Chapter 1 General Provisions Article 1 (Purpose and Basis) In order to ensure the basic medical needs of employees, these measures are formulated in accordance with the "Shanghai Implementation Plan for Implementing the "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees".
Article 2 (Scope of Application) These Measures apply to the basic medical insurance and related management activities of urban enterprises, agencies, institutions, social groups and private non-enterprise units (hereinafter collectively referred to as employers) and their employees within the scope of this city.
Employees as mentioned in these Measures include active employees, retirees and other insured persons.
Article 3 (Management Department) The Shanghai Municipal Medical Insurance Bureau (hereinafter referred to as the Municipal Medical Insurance Bureau) is the administrative department in charge of basic medical insurance in this city and is responsible for the unified management of basic medical insurance in this city.
Each district and county medical insurance office (hereinafter referred to as the district or county medical insurance office) is responsible for the management of basic medical insurance within its jurisdiction.
The municipal health, labor and social security, finance, auditing, drug supervision, civil affairs and other departments shall coordinate and manage basic medical insurance in accordance with their respective responsibilities.
This city's social insurance agency is responsible for the collection and payment of medical insurance premiums.
The Shanghai Medical Insurance Affairs Management Center (hereinafter referred to as the Municipal Medical Insurance Center) is the city’s medical insurance agency, responsible for the settlement and allocation of medical expenses and the management of basic medical insurance personal accounts (hereinafter referred to as personal medical accounts).
Chapter 2 Registration and Payment Article 4 (Registration Procedures) Employers shall, in accordance with the regulations of the Municipal Medical Insurance Bureau, handle basic medical insurance registration procedures with the designated social insurance agency; among them, newly established employers shall
Complete the basic medical insurance registration procedures within 30 days.
If the employer terminates in accordance with the law or the basic medical insurance registration items are changed, it shall go through the cancellation or change registration procedures with the original registration agency within 30 days from the date of the relevant circumstances.
When handling the procedures stipulated in the first two paragraphs of this article, the social insurance agency shall conduct an audit in accordance with the requirements of the Municipal Medical Insurance Bureau, and promptly notify the Municipal Medical Insurance Bureau of the employer's registration, change of registration, or cancellation of registration in accordance with regulations.
Article 5 (Calculation method and payment proportion of employee payment base) The payment base of current employees is their average monthly salary in the previous year.
If my average monthly salary in the previous year exceeds 300% of the average monthly salary of employees in the city in the previous year, the excess will not be included in the payment base; if it is lower than 60% of the average monthly salary of employees in the city in the previous year, the excess will not be included in the payment base.
60% of the average monthly salary of active employees in the city is the payment base.
Individual active employees shall pay basic medical insurance premiums at a rate of 2% of their contribution base.
Individual retirees do not pay basic medical insurance premiums.
Article 6 (Calculation method of employer’s payment base and payment proportion) The employer’s payment base is the sum of the payment bases of its employees.
The employer shall pay basic medical insurance premiums at a rate of 10% of its payment base, and pay local additional medical insurance premiums at a rate of 2% of its payment base.
Article 7 (Channels for disbursement of medical insurance premiums) Medical insurance premiums paid by the employer shall be disbursed according to the channels prescribed by the financial department.
Article 8 (Collection and Payment Management) The calculation of the amount of contributions paid by employers and employees, the payment procedures, and the handling of collection disputes shall be carried out in accordance with the relevant provisions on the collection and management of social insurance premiums.
Chapter 3 Personal Medical Account, Overall Fund and Supplementary Fund Article 9 (Basic Medical Insurance Fund) The basic medical insurance fund consists of the overall fund and individual medical account.
The basic medical insurance premiums paid by the employer shall be included in the personal medical account in accordance with the provisions of paragraphs 2 and 3 of Article 11 of these Measures, and the remaining part shall be included in the overall fund.
Article 10 (Establishment of Personal Medical Accounts) The Municipal Medical Insurance Center shall establish personal medical accounts for employees after the employer has completed the basic medical insurance registration procedures and paid the medical insurance premiums as required.
Article 11 (Inclusion of funds in personal medical accounts) All basic medical insurance premiums paid by active employees shall be included in their personal medical accounts.
The basic medical insurance premiums paid by the employer shall be included in the personal medical accounts of active employees according to the following proportions: (1) For those under 34 years old, 0.5% of the average annual salary of employees in this city in the previous year; (2) For those between 35 and 44 years old
(3) For those aged 45 to retirement, the rate is 1.5% of the average annual salary of employees in this city in the previous year.
The basic medical insurance premiums paid by the employer shall be included in the personal medical account of retirees according to the following proportions: (1) For those who retire under the age of 74, 4% of the average annual salary of employees in this city in the previous year; (2) For those over 75 years old
, based on 4.5% of the average annual salary of employees in this city in the previous year.
Article 12 (Stop counting of personal medical account funds) If an employee fails to pay basic medical insurance premiums when he or she should pay them or interrupts the enjoyment of basic pension insurance benefits, the calculation according to the second or third paragraph of Article 11 of these Measures shall be stopped.
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