Hainan Special Economic Zone urban workers medical insurance regulations implementation rules

Article 1 In accordance with the Regulations on Medical Insurance for Urban Employees of the Hainan Special Economic Zone (hereinafter referred to as the Regulations), these Implementing Rules are hereby formulated. Article 2 All urban workers within the scope of the Hainan Special Economic Zone, regardless of their household registration, shall participate in medical insurance in accordance with the provisions of the Regulations. Article 3 Employees of organizations outside the province stationed in Qiong shall participate in medical insurance in accordance with the provisions of the Regulations, except for those who have already participated in medical insurance in their place of origin and have provided certificates from the medical insurance organizations in their place of origin. Article 4 The employees of foreign countries and organizations of Hong Kong, Macao and Taiwan stationed in Qiong shall participate in medical insurance in accordance with the regulations. However, foreigners and personnel from Hong Kong, Macao and Taiwan are excluded. Article 5 The central and provincial organs, institutions and social organizations stationed in Haikou and Fucheng districts, enterprises registered in the industrial and commercial administrative departments at or above the provincial level, army organs recruiting non-military practitioners and units approved by the provincial social security institutions to handle medical insurance across the province, shall apply for medical insurance in the provincial social security institutions.

Employers in the provincial agricultural reclamation system handle their medical insurance at the provincial social security agency for reclamation.

Employers in the Yangpu Economic Development Zone apply for medical insurance at the Yangpu Social Security Agency.

Other employers shall apply for medical insurance at the social security institutions of the cities, counties and autonomous counties where they are located. Article 6 Institutions that are subsidized by the financial gap to enjoy public medical care, the amount of subsidy for medical insurance premiums shall be approved by the financial department based on the income and expenditure of the unit, and shall be allocated to the unit on a monthly or quarterly basis, and the unit shall pay the medical insurance premiums to the social security institution directly. Article 7 The total amount of wages for the payment of medical insurance premiums shall be approved on an annual basis and settled at the end of the year. Article 8 In addition to the medical insurance stipulated in the regulations, an employing unit may apply for supplementary medical insurance for its employees.

The amount of supplementary medical insurance premiums shall be determined by the employer and credited to the individual medical account, which shall be used in accordance with the regulations.

Supplementary medical insurance shall be handled in a fair, open and legal manner. Article 9 of the regulations referred to as the average social wage, according to the people's government statistics department published statistics to determine, not to implement the classification of calculation.

Hospitalization or emergency rescue for diseases listed in the catalog of diseases for which medical fees are paid by the ****ji medical account shall be paid by the ****ji medical account in accordance with the provisions of the regulations.

Diseases or physical defects that are not covered by the ****ji medical account in the catalog of medical treatment categories are covered by their own medical fees.

The medical treatment of diseases that are not listed in the list of diseases for which medical fees are paid by the ****JI Medical Account and those for which medical fees are not paid by the ****JI Medical Account, and which require hospitalization or emergency rescue due to the seriousness of the condition, shall be certified by the medical institution and reported to the social security institution for examination and approval, and then the medical fees shall be paid by the ****JI Medical Account in accordance with the regulations; and the medical fees shall be paid by the ****JI Medical Account if the medical treatment is not approved by the social security institution. the person himself/herself.

Outpatient emergency rescue process and hospitalization process is not interrupted, can be handled as a one-time medical expenses. Article 12 If a patient's emergency resuscitation or hospitalization process is intermittent, the specific year shall be approved by the time of discharge procedures.

Practitioners, retirees again that year for the treatment of diseases belonging to the medical account by the *** relief medical care to pay for hospitalization or emergency rescue, the current year has been paid for the medical expenses listed in Article 30, paragraph 1 of the regulations, individuals no longer bear the medical expenses, but should be the first advance payment of the medical expenses listed, discharge or emergency rescue treatment with the relevant medical documents and social security institutions to settle the bill. Article 13 The use of high-tech examinations must be in accordance with the indications for the examination of diseases for which medical fees are to be paid from the ****ji medical account. The examination fee shall be borne by the patient himself/herself. Article 14 For the installation of domestic or imported artificial organs (heart valves, artificial crystals, artificial larynxes and artificial hip joints), pacemakers, etc., the ****Care Account shall pay the prescribed fees according to the standard of the domestic universal type; if there is no domestic universal type with comparable prices, and if the use of them is approved by the social security institutions, the patient shall bear 30% of the fees.

Organs of the human body approved for use by the social security institutions, ***Jiji medical account at the average price of the domestic market or at the price of similar artificial organs to pay. Article 15 Medical items (shock wave lithotripsy, hemodialysis, peritoneal dialysis, hyperbaric oxygen chamber, microwave diathermy irradiation, X-ray knife, r-knife, etc.) that use high-tech equipment to carry out treatments at a cost higher than 50% or more than that of conventional treatments are accounted for individually, and are paid for by the individual at his or her own expense by 20%.