily pay 110% of the amount of the previous year's contributions of the employer as the amount of its contributions.
Article 12 of the medical insurance premiums paid in full and on time, by the medical insurance agency and the employer signed a contract, or entrusted to the depositary bank to deduct from its account.
The medical insurance premiums payable by individual employees shall be withheld by the employing organization from their wages.
Article 13 of the employer fails to pay and withhold medical insurance premiums in accordance with the provisions of the employer shall be ordered to pay; overdue payment is still not paid, in addition to make up for the amount of arrears of payment, from the date of arrears of payment, a late payment of 2 per cent of the daily charge. The late payment fee shall be added to the medical insurance fund.
Article XIV of the total wages of individual employees more than 300% of the city's average social wage in the previous year, 300% as the basic medical insurance premiums for the contribution base. Participating units did not pay or pay the full amount of medical insurance premiums, the unit employees (including retirees) is limited to the use of individual medical account funds, until exhaustion, do not enjoy the relevant treatment paid by the social medical fund, the unpaid period of medical fees are still the responsibility of the employee's unit.
Article 15 of the basic medical insurance premiums for laid-off workers of state-owned enterprises, including unit contributions and individual contributions, are paid by the industry or enterprise re-employment service centers in accordance with the city's average wage of 60% of the previous year as the basis for the payment of the average salary of employees.
Article 16 of the law declared bankruptcy of the employer, in the settlement of debts should be given priority in the settlement of the outstanding medical insurance premiums and pay the full retirees need later (calculated to 70 years of age) of the basic medical insurance premiums.
Article 17 of the contributory units abolished or merged, mergers, transfers, leases, contracting, the receiver or operator must assume the responsibility for the medical insurance of the former contributory units and their employees, and pay or make up the basic medical insurance premiums for the employees in a timely manner.
Article 18 The employer shall report to the workers' congress on the payment of medical insurance premiums, and consciously accept the supervision of the trade union of the employer and the workers.
Article 19 of the medical insurance premiums paid by the employer, the party and government organs and financial provision of institutions by the same level of financial allocation. Differential, self-supporting institutions and enterprises to pay the basic medical insurance premiums, from the welfare costs, the welfare costs are insufficient, may be charged to the public welfare fund, or approved by the financial departments at the same level and included in the cost.
Chapter IV of the basic medical insurance fund and the establishment of individual accounts
Article 20 of the basic medical insurance fund to implement a combination of social coordination and individual accounts.
(1) Establishment of Individual Accounts
1. Health insurance agencies establish individual medical accounts for employees and manage them in a unified manner. The agency shall set up medical insurance numbers for employees participating in basic medical insurance, and the individual accounts shall be managed through a computer network using medical insurance smart cards (IC cards).
Individual account consists of two parts: ① individual working employees pay 2% of their total wages to the basic medical insurance premiums. ② 30% of the employer's contribution to medical insurance premiums should be allocated to the personal account of the part of the retiree's personal account is higher than the equivalent of the amount of the personal account of the active employees 20%.
2. The determination of the full age of active employees is based on the full age before July 1 of the year, and is approved at once when the roster is declared. No change will be made to the proportion of personal account credited in the current year, and any change will be uniformly adjusted in the next year's approval.
3. When an active employee reaches the legal retirement age, he/she will no longer pay the basic medical insurance premiums from the month following his/her formal retirement and will enjoy the basic medical treatment for retirees accordingly.
(2) Composition of the Coordinated Fund
The basic medical insurance premiums paid by the employing organization shall be transferred to the employee's personal account according to the ratio stipulated in the preceding paragraph, and the rest shall be paid into the Basic Medical Insurance Coordinated Fund.
Article 21: The principal and interest of the individual account shall be owned by the insured person, and shall be limited to the payment of medical expenses, shall not be overdrawn, shall not be withdrawn in cash, and may be carried forward and inherited in accordance with the law. When an employee transfers to another job, the balance of the individual account is transferred.
Chapter V medical insurance services
Article 22 of the city, all approved by the health administrative department and obtained a "license to practice medical institutions" of general hospitals, Chinese medicine hospitals, specialty hospitals, outpatient clinics, infirmaries, community service stations and other health care institutions; all the state-run, collective holding a "drug business enterprise license", "Drug Business Enterprise Certificate of Conformity," "Business License" by the Drug supervision and management department of the annual review of qualified retail pharmacies, willing to undertake urban basic medical insurance services, can apply for fixed-point qualification.
Article 23 of the designated medical institutions and designated pharmacies shall adhere to the relevant provisions of the basic medical insurance for employees, in accordance with the "treatment of diseases, reasonable inspection, rational use of medicines, scientific compounding", the use of domestically produced medicines do not need to use imported drugs, the principle of joint venture drugs, standardize the behavior of medical and pharmaceutical services, and to provide high-quality basic medical services for the insured. Basic medical services.
Article 24 The municipal labor and social security administrative department shall, on the basis of the application of the reporting unit, examine its qualifications, and approve the qualified medical institutions and retail pharmacies to become designated medical insurance service institutions, and issue certificates to designated medical institutions and designated retail pharmacies.
Article 25 of the designated medical institutions and designated retail pharmacies shall be equipped with full-time (part-time) management personnel, and medical insurance agencies **** with the management of designated medical services.
Article 26 of the fixed-point medical institutions for the issuance of the "urban workers' basic medical insurance card" of the person diagnosed with a disease requiring hospitalization, in the patient to pay the hospitalization deposit, should be promptly arranged for hospitalization.
When a person entitled to medical insurance treatment is discharged from the hospital, a list of hospitalization medical expenses shall be issued by the designated medical institution, and in addition to the out-of-pocket medical expenses, the rest shall be paid by the medical insurance agency.
Article 27 of the designated medical institutions shall vigorously develop community medical services, improve the quality of medical services, and reduce the cost of medical services.