Archived（May 31, 2018）
Measures of the Shenzhen Municipality on Social Medical Insurance deliberated and adopted at the Eighty-Third Executive Meeting of the Fourth Municipal Government is now promulgated and will take effect as of March 1, 2008.
Mayor Xu Zongheng
January 30, 2008.
Measures of the Shenzhen Municipality on Social Medical Insurance
Chapter I General Provisions
Article 1 In order to establish, improve the social medical insurance system of the Shenzhen City, to strengthen the capacity of participants to resist the risks of diseases, and to guarantee their needs in medical services, these measures are hereby formulated in accordance with the related rules of the state and in the light of the actual conditions of this city.
Article 2 This City shall put into practice a multitier social medical insurance system.
The government shall establish the systems of basic medical insurance, local supplementary medical insurance, and birth medical insurance.
The basic medical insurance shall set up four types of medical insurance, namely, comprehensive medical insurance, hospitalization medical insurance, farmer-turned migrant workers medical insurance, and medical insurance for children hospitalization and outpatient service for serious diseases.
The government shall establish the medical subsidy system of public servants, encourage and support enterprises in establishing the supplementary medical insurance system, and encourage individuals to participate in the commercial medical insurance.
Article 3 The employer units in this city and their employees, and other persons having the registered permanent residence in this city shall participate in the medical insurance according to these measures.
The employer units referred to in these measures shall mean the government offices, public institution units, social organizations, enterprises, civilian-run non-enterprise units, individual economic organizations.
The participating units referred to in these measures shall mean the employer units that have participated in the medical insurance.
The participants referred to in these measures shall mean the persons who have participated in the medical insurance.
The farmer-turned migrant workers referred to in these measures shall mean the workers who are employed in this city and have no registered permanent residence in this city but in the countryside.
Article 4 The medical insurance system shall follow the principle of combination of fairness and efficiency, correspondence between rights and obligations, adaptation of the security level to the level of the development of social productive forces.
Article 5 The municipal administrative department of labor security (hereinafter referred to as the municipal department of labor security) shall be in charge of the medical insurance of this city, the municipal agency of social insurance shall specifically operate the medical insurance.
The related municipal departments of development and reform, education, civil administration, finance, prices, drug administration, etc. shall assist in providing the quality medical insurance.
Article 6 The municipal supervision committee of social insurance funds shall be responsible for the supervision over the implementation of the laws, regulations, and rules on the medical insurance and the income, expenditure, and management of the funds.
Article 7 The municipal government may, according to the income and expenditure of the medical insurance funds, make corresponding adjustments of the premium rates, the ratio between pool funds and individual accounts, and benefits.
Chapter II Limits of Insurance Participation
Article 8 The comprehensive medical insurance shall apply to the following persons:
(1) the persons on the job who have the registered permanent residence in this city;
(2) the retirees who had the registered permanent residence in this city before their retirement and receive monthly payment for the old-age insurance benefits from the municipal agency of social insurance;
(3) the retirees of the units stationing in Shenzhen and participating in the former overall trade plan of the old-age insurance who receive monthly payment for the old-age insurance benefits from the social insurance agencies of the Guangdong Province and Beijing City and participated in the medical insurance of this city before their retirement;
(4) the retirees who had the registered permanent residence in this city before reaching the statutory age of retirement, but receive no monthly payment for the old-age insurance benefits;
(5) the persons who have the registered permanent residence in this city after reaching the statutory age of retirement and enjoy no medical insurance in other places of this country;
(6) the persons who have the registered permanent residence in this city, are over 18 years old but have not reached the statutory age of retirement, do not register themselves as students, enjoy neither unemployment insurance benefits nor minimum living standards allowances, and have no employer units to be affiliated with;
(7) the other persons stipulated by the municipal government.
Employer units shall be encouraged to participate in the comprehensive insurance
for their employees who have no registered permanent residence in this city.
Article 9 The hospitalization medical insurance shall apply to the following persons:
(1) the persons on the job who has no registered permanent residence in this city but in towns;
(2) the retirees who receive monthly payment for the old-age insurance benefits from the municipal agency of social insurance, but have no registered permanent residence in this city;
(3) the unemployed persons who have the registered permanent residence in this city and are still in the period of receiving unemployment allowances;
(4) the persons who have the registered permanent residence in this city, are over 18 years old, and enjoy the minimum living standards allowances;
(5) the farmer-turned migrant workers who have established the labor relationship with employer units other than enterprises in this city;
(6) the other persons stipulated by the municipal government.
The persons who have the registered permanent residence in this city and have not
reached the statutory age of retirement, but have difficulty in making a living may apply to participate in the hospitalization medical insurance.
Enterprises shall be encouraged to participate in the hospitalization medical insurance for their farmer-turned migrant workers.
Article 10 The farmer-turned migrant workers medical insurance shall apply to the farmer-turned migrant workers who have established the labor relationship with enterprises in this city.
If enterprises submit applications, their low-income employees on the job who have no registered permanent residence in this city but in towns may participate in the farmer-turned migrant workers medical insurance.
Article 11 The medical insurance for children hospitalization and outpatient service for serious diseases shall apply to the children who have registered in the nursery institutions, elementary schools, junior middle schools, senior middle schools, polytechnic schools, special schools, technical schools and vocational schools (not including universities and colleges) and the children who have the registered permanent residence in this city, are under 18 years old, but do not go to school or nursery institutions. Specific measures shall be stipulated separately.
Article 12 The local supplementary medical insurance shall apply to the persons who have participated in the comprehensive medical insurance and the hospitalization medical insurance.
Article 13 The birth medical insurance shall apply to the persons who have participated in the comprehensive medial insurance, but have not reached the statutory age of retirement.
Article 14 The persons who have participated in the out-of-city medical insurance shall not participate in the medical insurance of this city.
Chapter III Collection and Management of Funds
Article 15 The medical insurance funds shall include the basic medical insurance fund, the local supplementary medical insurance fund, and the birth medical insurance fund.
The basic medical insurance fund shall consist of the pool fund and individual accounts, the pool fund shall consist of the serious disease pool fund, the community outpatient service pool fund, and the regulating fund.
Article 16 The medical insurance funds shall be all put in the special financial accounts of the medical insurance funds, managed through separation between income and expenditure, earmarked for their specified purposes only, and strictly prohibited from being converted to other use and misappropriated.
Article 17 The principle of determining income according to expenditure, keeping balance of income and expenditure, and having only a small amount of surplus shall be put into practice for the medical insurance funds.
If there is a deficit of the medical insurance funds caused by special circumstances such as the breaking-out of an epidemic, major natural disasters, etc., financial subsidies shall be provided.
Appropriate financial subsidies shall be provided for the non-employee residents having the registered permanent residence in this city and farmer-turned migrant workers to participate in medical insurance. Specific measures shall be formulated separately.
Article 18 The sources of the medical insurance funds shall be:
(1) the medical insurance premiums paid by participating units, participants;
(2) the interests of the medical insurance premiums;
(3) the financial subsidies;
(4) the other income.
Article 19 The persons who have participated in the comprehensive medical
insurance shall pay their basic medical insurance premiums according to the following rules:
(1) the persons on the job shall take the total of the monthly wages as a payment base, and their monthly payment shall be 8% of the payment base in which 6% shall be paid by the employer units and 2% by the individuals, those whose monthly total wages are 300% higher than the previous year’s average monthly wages of the employees on the job in this city shall take 300% of the previous year’s average monthly wages of the employees on the job in this city as a payment base, those whose total monthly wages are 60% lower than the previous year’s average monthly wages of the employees on the job in this city shall take 60% of the previous year’s average monthly wages of the employees on the job in this city as a payment base;
(2) the retirees who had the registered permanent residence in this city before retirement and receive monthly payment for the old-age insurance benefits from the municipal agency of social insurance shall take their monthly old-age insurance pension as a payment base, and monthly payment of 11.5% of the payment base shall be made by the old-age insurance fund;
(3) the retirees of the units stationing in Shenzhen and participating in the former overall trade plan of the old-age insurance who receive monthly payment for the old-age insurance benefits from the social insurance agencies of the Guangdong Province and Beijing City and participated in the medical insurance of this city before their retirement shall take the previous year’s average monthly wages of the employees on the job in this city as a payment base, the former employer units shall make one-time lump-sum payment of 11.5% of the payment base × 12 months × 18years;
(4) the retirees who had the registered permanent residence in this city before reaching the statutory age of retirement, but receive no monthly payment for the old-age insurance benefits shall choose a payment base between 6% and 300% of the previous year’s average monthly wages of the employees on the job in this city, and then make monthly payment of 11.5% of the payment base on their own;
(5) the persons who have the registered permanent residence in this city after reaching the statutory age of retirement and have no medical insurance in other places of this country shall take the previous year’s average monthly wages of the employees on the job in this city as a payment base and make one-time lump-sum payment of 11.5% of the payment base×12months×18years when participating in the medical insurance of this city for the first time;
(6) the persons who have the registered permanent residence in this city, are over 18 years old but have not reached the statutory age of retirement, do not register themselves as students, enjoy neither unemployment insurance benefits nor minimum living standards allowances, and have no employer unit to be affiliated with shall choose a payment base between 6% and 300% of the previous year’s average monthly wages of the employees on the job in this city and make monthly payment of 8% of the payment base on their own.
(7) the other persons’ payment shall be made according to the related rules of the municipal government.
Article 20 The persons who have participated in the hospitalization medical
insurance shall pay their basic medical insurance premiums monthly, the premium rate shall be 0.8% of the previous year’s average monthly wages of the employees on the job in this city, and specific methods shall be as follows:
(1) the premiums of the persons on the job shall be paid by their employer units in the proportion of 6% of the payment base and by the individuals themselves in the proportion of 2% of the payment base;
(2) the premiums of the retirees who receive monthly payment for the old-age insurance benefits from the municipal agency of social insurance, but have no registered permanent residence in this city and the unemployed persons who have the registered permanent residence in this city and are still in the period of receiving unemployment allowances shall be paid by the municipal agency of social insurance respectively from the mutual aid fund of the basic old-age insurance and the unemployment insurance fund;
(3) the other people’s methods of payment shall be stipulated separately.
Article 21 The local supplementary medical insurance premiums shall be paid
according to the following standards:
(1) the persons who have participated in the comprehensive medical insurance shall pay 0.5% of their payment base;
(2) the persons who have participated in the hospitalization medical insurance shall pay 0.2% of their payment base.
The premiums of the persons on the job shall be paid by the employer units, the
others shall pay these premiums through the channels and in the way as they pay their basic medical insurance premiums.
Article 22 The farmer-turned emigrant workers medical insurance premiums shall be paid at the rate of 12 RMB per person for a month in which 8 RMB shall be paid by the employer unit and 4 RMB paid by the individual.
Article 23 The birth medical insurance premiums shall be paid monthly at the rate of 5% of the payment base of the comprehensive medical insurance, employer units shall pay such premiums for the persons on the job, and the others shall make payment on their own.
Article 24 Employer units shall go through formalities for the registration and participation in the insurance at the municipal agency of social insurance within 30 days from the date of their establishment or having obtained their licenses.
The participants who have no employer unit but the registered permanent residence in this city shall go through formalities themselves for the individual participation in the insurance at the municipal agency of social insurance.
The medical insurance premiums shall be collected by the banks at which participating units and participants have opened accounts and then transferred to the accounts of the social insurance funds opened at the banks by the municipal agency of social insurance.
Article 25 If employer units and participants fail to make payment of the medical insurance premiums, they shall not be allowed to pay overdue premiums later.
If the participants who participated in the basic medical insurance of this city for more than 1 year consecutively and discontinued the participation for no more than 3 months in one medical insurance year because of the change of their job, the years of the consecutive participation in the insurance before and after the discontinuation may add up for the calculation of the years of the consecutive participation in the insurance after restarting payment for premiums.
The years of the participation in the insurance shall be recalculated from scratch if the periods of the discontinuation of the participation in the insurance in one medical insurance year add up to more than 3 months.
Article 26 Employer units may select the types of medical insurance to participate, but may not make changes within 12 months after making the selection.
If a participant reselects the type of medial insurance, the years of the participation in the basic medial insurance of the participant during the periods of the participation in different types of medical insurance may be converted to each other.
The years of the participation in the local supplementary medical insurance of the participants of the comprehensive medical insurance and the hospitalization medical insurance may be converted to each other.
The years of the participation in the former laborer medical insurance shall be taken as the equivalent to the years of the participation in the farmer-turned emigrant workers medical insurance.
Article 27 The medical insurance premiums paid by employer units and individuals shall be listed as pre-tax expenses.
Article 28 The interests of the funds in the medical insurance pool funds and individual accounts shall be calculated according to the related rules of the state.
Article 29 The basic medical insurance premiums paid by participating units and participants shall be put in the basic medical insurance fund to pay for the benefits of the basic medical insurance; the local supplementary medical insurance premiums shall be put in the local supplementary medical insurance fund to pay for the benefits of the local supplementary medical insurance and the other expenses stipulated by these measures; the birth medical insurance premiums shall be put in the birth medical insurance fund to pay for the benefits of the birth medical insurance.
Article 30 The municipal agency of social insurance shall open individual accounts for the participants of the comprehensive medical insurance mainly to pay for outpatient services, the specific proportion shall be as follows:
(1) in the case of non-retiree participants, 5% of the payment base shall be credited to their individual account if they are under 45, and 5.6% of the payment base shall be credited to their individual account if they are over 45;
(2) in the case of retiree participants, 8.05% of the payment base shall be credited to their individual accounts. As for those who have made one-time lump-sum payment, the amount which should be put in their individual accounts shall be credited to their individual accounts monthly, and the years of their consecutive payment shall be calculated from the first day of the month following the month when the payment is made.
The rest of the basic medical insurance premiums of the comprehensive medical
insurance shall be put in the serious disease pool funds mainly to pay for the medical expenses stipulated by these measures.
Article 31 The municipal agency of social insurance shall establish the community outpatient service pool fund and the regulating fund for the participants of the hospitalization medical insurance and the farmer-turned emigrant workers medical insurance, 6 RMB from the medical insurance premiums of each participant shall be put in the outpatient service pool fund of the community where the community health service center selected by each participant is located to pay for outpatient services; 1 RMB from the medial insurance premiums of each participant shall be put in the regulating fund to regulate medical expenses between account-settling hospitals of the selected community health service centers.
The remaining part of the basic medical insurance premiums of the hospitalization medical insurance and the farmer-turned emigrant workers medical insurance other than those put in the community outpatient service fund and the regulating fund shall be put in the serious disease pool fund.
If there is a surplus in the community outpatient service fund, it shall be carried over to the next year for expenses.
Article 32 If the participants who have the registered permanent residence in this city move their registered permanent residence to other places of this country or the participants who have no registered permanent residence in this city leave this city, their relationship with the medical insurance of this city may be terminated after they submitted applications, the remaining sum of their individual accounts shall be transferred to the social insurance agencies of the places where they have the registered permanent residence; if the remaining sum cannot be transferred, it shall be returned to the participants themselves by one-time lump-sum payment.
If participants die, the remaining sum of their individual accounts shall be paid to their heirs; if there is no heir, the remaining sum shall be transferred to the basic medical insurance pool fund.
If the participants who have made one-time lump-sum payment for the medical insurance premiums die, the amount of their paid medical insurance premiums which has not been credited to the individual accounts shall be transferred to the basic medical insurance pool fund.
Chapter IV Benefits
Article 33 Participants shall enjoy the benefits of medical insurance stipulated by these measures from the first day of the following month after they have gone through formalities for the participation in the insurance and paid the medical insurance premiums in full.
If participating units, participants fail to pay the medical insurance premiums in full or discontinue such payment, the participants shall stop enjoying the medical insurance benefits paid by the medical insurance pool fund from the first day of the following month after they fail to pay the medical insurance premiums in full or discontinue such payment, but may continue to use the remaining sum of their individual accounts.
Article 34 The participants of the basic medical insurance shall enjoy the benefits of the basic medical insurance within the coverage of the drug catalogue, diagnosis and treatment, and medical service facility standards of the basic medical insurance.
The participants of the local supplementary medical insurance shall enjoy the benefits of the local supplementary medical insurance stipulated by these measures.
The participants of the birth medical insurance shall enjoy the benefits of the birth medical insurance stipulated by these measures.
Article 35 The catalogues of drugs, diagnosis and treatment, and service facility standards of the basic medical insurance shall be put into practice according to the catalogues published by the state and the Guangdong provincial department of labor security.
The coverage of the drug catalogue, diagnosis and treatment, special medical materials and man-made organs, examination and treatment by large-scale medical facilities of the local supplementary medical insurance shall be put into practice according to the catalogue formulated and released jointly by the municipal department of labor security and the municipal department of health.
The coverage of special medical materials and man-made organs, and their payment ceiling listed as a charge to the account of the basic medical insurance pool fund shall be put into practice according to the coverage and the payment ceiling released by the municipal department of labor security.
Article 36 The individual accounts of the participants of the comprehensive medical insurance shall be used to pay the participants’ basic expenses of outpatient services, outpatient expenses of the drugs within the coverage of the drug catalogue of the local supplementary medical insurance and the diagnosis and treatment covered by the local supplementary medical insurance, and expenses of buying prescription drugs at designated retail drugstores.
If the accumulated amount of the balance of individual accounts reaches the previous year’s average monthly wages of the employees on the job in this city, the excess may be used to pay for the basic medical expenses, local supplementary medical expenses originally paid by participants themselves when they see a doctor at designated medical institutions, or for buying nonprescription drugs within the coverage of the drug catalogues of the basic medical insurance and the local supplementary medical insurance at designated retail drugstores, also for physical examinations, preventive vaccination, and the outpatient service expenses of the children who have already participated in the children hospitalization medical insurance and the serious disease outpatient service medical insurance.
Article 37 If participants run out of the funds of their individual accounts, their medical expenses of outpatient services shall not be paid by the serious disease pool fund of the basic medical insurance and the local supplementary medical insurance fund except those stipulated by Articles 38, 39, 40, 41 of these measures.
Article 38 Of the expenses of the participants of the comprehensive medical insurance incurred by the ambulatory drugs prescribed at designated community health service centers within the coverage of the drug catalogue of the basic medical insurance and the drug catalogue of the local supplementary medical insurance, 70% shall be paid by the individual accounts, 30% shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance and paid by the local supplementary medical insurance fund respectively, but the expenses of the outpatient services for serious diseases shall be paid according to the related rules on the serious diseases of medical insurance.
Article 39 Of the expenses of the ambulatory examination and treatment by large-scale medical facilities needed by the participants of the comprehensive medical insurance for their illness and approved by the medical institutions designated by the municipal agency of social insurance, 80% shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance.
The municipal department of labor security shall formulate separately the measures on the administration of the examination and treatment by large-scale medical facilities.
Article 40 If participants need to do ambulatory dialysis because of chronic renal failure caused by serious ambulatory diseases, to take anti-rejection drugs as outpatients after organ transplanting, and to take ambulatory chemotherapy, interventional treatment, radiotherapy, and nuclein treatment for malignant tumors, 90% of the resultant basic medical expenses after approval by the municipal agency of social insurance shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance, 80% of the local supplementary medical expenses shall be paid by the local supplementary medical insurance fund.
As for the expenses of the transfusion which is needed for participants because of the state of their illness, 90% of these expenses shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance if the participants are those of the comprehensive medical insurance, 70% of these expenses shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance if the participants are those of the hospitalization medical insurance and the farmer-turned emigrant workers medical insurance.
Article 41 If the participants of the comprehensive medical insurance suffer from the serious ambulatory diseases other than those stipulated in the first section of Article 40 of these measures, the resultant basic expenses, drug expenses within the coverage of the drug catalogue of the local supplementary medical insurance, and expenses of the diagnosis and treatment covered by the local supplementary medical insurance shall be charged to the individual accounts, if there is no enough fund in the individual accounts to make full payment and the expenses of medical insurance in the current medical insurance year exceed 5% of the previous year’s average wages of the employees on the job in this city, 70% of the excess shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance or paid by the local supplementary medical insurance fund.
The municipal department of labor security shall stipulate separately the types of serious ambulatory diseases referred to in the previous section.
Article 42 The participating units of the hospitalization medical insurance and the farmer-turned emigrant workers medical insurance, and the participants of the hospitalization medical insurance who have no employer units shall select one community health service center in the neighborhood to be their designated medical institutions for outpatient services.
Article 43 If the participants of the hospitalization medical insurance, the farmer-turned emigrant workers medical insurance go to their selected community health service centers for outpatient services (including emergency treatment), the resultant expenses shall be dealt with according to the following rules:
(1) in the case of the drugs of Category A and the drugs of Category B in the drug catalogue of the basic medical insurance, the expenses shall be paid by the community outpatient service pool fund in the proportion of 80% and 60% respectively;
(2) in the case of the diagnosis and treatment or medical materials in the catalogue of the basic medical insurance, 90% of the expenses shall be paid by the community outpatient service pool fund if the unit price is lower than 120 RMB, and 120 RMB shall be paid by the community outpatient service pool fund if the unit price is more than 120 RMB;
(3) in the case of the medical expenses of outpatient services incurred by transferring participants to other designated medical institutions because of the state of the participants’ illness after approval by account-settling hospitals, or in the case of the medical expenses incurred by the emergency treatment in non-account-settling hospitals, the expenses shall be reimbursed in the proportion of 90% of the expenses paid by the community outpatient service pool fund according to Items (1), (2) of this article.
The total amount of the expenses of outpatient services (including emergency
treatment) paid by the community outpatient service pool fund to each participant of the hospital medical insurance in one medical insurance year shall be no more than 800 RMB.
Article 44 In the case of the drug expenses of participants in hospitalization which are within the coverage of the drug catalogue of the basic medical insurance, they shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance in the proportion of 95% for retirees and 90% for the others.
In the case of the basic medical expenses of participants in hospitalization which are incurred by the diagnosis and treatment and regular medical materials covered by the catalogue of the basic medical insurance, they shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance in the proportion of 95% for retirees and 90% for the others.
If participants in hospitalization need to use special medical materials, install or replace man-made organs, and use the disposable medical materials whose unit price is more than 1,000 RMB in the diagnosis and treatment of their illness covered by the basic medical insurance, the expenses shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance at the price which is 90% of the price of the domestically-made regular type of materials; if there is no comparable price of the domestically-made regular type of materials, the expenses shall be listed to be charged to the account of the serious disease pool fund of the basic medical insurance at the price which is 60% of the price of the imported regular type of materials.
The bed expense of the participants of the comprehensive medical insurance and the hospitalization medical insurance shall not be more than 50 RMB per day, and the bed expense of the participants of the farmer-turned emigrant workers medical insurance shall not be more than 35 RMB per day.
Article 45 Different deductibles of hospitalization shall be set for hospitals according to their different levels, namely, 100 RMB for the city hospitals of the first level and their branch hospitals, 200 RMB for the city hospitals of the second level, 300 RMB for the city hospitals of the third level, 400 RMB for the hospitals out of city.
The expenses of hospitalization listed as a charge to the account of the serious disease pool fund of the basic medical insurance, which are below the deductible of hospitalization, shall not be paid by the serious disease pool fund of the basic insurance.
When participants have been transferred to different hospitals for hospitalization and treatment, the deductible shall be different in calculation.
Article 46 The payment ceiling of the basic medial insurance pool fund for participants in one medical insurance year shall correspond to the years of their consecutive participation in the basic medical insurance, in the case of the consecutive insurance participation of less than half year, half year but less than 1 year, 1 year but less than 2 years, 2 years but less than 3 years, or more than 3 years, the payment ceiling shall be 50%, 100%, 200%, 300%, or 400% respectively of the previous year’s average wages of the employees on the job in this city.
Article 47 The medical expenses of the participants of the comprehensive medical insurance and the hospitalization medical insurance in hospitalization listed to be charged to the account of the basic medical insurance, which are over the deductible of hospitalization but below the payment ceiling of the pool fund, shall be paid in full by the serious disease pool fund of the basic medical insurance.
The medical expenses of the participants of the farmer-turned emigrant workers medical insurance in hospitalization listed to be charged to the account of the basic medical insurance, which are over the deductible of hospitalization but below the payment ceiling of the pool fund, shall be paid by the serious disease pool fund of the basic medical insurance in different proportion according to different levels of hospitals, namely, 95%, 90%, 80%, 70% for the city hospitals of the first level, city hospitals of the second level, city hospitals of the third level, hospitals out of city respectively, the rest shall be paid by the participants themselves.
The expenses of the hospitalization of the participants of the farmer-turned emigrant workers medical insurance in non-account-settling hospitals for the emergency treatment and rescue when they are away on official business or take a business trip shall be reimbursed in the proportion of 90% of the expenses which should be covered according to the previous section, or charged to the accounts if hospitals have conditions to do so.
Article 48 The retirees who have participated in the comprehensive medical insurance shall enjoy 500 RMB of the one-time retirement subsidy of the local supplementary medical insurance and enjoy 20 RMB of the monthly subsidy of the local supplementary medical insurance, the municipal agency of social insurance shall list these subsidies to be charged to the local supplementary medical insurance fund and credited to the individual accounts, and the subsidies may be used for the retirees’ own physical examinations.
Article 49 The payment ceiling of the local supplementary medical insurance fund for participants in one medical insurance year shall be correspond to the years of their consecutive participation in the local supplementary medical insurance, in the case of the consecutive insurance participation of half year but less than 1 year, 1 year but less than 2 years, 2 years but less than 3 years, and 3 years but less than 6 years, the payment ceiling shall be 50,000, 100,000, 150,000, and 200,000 respectively, and there is no payment ceiling set for the participants whose years of the consecutive insurance participation are more than 6 years.
The years of the participation in the local supplementary medical insurance, which were calculated before these measures take effect, may continue to be calculated.
Article 50 In the case of the following expenses of the participates of the local supplementary medical insurance which are below the payment ceiling of the local supplementary medical insurance fund, 90% shall be paid by the local supplementary medical insurance fund:
(1) the expenses listed to be charged to the account of the basic medical insurance pool fund and in excess of the payment ceiling of the basic medical insurance pool fund;
(2) the expenses of the drugs stipulated by the drug catalogue of the local supplementary medical insurance and the diagnosis and treatment covered by the local supplementary medical insurance.
Article 51 If the participants of the birth medical insurance meet the requirements
of the birth control policy, their medical expenses (not including infants’ expenses) of antenatal examinations, hospitalization for delivery, postpartum housecalls, birth control operations shall be paid by the birth medical insurance fund, specific measures shall be formulated separately by the municipal department of labor security.
Article 52 If the participants should leave hospital but fail to do so after meeting the requirements for being discharged from hospital, the medical expenses of hospitalization from the date when they should leave hospital shall not be paid by the medical insurance funds.
Article 53 The medical expenses of participants incurred in one of the following situations shall not be paid by the medical insurance funds:
(1) to purchase drugs themselves except in the situation stipulated by the second section of Article 36 of these measures;
(2) to have injuries caused by industrial accidents, third party’s liabilities;
(3) to have injuries caused by their intentional acts or illegal acts;
(4) to have injuries caused by traffic accidents, medical accidents;
(5) to go to foreign countries, Hong Kong, Macao, and Taiwan to see a doctor without authorization;
(6) the other situations stipulated by the state, Guangdong Province, and this municipality.
Chapter V Participants’ Seeing a Doctor, Changing Clinics (Hospitals), and Seeking Medical Services Out Of City
Article 54 The participants of the comprehensive medical insurance shall see a doctor at the designated medical institutions within the city.
The participants of the hospitalization medical insurance shall see a doctor for outpatient services at the selected community health service centers, and see a doctor for hospitalization and serious ambulatory diseases at the designated medical institutions within the city.
The participants of the farmer-turned emigrant workers medical insurance shall see a doctor for outpatient services at the selected community health service center, and may also see a doctor at other designated community health service centers subordinating to the same account-settling hospital that the selected community health service center subordinates to; see a doctor for the emergency treatment and rescue at the designated medical institutions within the city; be treated at the accounting-settling hospital of the selected community health service center if hospitalization is needed; and may also see a doctor at other medical institutions after having gone through formalities to change clinics according to the rules.
Article 55 If the participants of the comprehensive medical insurance, hospitalization medical insurance suffering the types of diseases stipulated by the municipal agency of social insurance need to see a doctor at the out-of-city medical institutions designated by this city, they shall go to the designated medical institutions of this city assigned by the municipal agency of social insurance to obtain referral letters and go through formalities to see a doctor out of city:
Article 56 If one of the following situations apply to the participants of the comprehensive medical insurance, hospitalization medical insurance when they are accepting the diagnosis and treatment at the designated medical institutions within this city, they may apply to see a doctor at medical institutions out of city:
(1) the diseases that the participants suffer from are the types of diseases announced by the municipal department of labor security as those to be qualified for changing clinics;
(2) the difficult and complicated cases of illness which cannot be diagnosed yet through group consultations of doctors at the city hospitals of the third level or city special hospitals;
(3) the patients in critical conditions who currently cannot be treated at the city hospitals of the third level or city special hospitals due to lack of facilities and technologies.
Article 57 If the participants of the comprehensive medical insurance,
hospitalization medical insurance who are qualified to be referred to out-of-city medical institutions apply to see a doctor at out-of-city medical institutions, they shall go through formalities to change clinics (hospitals) according to the following procedures:
(1) the doctors in charge of their cases at the city hospitals of the third level or city special hospitals which have accepted them to be treated shall provide the summary of their medical records and give reasons for changing clinics;
(2) the doctors in charge of their cases shall fill out two copies of Application Form of the Social and Medical Insurance of the Shenzhen City for Referring to Out-Of-City Medical Institutions;
(3) after the department directors of referring hospitals write comments and sign their names on the application forms, and submit them to the medical service offices or medical insurance offices to be examined, approved, and stamped with the official seals of hospitals, the participants may be transferred to out-of-city medical institutions for diagnosis and treatment if they just need approval given by the designated medical institutions themselves because of the diseases they suffer from; the participants may not be transferred to out-of-city medical institutions for diagnosis and treatment until a second time approval if they also need approval given by the municipal agency of social insurance because of the diseases they suffer from.
The medical institutions accepting referrals shall be the non-profit medical
institutions at the level equivalent to or higher than that of referring medical institutions.
Article 58 If the participants of the farmer-turned emigrant workers medical insurance in hospitalization need to change medical institutions because of their illness, they may be transferred to medical institutions one level after another gradually after the original account-settling hospitals have issued referral certificates, may also be transferred to the specialized medical institutions at the same level in this city, referring hospitals at each level shall issue referral certificate to the hospitals accepting the referrals.
Article 59 If the participants who have been transferred to out-of-city medical institutions for diagnosis and treatment need to change medical institutions again, the medical institutions which accepted them as referrals in the first place shall issue referral certificates, and the medical institutions which accept the referrals shall be the non-profit medical institutions of the same level as the referring medical institutions or of the higher level than these institutions.
Article 60 The participants who have the registered permanent residence in this city but are dispatched to the other cities of this country (not including Hong Kong, Macao, and Taiwan, similarly hereinafter) to stay over a long period of time shall select three designated medical institutions of the medical insurance of the localities where they work as the medical institutions in which they see a doctor, and reported their selection to the municipal agency of social insurance to be put on record;
The participants who live in the other cities of this country over a long period of time after retirement shall select three designated medical institutions of the medical insurance of the localities where they live over a long period of time as the medical institutions in which they see a doctor, and report their selection to the municipal agency of social insurance to be put on record.
Article 61 If the participants referred to in Article 60 are hospitalized for emergency treatment in the medical institutions of other places of this country which are placed on record, the resultant basic medical expenses and local supplementary medical expenses shall be allowed to be reimbursed at the rate which is not higher than that of the medical expenses of this city after the participants submit applications and the municipal agency of social insurance examines and approves the actually resultant expenses.
The basic medical expenses and local supplementary medical expenses incurred by outpatient services when participants see a doctor in the other places of this country shall be debited to their individual accounts in the process of examination and approval of their reimbursement.
If the birth medical expenses incurred by participants in the other places of this country meet the stipulations of these measures, the actually resultant medical expenses shall be, after the participants submit applications, examined by the municipal agency of social insurance, and allowed to be reimbursed at the rate which is not higher than that of the medical expenses in this city and the payment to the hospitals at the municipal level.
In the case of the medical expenses of hospitalization for emergency treatment in foreign countries, or Hong Kong, Macao, Taiwan incurred by participants when going there for business trip or to visit relatives, the actually resultant medical expenses shall be, after the participants submit applications, examined by the municipal agency of social insurance, and allowed to be reimbursed at the rate which is not higher than that of the medical expenses in this city and the payment to the hospitals at the municipal level.
Article 62 If participants see a doctor at out-of-city designate medical institutions determined by the municipal agency of social insurance without completing the related formalities stipulated by these measures, the resultant medical expenses of hospitalization which are within the coverage of the medical insurance funds may be allowed to apply for reimbursement, but the rate of reimbursement shall be reduced 20% according to these measures; if participants see a doctor at non-designated medical institutions in this country, the resultant medical expenses which are within the coverage of the medical insurance funds may be allowed to apply for reimbursement, but the rate of reimbursement shall be reduced 40% according to these measures.
Chapter VI Designated Medical Institutions and Designated Retail Drugstores
Article 63 The municipal agency of social insurance shall determine designated medical institutions, designated retail drugstores according to the principles of unified planning, reasonable distribution, convenience for seeing a doctor, giving considerations to various needs, total amount control, encouragement of competition, and being correspondent to the management capability and information system capacity.
The municipal agency of social insurance shall give priority to selecting non-profit medical institutions as designated medical institutions; if any non-profit medical institutions are selected and determined by the municipal agency of social insurance as designated medical institutions, they shall not refuse; if non-profit medical institutions cannot satisfy the demand for insured medical services, the municipal agencies shall select private medical institutions with both good medical facilities and good reputation in the society to be designated medical institutions, and select retail drugstores with both good management and good reputation to be designated retail drugstores.
Article 64 The hospitals, clinics, and community health service centers which meet the following requirements may submit applications to the municipal agency of social insurance, sign agreements on designated medical services, and become designated medical institutions:
(1) to have the medical technological facilities and medical staff corresponding to the level of the medical institutions;
(2) to abide by the laws, regulations, rules, and other provisions of the state, Guangdong Province, and this municipality on the administration of medical services;
(3) to strictly implement the various rules of the state, Guangdong Province, and this municipality on the charge for non-profit medical services and the prices of retail drugs, and to put into practice a system to publish the rates and solicit public opinions;
(4) to promise to strictly abide by the related rules of the policies of this municipality on the social medical insurance system, to establish the internal management system corresponding to medical insurance management, to have good organizations for medical insurance management, to have leading officials put in charge of medical insurance, to provide the necessary full-time management personnel, and to be equipped with computers, etc. which meet the needs of social medical insurance.
If the internal medical institutions of the units of enterprises and public
institutions meet the requirements listed in the previous section and the employees
of each of these units are over 1,000, these institutions may also apply to become designated medical institutions and provide medical services for the participants of their own units.
Article 65 The retail drugstores meeting the following requirements may submit applications to the municipal agency of social insurance, sign agreements on designated medical services, and become designated retail drugstores:
(1) to be qualified for the operation in the pharmacy business;
(2) to abide by the laws, regulations, rules, and provisions of the state, Guangdong Province, and this municipality on the administration of medical services;
(3) to strict implement the policies of the state, Guangdong Province, and this municipality on drug prices;
(4) to be capable of supplying drugs for medical insurance promptly;
(5) to have at least two qualified practicing pharmacists or pharmaceutical technicians holding the title of pharmacist (including pharmacist of traditional Chinese medicine) on the job when retail drugstores are open;
(6) to promise to strictly implement the related rules of the policies of this municipality on the social medical insurance system, to have a standardized internal management system, to provide the necessary management personnel, and to be equipped with computers, etc. which meet the needs of social medical insurance;
(7) to have more than 80% of the drugs listed in the drug catalogue of the basic medical insurance and the drug catalogue of the local supplementary medical insurance kept in stock.
If the other conditions are equal, priority shall be given to the regular chain
drugstores and 24-hour retail drugstores which sell no other commodities than drugs and medical appliances to be selected as designated retail drugstores.
Article 66 The medical institutions and retail drugstores which apply to be designated ones shall submit applications to the municipal agency of social insurance in September of every year; the municipal agency of social insurance shall conduct the comprehensive evaluation within 2 months, and make public the result of the comprehensive evaluation, the medical institutions and retail drugstores ranked ahead of others in the comprehensive evaluation shall be selected as designated medical institutions and designated retail drugstores.
Article 67 The municipal agency of social insurance shall sign agreements with designated medical institutions and designated retail drugstores, and administer them according to the agreements.
The municipal agency of social insurance shall carry out the supervision and administration of designated medical institutions, designated retail drugstores according to these measures and agreements, make credit rating every 2 yeas based on their execution of the agreements, the rating results shall be made public, the municipal agency of social insurance shall give awards to designated medical institutions, designated retail drugstores and related personnel according to the rating results, the expenses of awards shall be listed in the departmental budget of the municipal agency of social insurance.
The standards of the credit rating of designated medical institutions, designated retail drugstores shall be set by the municipal department of labor security jointly with the municipal department of quality and technology supervision, reported to the municipal government and implemented after approval.
Article 68 Designated medical institutions shall insist on the principle of “treatment according to illness, reasonable examination, reasonable prescription, reasonable treatment, making charges according to rules”, provide medical services for participants according to these measures and agreements.
Article 69 Designated medical institutions shall establish the system of the separate accounting and separate management of medical services and drugs, set the standards for medical acts, strictly prohibit various acts to write prescriptions, etc. to take a cut for profits, reduce the proportion of the expenses paid by participants themselves in the total of medical expenses, and lessen the economic burden of participants.
Article 70 Designated medical institutions and designated retail drugstores shall set up the special management offices of medical insurance, establish the internal management systems corresponding to the medical insurance system, and carry out self-management, self-disciplining.
Article 71 Designated medical institutions and designated retail drugstores shall strictly implement the rules of the government on the rates of medical charges and the prices of drugs, and make them public.
Designated medical institutions shall provide for participants the detail lists of outpatient service charges or daily detail lists of hospitalization charges.
Article 72 Designated medical institutions shall keep documents for themselves such as participants’ prescriptions, approval forms of the examination and treatment by large-scale medical facilities, reports, examination and treatment forms, lists of charges for medical services and drugs, etc. at least for 2 years in order to be ready for the verification conducted by the municipal agency of social insurance.
Designated retail drugstores shall keep participants’ prescriptions and detail lists on their own for at least 2 years in order to be ready for the verification conducted by the municipal agency of social insurance.
Article 73 When providing medical services, designated medical institutions shall implement the related management rules of the basic medical insurance and the local supplementary medical insurance on drug catalogues, diagnosis and treatment, and standards of medical service facilities.
When providing for participants other drugs, diagnosis and treatment, medical service facilities than what are stipulated in the previous section, designated medical institutions shall ask for participants’ approval.
The diagnosis and treatment conducted by designated medical institutions in cooperation with other units, individuals, or contracted for by them shall not be charged to the accounts of medical insurance.
Article 74 When designated medical institutions provide medical services for participants and debit charges to the accounts, they shall check participants’ identity. If participants refuse to present the related identity certificates, the medical institutions shall not collect their medical expenses by charging to the accounts.
Article 75 When participants use their individual accounts of medical insurance to purchase drugs, designated retail drugstores shall verify the following items:
(1) whether the social insurance cards used by participants belong to the participants themselves;
(2) whether participants have prescriptions given by designated medical institutions if they want to purchase prescription drugs;
(3) whether the accumulated total balance of participants’ individual accounts reaches the previous year’s average monthly wages of the employees on the job in this city if they want to purchase prescription drugs.
Chapter VII Settlement of Expenses
Article 76 Designated medical institutions and designated retail drugstores shall settle with the municipal agency of social insurance the actual medical expenses incurred by providing medical services to participants according to these measures or agreements.
The settlement methods shall be agreed on in the agreements signed by the municipal agency of social insurance and designated medical institutions, designated retail drugstores.
The settlement of medical expenses may be made by the methods such as the settlement according to service items, settlement according to service units, settlement according to types of diseases, settlement according to outpatient service quota per capita, settlement according to total advance payment, etc.
Article 77 If the medical expenses incurred by participants for seeing a doctor at designated medical institutions or purchasing drugs at designated retail drugstores meet the provisions of the basic medical insurance, local supplementary medical insurance, and birth medical insurance, they shall be settled according to the following rules:
(1) those within the coverage of the basic medical insurance pool fund, local supplementary medical insurance fund, birth medical insurance fund shall be charged to the accounts accurately by designated medical institutions according to the rules;
(2) those within the scope covered by the individual accounts shall be debited by designated medical institutions or designated retail drugstores to the individual accounts of participants; if the sum of the accounts is not enough to pay for the expenses, the amount still due shall be collected from participants directly.
Article 78 If one of the following cases applies to the medical expenses incurred
by participants for seeing a doctor, the participants shall pay cash first, and then submit their applications with related bills and materials to the municipal agency of social insurance, the municipal agency of social insurance shall reimburse the expenses after they are examined and approved according to the rules:
(1) the medical expenses incurred by the participants of the comprehensive medical insurance, hospitalization medical insurance for the emergency treatment in the other cities of this country or for the hospitalization after approved transfer to the other cities of this country for treatment;
(2) the medical expenses incurred by the participants, who have the registered permanent residence in this city and are dispatched to work in the other cities of this country for a long period of time or by the participants who live in the other cities of this country after retirement, for seeing a doctor at the medical institutions put on record;
(3) the medical expenses incurred by participants in doing ambulatory dialysis as outpatients because of chronic renal failure caused by serious diseases, taking anti-rejection drugs as outpatients after organ transplanting, and taking ambulatory chemotherapy, interventional treatment, radiotherapy, and nuclein treatment for malignant tumors at designated medical institutions;
(4) the medical expenses incurred by the participants of the farmer-turned emigrant workers medical insurance in hospitalization following the emergency treatment and rescue at non-account-settling hospitals when they are away on official business or take a business trip;
(5) the medical expenses incurred by participants for the out-of-hospital diagnosis and treatment within the coverage of the catalogue approved by hospitals when they are hospitalized;
(6) the birth medical expenses in the other cities of this country which meet the requirements of these measures.
Article 79 If one of the following cases applies to the medical expenses of
outpatient services incurred by the participants of the hospitalization medical insurance, farmer-turned emigrant workers medical insurance in seeing a doctor, the participants shall pay cash first, and then submit their applications with related bills and materials to account-settling hospitals or designated medical institutions, the account-settling hospitals shall reimburse the expenses after they are examined and approved according to the rules:
(1) the medical expenses of outpatients services for the needs of illness at non-account-settling hospitals after approval given by account-settling hospitals;
(2) the medical expenses of outpatient services, emergency treatment at non-account-settling hospitals when participants are away on official business or take a business trip;
(3) designated medical institutions cannot charge the medical expenses to the accounts because of the failure of computers or the damages of Social Insurance Card.
If the participants of the farmer-turned emigrant workers medical insurance have
paid cash for the medical expenses of hospitalization after being transferred to designated medical institutions with approval given by account-settling hospitals, they may go for reimbursement according to the rules by presenting related bills and materials for the examination and approval at account-settling hospitals.
Article 80 If one of the following cases applies to the medical expenses incurred by the participants of the hospitalization medical insurance in their hospitalization or by the participants of the comprehensive medical insurance for outpatient services, the participants shall pay cash first, and then go for reimbursement according to the rules by presenting related bills and materials for the examination and approval at the medical institutions where they see a doctor:
(1) the designated medical institutions where they see a doctor cannot charge the expenses to the accounts because of the failure of computers or the damages of Social Insurance Card;
(2) the prescription drugs within the coverage of the catalogue of the basic medical insurance purchased out of hospital with approval given by hospitals when participants are hospitalized.
Article 81 Participants shall submit the following materials for reimbursement
within 12 months from the date when medical expenses are incurred (from the date of being discharged from hospital in the case of hospitalization):
the referral certificates issued by referring hospitals, outpatient medical record and hospitalization medical record with affixed seals of hospitals providing medical services, medical certificates of disease (outpatient services), medical certificate of discharge or discharge brief (hospitalization), detail lists of expenses, original receipts for charges, certificates of employer units, and social insurance cards, etc.
Article 82 If the participants who have the registered permanent residence in this city live in other places for a long period of time after retirement, the remaining sum of their individual accounts of medical insurance and the amount of money which should be credited to these accounts according to these measures may be, after the participants apply themselves, transferred to the social insurance agencies of the localities where they live for a long period of time; if the sum of the individual accounts cannot be transferred, it may be, after the participants apply themselves, given to them as a one-time lump-sum payment and credited to their bank accounts receiving old-age pension; after that, the sum which should be credited to their individual accounts every month shall be credited to their bank accounts receiving old-age pension, and they shall no longer enjoy the benefits stipulated in Article 41 of these measures.
If the retirees who have no registered permanent residence in this city but receive monthly payment for the benefits of the old-age insurance from the municipal agency of social insurance live in other places for a long period of time, the sum allocated from their medical insurance premiums to the community outpatient service pool fund shall be, after the participants apply themselves, credited to their bank accounts receiving the old-age insurance pension, and they shall no longer enjoy the benefits stipulated in Article 43 of these measures.
Chapter VIII Supervision and Inspection
Article 83 The municipal agency of social insurance shall establish and improve the financial system of the medical insurance funds, and make public the income and expenditure of the medical insurance funds to the society.
Article 84 The departments of finance, audit shall conduct regular audits of the income and expenditure, transfer and settlement, and management of the medical insurance funds according to law, and report the audit results to the municipal supervision committee of the medical insurance funds.
Article 85 The administrative departments in charge of health at various levels shall strengthen the supervision and administration of designated medical institutions, take the implementation of the rules of medical insurance as an item of the assessment of the comprehensive objective management of designated medical institutions, and link it up with the objective responsibility system of hospital presidents.
Article 86 The municipal department of prices shall strengthen the supervision over how designated medical institutions and designated retail drugstores implement the policies of the state, Guangdong Province, and this municipality on the prices of medical services and drugs.
The municipal department of drug supervision and administration shall strengthen the supervision over the quality of the drugs of designated medical institutions and designated retail drugstores.
Article 87 The municipal agency of social insurance shall set up a committee of medical insurance experts to carry out the following tasks:
(1) to offer technical opinions on medical services for the municipal department of labor security to make related policies according to these measures;
(2) to provide technical instructions for the municipal agency of social insurance to exercise supervision over the medical insurance, to give expert opinions on the difficult medical problems found in the supervision and inspection;
(3) to put forward expert opinions for the municipal agency of social insurance to determine the types of serious ambulatory diseases under the medical insurance;
(4) to give expert opinions on the disputes between participants and designated medical institutions about discharging, and to make comprehensive evaluation of the reasonableness of abnormal medical expenses;
(5) the other tasks of the medical insurance assigned by the municipal agency of social insurance.
The work outlays of the committee of medical insurance experts shall be listed
as part of the departmental budget of the municipal agency of social insurance.
Article 88 Participating units shall make public every half year to employees the payment for medical insurance premiums.
Participating units and participants shall have the right to inquire of the municipal agency of social insurance about the payment of their units’ or their own payment for medical insurance premiums, payment for benefits, etc.
The municipal agency of social insurance shall provide convenience for participating units and participants in their inquiries.
Article 89 Any units and individuals shall have the right to report and charge law violation, rule violation against designated medical institutions, designated retail drugstores, participating units, participants, and the personnel of the municipal agency of social insurance.
After what is reported has been verified, the municipal agency of social insurance shall give informers awards from the reward fund, specific measures shall be worked out separately.
Article 90 The personnel of the municipal agency of social insurance and the appointed medical insurance supervisors shall carry out the supervision and inspection of the medical insurance conducts of designated medical institutions, designated retail drugstores, participating units, and participants.
If designated medical institutions and designated retail drugstores cannot provide or cannot fully provide the material, the municipal agency of social insurance may refuse to pay corresponding expenses.
When inspecting participating units’ payment for premiums, the municipal agency of social insurance may ask the units under the inspection to provide the materials related to payment of medical insurance premiums such as those about the employment, payroll, and financial statements, etc.; may also record in writing, tape-record, video-record, photograph, and duplicate related materials, but shall keep secrets for the units under the inspection.
Article 91 When seeing a doctor at designated medical institutions, participants shall present their social insurance cards. If participants lose their social insurance cards, they shall report the loss to the municipal agency of social insurance; if the medical expenses are incurred when issuing a new card is still in process after reporting the loss, applications may be submitted with related certificates and bills to the municipal agency of social insurance for reimbursement, and in the case of the outpatient expenses of the participants of the comprehensive medical insurance, they shall be debited to the individual accounts according to these measures.
Article 92 If the loss of participants’ social insurance cards causes the medical insurance pool funds losses, the municipal agency of social insurance may recover the losses from medical institutions or the persons who use these lost cards under other people’s name.
Article 93 If participants and designated medical institutions have disputes on the date of discharging from hospital, they may apply for coordination to the municipal agency of social insurance, the municipal agency of social insurance may solicit expert opinions from the committee of medical insurance experts, and decide the date of discharging within 7 business days from the date of accepting the applications.
Chapter IX Legal Liabilities
Article 94 If employer units fail to pay medical insurance premiums according to the rules, it shall be dealt with according to the related stipulations of Provisional Regulations on Collection and Payment of Social Insurance Premiums and Regulations on the Supervision of Labor Security.
If employer units fail to pay medical insurance premiums according to the rules, the medical expenses incurred by participants during this period shall be paid by the employer units according to the standards set by these measures; if participants’ years of consecutive insurance participation are affected so that there is a loss in terms of their benefits of medical insurance, their loss shall be made up by the employer units according to the standards set by these measures.
Article 95 If designated medical institutions, designated retail drugstores breach the agreements signed with social insurance agencies, it shall be dealt with according to the agreements; those who are suspected of committing crimes shall be handed over to a judicial office to be dealt with according to law.
Article 96 If designated medical institutions, designated retail drugstores violate the rules on the price administration, drug administration, or medical and health administration, the municipal departments of prices, drug, medical and health administration shall punish them according to related provisions, and promptly report the punishments to the municipal agency of social insurance.
Article 97 If participating units perform the formalities of the participation in the medical insurance for those who are not qualified to participate in the medical insurance of this city, these participants’ medical insurance shall be invalid, the medical insurance premiums which have been paid shall be returned to the participating units and individuals respectively, and the municipal agency of social insurance may impose a fine of more than 5,000 but less than 10,000 RMB on the participating units at the same time; in the case of the expenses which have already been paid by the medical insurance pool funds shall be recovered by the municipal agency of social insurance; those suspected of committing crimes shall be handed over to a judicial office to be dealt with according to law.
Article 98 If units or individuals swindle money out of the medical insurance funds, the municipal department of labor security shall order returning, if the circumstances are serious, the municipal department of labor security shall impose a fine of more than one time but less than two times of the sum of the swindled money; those suspected of committing crimes shall be handed over to a judicial office to be dealt with according to law.
Article 99 Those who obstruct and impede the inspection and investigation conducted by the personnel of the municipal department of labor security, the municipal agency of social insurance to obtain evidence shall be punished according to Law of the People’s Republic of China on Public Security Administration Punishments.
Article 100 If any staff members of the municipal agency of social insurance abuse power, neglect duties, practice favoritism and commit irregularities, they shall be sanctioned according to law; those suspected of committing crimes shall be handed over to a judicial office to be dealt with according to law.
Article 101 If the administrative counterparts in the relationship of medical insurance have objection to the specific administrative acts performed by the municipal department of labor security, the municipal agency of social insurance, they may apply for administrative review or take administrative action.
Chapter X Supplementary Provisions
Article 102 In the case of the medical insurance of the registered students of the universities and colleges in Shenzhen whose establishment are approved by governments at various levels, it shall be implemented by reference to the related provisions on the comprehensive medical insurance, hospitalization medical insurance in these measures, their universities and colleges shall go through formalities in a unified manner for them to participate in the insurance, and pay medical insurance premiums.
Article 103 Enterprises may retain no more than 4% of the total of employees’ wages as the enterprise supplementary medical insurance premiums to pay for the benefits of the enterprise supplementary medical insurance, and the payment shall be listed as the expenditure of the employee welfare funds, specific measures shall be formulated by the municipal government separately.
Article 104 The municipal government shall formulate separately the measures on the medical insurance of the retirees with honors and the disabled servicemen of Grade 1 - Grade 6 (former revolutionary wounded and disabled servicemen of higher than Grade 2 of Level 2).
Article 105 The former personnel of rural urbanization shall participate in the medical insurance and pay premiums by taking limited cooperative stock companies as their employer units.
Article 106 If the amount of the self-paid medical expenses of participants is so large that the resultant living standards of the participants are lower than the level of the minimum living standards of this city and they are not able to pay medical expenses, they may apply to the municipal agency of social insurance for special subsidies to pay medical expenses, specific measures shall be formulated separately by the municipal department of labor security jointly with the municipal departments of finance, civil administration.
Article 107 The municipal department of labor security may formulate supporting measures on the administration of medical insurance according to these measures.
Article 108 The data published by the municipal department of statistics shall be taken as the criterion for the calculation of the previous year’s monthly average wages of the employees on the job in this city. The previous year’s monthly average wages of the employees on the job in this city referred to in these measures shall be calculated according to the monthly average wages of employees on the job in this city in the previous 2 years for the first half year and according to the monthly average wages of employees on the job in this city in the previous year for the second half year.
Article 109 The medical insurance year referred to in these measures shall mean the year from July 1 to June 30 of the next year.
Article 110 “more than”, “less than” referred to in these measures shall include that number following these phrases.
Article 111 These measures shall take effect as of March 1, 2008, and Measures of the Shenzhen Municipality on the Social Medical Insurance of Employees in Cities and Towns (No. 125 of the Order of the Shenzhen Municipal People’s Government) enacted on May 27, 2003 and Provisional Measures of the Shenzhen Municipality on the Medical Insurance of Laborers shall be annulled at the same time.
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