Legal objectivity: In accordance with the requirements of the "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees" (Guofa [1998] No. 44), the framework of the basic medical insurance system for urban employees includes six parts: First, establish a reasonably affordable medical insurance system

Basic medical insurance premiums under the same payment mechanism are paid simultaneously by employers and individuals, reflecting the compulsory features of national social insurance and the unification of rights and obligations.

Medical insurance premiums are paid by both units and individuals, which not only expands the source of medical insurance funds, but more importantly clarifies the responsibilities of units and employees and enhances personal self-protection awareness.

In this reform, the state has stipulated control standards for the employer contribution rate and individual contribution rate: the employer contribution rate is controlled at about 6% of the total employee salary, and the specific proportion is determined by each locality. The employee contribution rate is generally 2% of the employee's salary income.

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The second is to establish a pooling fund and individual accounts. The basic medical insurance fund is composed of a pooling fund used by the society as a whole and a personal account fund used specifically by individuals.

All individual payments are transferred to personal accounts, about 30% of unit payments are transferred to personal accounts, and the remainder is established as a coordinating fund.

The personal account is used exclusively for personal medical expenses and can be carried forward and inherited. The principal and interest of the personal account belong to the individual.

The third is to establish a payment mechanism with separate unified accounts and clear scope. The overall fund and individual accounts determine their respective payment scopes. The overall fund mainly pays for large amounts and inpatient medical expenses, and the personal account mainly pays for small amounts and outpatient medical expenses.

The overall planning fund must follow the principle of "determining expenditure based on revenue and balancing revenue and expenditure" and determine the minimum payment standard and maximum payment limit based on the actual situation of each place and the affordability of the fund.

The fourth is to establish an effective and restrictive medical service management mechanism. The payment scope of basic medical insurance is limited to medical expenses within the prescribed basic medical insurance drug catalog, diagnosis and treatment items and medical service facility standards; implementation of designated medical institutions and pharmacies that provide basic medical insurance services

Management; Social insurance agencies and basic medical insurance service agencies (designated medical institutions and designated retail pharmacies) must settle fees according to the settlement methods stipulated in the agreement.

The fifth is to establish a unified socialized management system. Basic medical insurance implements social management at a certain level of coordination. In principle, the administrative regions at or above the prefecture level (including prefectures, cities, prefectures, and leagues) are the coordination units, and counties can also be the coordination units.

The social insurance agency in the coordinating area is responsible for the unified collection, use and management of the fund, and ensures the full collection, reasonable use and timely payment of the fund.

Sixth, establish a sound and effective supervision mechanism. Basic medical insurance funds shall be managed through special fiscal accounts; social insurance agencies must establish and improve rules and regulations; coordinating areas must establish social supervision organizations for basic medical insurance to strengthen social supervision.

It is necessary to further establish and improve the fund's budget and final accounting system, financial accounting system and internal audit system of social insurance agencies.