(1) Provisions on medical treatment period for employees who are sick or injured at work.
According to the provisions of Article 3 of the Provisions on Medical Treatment Period for Enterprise Employees Suffering from Illness or Non-work-related Injury (hereinafter referred to as the Provisions on Medical Treatment Period), if an enterprise employee needs to stop working for medical treatment due to illness or non-work-related injury, a medical treatment period of three months to twenty-four months shall be given according to his actual working years and working years in this unit:
1, the actual working experience is less than ten years, and the working experience in this unit is less than five years, which is three months; More than five years is six months.
2, the actual working life of more than ten years, less than five years in this unit for six months; More than five years but less than ten years and nine months; Twelve months of more than ten years and less than fifteen years; Fifteen years, twenty years and eighteen months; Twenty years or more is twenty-four months.
Article 4 stipulates that if the medical treatment period is three months, it shall be calculated according to the accumulated sick leave time within six months; For six months, calculate the accumulated sick leave time within twelve months; Nine months is calculated according to the accumulated sick leave time within fifteen months; Twelve months is calculated according to the accumulated sick leave time within eighteen months; Eighteen months is calculated according to the accumulated sick leave time within twenty-four months; Twenty-four months is calculated according to the accumulated sick leave time within 30 months.
Paragraph 2 of Article 1 of the Notice of the Ministry of Labor on Implementing the Provisions on Medical Treatment Period for Employees Suffering from Illness or Non-work-related Injury stipulates that the sick leave period includes public holidays, holidays and statutory holidays. Article 2 Regarding the medical treatment period of special diseases, Article 1 stipulates that according to the current actual situation, if some employees suffer from special diseases (such as cancer, mental illness, paralysis, etc. ) If it cannot be cured within 24 months, the medical treatment period may be appropriately extended with the approval of the enterprise and the labor department.
In addition, according to Item 1 of Article 29 of the Labor Law, if a worker is sick or injured, the employer shall not terminate the labor contract according to the provisions of Articles 26 and 27 within the prescribed medical treatment period. Article 2 of the Regulations on Medical Treatment Period also stipulates that the medical treatment period refers to the period when employees of an enterprise stop working due to illness or non-work-related injuries and do not terminate the labor contract.
(2) Provisions on the treatment of employees during medical treatment for illness or non-work-related injuries.
According to Article 5 of the Regulations on Medical Treatment Period, the sick pay, disease relief and medical treatment of enterprise employees during the medical treatment period shall be implemented in accordance with relevant regulations. Specifically:
1, sick pay.
According to Article 59 of the Opinions of the Ministry of Labor on Several Issues Concerning the Implementation of the Labor Law of People's Republic of China (PRC) (hereinafter referred to as the Opinions of the Labor Law), during the treatment period of employees' illness or non-work-related injuries, enterprises shall pay their sick pay or disease relief funds in accordance with relevant regulations, which can be paid below the local minimum wage, but not less than 80% of the minimum wage.
2, disease relief funds.
Article 5 of the Medical Treatment Period Regulations stipulates that sick pay and sickness benefits are juxtaposed, but article 59 of the Labor Law Opinions stipulates that it is optional. Judging from the stipulated time, the former stipulates the time first, and the latter stipulates the latter. According to Article 83 of the Legislative Law, if the regulations formulated by the same organ are inconsistent with the old regulations, the new regulations shall apply. For sick pay and sickness allowance, the provisions of the Labor Law Opinions should be applied, that is, only one of them can be applied, that is, sick pay or sickness allowance can be applied. But no matter what kind of treatment is applied, it cannot be lower than 80% of the minimum wage. In this regard, local practices vary. For example, as stipulated in Article 1 of the Notice on Publishing (Lu Laofa [1995] No.67) forwarded by the Labor Department of Shandong Province, if an employee of an enterprise suffers from illness or non-work-related injury and the cumulative downtime does not exceed 180 days during the medical treatment period, the enterprise will pay him sick pay of 70% of his salary; If the accumulated time does not exceed 180 days, I will get 60% of my salary as sickness allowance. Therefore, sick pay and sickness allowance are applicable at the same time, as long as the accumulated days of employees injured due to illness or non-work do not exceed 180 days. Article 1 of the Notice of Shanghai Labor and Social Security Bureau on the Minimum Standard of Sick Pay or Disease Relief Fee for Employees of Enterprises in this Municipality (No.4 of Shanghai Labor and Social Security Bureau/kloc-0) stipulates that the sick pay or disease relief fee paid by enterprises to employees during sick leave shall not be lower than 80% of the minimum wage standard of employees of enterprises in this Municipality in that year. In other words, sick pay and sickness allowance can only be applied to one of them, but not to both.
3. medical care.
Article 3 of the State Council's Decision on Establishing the Basic Medical Insurance System for Urban Workers (hereinafter referred to as the Decision) stipulates that basic medical insurance funds and personal accounts shall be established. Paragraph 3 of Article 4 of the State Council's "Pilot Program for Improving the Urban Social Security System" stipulates that individual accounts are mainly used for minor illnesses or outpatient expenses, and pooling funds are mainly used for serious illnesses or hospitalization expenses. According to the second paragraph of Article 7 of the Decision, the people's governments of all provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the requirements of this Decision, formulate an overall plan for the reform of the medical insurance system and report it to the Ministry of Labor and Social Security for the record. The overall planning area shall, according to the planning requirements, formulate an implementation plan for basic medical insurance, which shall be implemented after being submitted to the people's governments of provinces, autonomous regions and municipalities directly under the Central Government for examination and approval. Specifically including:
(1) According to Article 1 of the Opinions of the Ministry of Labor and Social Security on the Management of Basic Medical Insurance for Urban Employees (hereinafter referred to as the Opinions on Insurance Projects), the basic medical insurance diagnosis and treatment projects refer to all kinds of medical technical services and medical instruments, equipment and medical materials that meet the following conditions:
First, necessary, safe, effective and affordable clinical diagnosis and treatment projects;
Second, the price department has formulated a diagnosis and treatment project with charging standards;
The third is the diagnosis and treatment projects within the scope of designated medical services provided by designated medical institutions for the insured.
Specifically, Article 2 of the Annex "Scope of National Basic Medical Insurance Diagnosis and Treatment Projects" on insurance projects in the Opinions makes clear and specific provisions on the scope of diagnosis and treatment projects where basic medical insurance pays part of the expenses.
(2) According to Article 2 of the Interim Measures of the Ministry of Labor and Social Security for the Administration of Medication Scope of Basic Medical Insurance for Urban Employees, the medication scope of basic medical insurance is managed through the formulation of the basic medical insurance drug list. Accordingly, the Ministry of Labor and Social Security has formulated the Catalogue of Medicines for Basic Medical Insurance, which clearly stipulates western medicine, Chinese medicine and Chinese herbal pieces.
4. Supplementary medical insurance
According to the fourth paragraph of Article 4 of the State Council's Decision on Establishing the Basic Medical Insurance System for Urban Employees and the provisions of the Pilot Program on Improving the Urban Social Security System, a social medical assistance system is established. Conditional enterprises can establish supplementary medical insurance for employees, and the withdrawal amount shall not exceed 4% of the total wages, which shall be charged from the cost.