Chapter 1 General Provisions Article 1 In order to establish and improve the basic medical insurance system for urban employees (hereinafter referred to as basic medical insurance), ensure basic medical care for employees, and promote social stability and economic development, according to the State Council's "On the Establishment of Urban Employees Basic Medical Insurance" These regulations are formulated based on the spirit of the Decision on the Basic Medical Insurance System" and the Zhejiang Provincial People's Government's "Notice on Issuing the Opinions of Zhejiang Province on Promoting the Reform of the Basic Medical Insurance System for Urban Employees" and taking into account the actual situation of this city.

Article 2 The task of the reform of this city’s basic medical insurance system is to gradually establish a basic medical insurance system for serious illness hospitalization of enterprise employees based on the affordability of the finance, employer and individual employees. A social medical insurance system that adapts to the socialist market economic system and guarantees the basic medical needs of employees.

Article 3 The principle for the reform of this city’s basic medical insurance system is that the level of basic medical insurance is compatible with the city’s economic and social development level and the affordability of all aspects; all urban employers and their employees should Participate in basic medical insurance and implement territorial management; the basic medical insurance fund implements a combination of social pooling and personal accounts, and basic medical insurance premiums are jointly borne by the employer and employees; the collection and payment of basic medical insurance premiums reflect the balance of rights and obligations. In combination, in the process of reforming the basic medical insurance system, the state, employers and employees should all assume corresponding management and economic responsibilities.

Article 4 These regulations apply to all types of urban enterprises, state agencies, institutions, social groups, private non-enterprise units and their employees (including retired personnel) within the administrative region of Hangzhou City.

Laid-off employees who have paid basic pension insurance premiums and medical insurance premiums in accordance with regulations (hereinafter referred to as co-payers) and those who have terminated (dissolved) their labor relationship with their employer after January 1, 1996 and continue to participate in basic This provision shall apply to persons with medical insurance (hereinafter referred to as terminated persons).

Article 5 The urban area of ??Hangzhou and the counties (cities) under the municipality shall serve as independent overall planning areas and implement the collection, use and management of basic medical insurance funds in accordance with the principle of territorial management.

Article 6 Employers and their employees must participate in basic medical insurance in accordance with these regulations and enjoy basic medical insurance benefits in accordance with these regulations.

Article 7 Enterprises, institutions and their employees that should be included in the basic pension insurance coverage according to relevant national regulations must participate in basic pension insurance while participating in basic medical insurance.

Chapter 2 Organizational Structure and Responsibilities

Article 8 The basic medical insurance work shall be uniformly managed by the labor and social security administrative department (hereinafter referred to as the labor and social security department), and the basic medical insurance shall be handled Institutions (hereinafter referred to as medical insurance agencies) implement the specific implementation. Departments such as health, drug supervision, finance, local taxation, prices, and auditing should cooperate with the labor and social security departments in accordance with their respective responsibilities.

Article 9 The main responsibilities of the labor and social security department:

(1) Responsible for formulating the development plan and overall plan for basic medical insurance and organizing its implementation;

( 2) Implement relevant laws and regulations on basic medical insurance, formulate or work with relevant departments to formulate supporting policies, and supervise and inspect the implementation of policies and systems;

(3) Work with finance, auditing and other departments to implement basic medical insurance Supervise and manage the income, expenditure and operation of insurance funds;

(4) Develop qualification approval methods for designated medical institutions and designated pharmacies in conjunction with the health, drug supervision, finance, price and other departments, and be responsible for the evaluation of designated medical institutions , review the qualifications of designated pharmacies, and conduct regular inspections and assessments;

(5) Coordinate and handle matters related to basic medical insurance.

Article 10 The main responsibilities of the medical insurance agency:

(1) Responsible for the management and use of basic medical insurance funds, and reviewing and supervising the employer’s basic medical insurance participation and payment status ;

(2) Responsible for identifying designated medical institutions and designated pharmacies, and working with relevant departments to inspect the basic medical insurance services of designated medical institutions and designated pharmacies;

(3) Cooperation The price department supervises and inspects the charging standards and drug prices of designated medical institutions and designated pharmacies;

(4) Responsible for the management of approval, review, transfer, reimbursement, etc. in basic medical insurance;

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(5) Responsible for the preparation of the draft budget and final accounts of the basic medical insurance fund and the financial accounting and internal audit work of the basic medical insurance fund; reporting various financial and statistical statements of the basic medical insurance; Analyze the operation status and provide fund early warning reports to superior departments in a timely manner;

(6) Undertake relevant supporting services for basic medical insurance.

Article 11 Strengthen the management of basic medical insurance, determine the functions and establishment of labor and social security departments and medical insurance agencies in accordance with the law, and ensure the normal operation of basic medical insurance.

Article 12 The business funds of medical insurance agencies shall be allocated by the financial department within the financial budget based on the actual needs of basic medical insurance management work, and shall not be deducted from the basic medical insurance fund.

Chapter 3 Raising Basic Medical Insurance Premiums

Article 13 Basic medical insurance premiums shall be paid by employers and individuals in accordance with the following provisions, with appropriate subsidies from the government:

< p> (1) Enterprises and private non-enterprise units will withdraw 8% based on the total wages of employees of the unit this year, of which 6% will be paid by the employer to the medical insurance agency on a monthly basis to establish a basic medical insurance pooling fund (hereinafter referred to as Coordination Fund), 2% will be transferred to the employee's personal account; for individual employees on the job, 2% of their total salary for the year will be withheld by the employer and all will be credited to their personal account.

(2) State agencies, public institutions and social groups shall pay 8% to the medical insurance agency on a monthly basis based on the total salary of the employees of the unit this year, of which 6% will be used to establish a unified fund and 2% Transfer it into the employee's personal account; 2% of the employee's total salary for the current year will be withheld by the employer and paid to the medical insurance agency on a monthly basis, and all of it will be credited to his or her personal account.

(3) The basic medical insurance premiums for laid-off workers who have entered the re-employment service center (workstation) shall be based on 60% of the average salary of employees in the coordinated area this year, and shall be calculated by each re-employment service center (workstation). A monthly payment of 6% to the medical insurance agency is used to establish a coordinating fund; the 2% paid by individual employees is withheld by each reemployment service center (workstation), transferred to the employer on a monthly basis, and all is credited to their personal account.

(4) Co-payers shall pay basic pension insurance premiums and medical insurance premiums in accordance with the provisions of the Municipal People's Government on the agreement of some laid-off employees to pay basic pension insurance premiums and medical insurance premiums.

(5) For terminated personnel, the average salary of employees in the coordinated area this year will be used as the base, and the individual will pay 6% to the medical insurance agency on a monthly basis.

(6) The government will subsidize 0.5% of the total wages of insured employees in the coordinating area this year (part of which will be used for medical subsidies for major diseases).

(7) If the total salary of the employing unit’s employees is lower than 65% of the average salary of employees in the coordinated area this year, 65% of the average salary of employees in the coordinated area this year will be used as the base for payment; if it is higher than the average salary of employees in the coordinated area this year 310 %, based on 310% of the average salary of employees in the coordinated area this year.

(8) Retired personnel and disabled revolutionary servicemen of Class B and above shall not pay basic medical insurance premiums.

Article 14 Basic medical insurance premiums must be paid in full on a monthly basis, without reduction or exemption, and without including taxes and fees.

Article 15: Basic medical insurance premiums are collected by the local taxation department and are managed in a special financial account. The funds are earmarked for special use and cannot be misappropriated by any unit or individual.

Article 16: The basic medical insurance premiums paid and withdrawn by the employer are listed as follows:

(1) State agencies use "recurrent expenditures" - "social security fees" Middle branch.

(2) Public institutions shall list expenditures in "Public Institution Expenditures (Operating Expenses" - "Social Security Fees".

(3) Enterprises shall list expenditures in "Welfare Fees Payable" 60%, and 40% will be deducted from "labor insurance premiums"

Article 17 If the employer changes the basic medical insurance registration items or the employer terminates according to law, it must report to the medical insurance agency within 30 days. The organization shall apply for relevant procedures.

Article 18 When the employer is terminated in accordance with the law, it must pay off the arrears of basic medical insurance premiums and set aside a certain amount of medical expenses for retired personnel in accordance with relevant regulations. The receiving unit shall be responsible for the management.

Article 19 The portion of the basic medical insurance fund raised in the current year shall be calculated based on the interest rate of bank demand deposits; the principal and interest of the fund carried forward from the previous year shall be deposited in three-month lump sums. Interest is calculated based on the interest rate; the deposited funds deposited in the social security fiscal account are calculated at an interest rate not lower than the three-year lump sum savings deposit rate.

Chapter 4 Overall Funds and Personal Accounts

Article 20 The overall fund shall be composed of 6% of the total wages of employees of the unit paid by the employer for the year, 6% of the average wages of employees in the coordinated area for the year for terminated employees, and 50% of the total contributions of co-payers.

Article 21 The unified fund is used to pay part of the medical expenses that should be borne by the unified fund according to regulations for hospitalization and outpatient services for prescribed diseases that are within the scope of basic medical insurance. The prescribed diseases refer to various types of diseases. Malignant tumors, systemic lupus erythematosus, hemophilia, aplastic anemia and chronic renal failure dialysis and anti-rejection treatment after organ transplantation included in the diagnosis and treatment items

Article 22 Enterprises and The personal accounts of insured persons in private non-enterprise units are temporarily established and managed by the employer, and the medical insurance agency is responsible for business guidance. When conditions are mature, the medical insurance agency will establish and manage them uniformly with the participation of state agencies, public institutions and social groups. The personal accounts of insured personnel and co-payers are uniformly established and managed by the medical insurance agency. Personal accounts of terminated personnel are not established before retirement, and personal accounts after retirement are uniformly established and managed by the medical insurance agency.

Article 23 The establishment and management of personal accounts of insured persons:

(1) The personal account of insured persons established by the employer consists of two parts.

Part of it is paid by the current employees to the unit at the rate of 2% of their total wages for the year, and all is included in their personal accounts; the other part is paid by the employer out of about 2% of the total wages of the unit's employees for the year, based on the insured amount. People of different age groups (under 35 years old, from 35 years old to 45 years old, from 45 years old to before retirement, from after retirement to 70 years old, and over 70 years old) are included, and should increase as the age group of the insured increases.

(2) The personal account of the insured person established by the medical insurance agency is composed of two parts. Part of it is paid by the current employees to the medical insurance agency at 2% of their total salary for the year, and all is included in their personal accounts; the other part is paid by the medical insurance agency based on the different age groups of the insured persons and their paid wages or basic pensions. A certain percentage of is included. The specific transfer ratio is:

(1) Those who are under 35 years old are transferred according to 0.4% of their total salary in the previous year;

(2) Those who are 35 to 45 years old are transferred according to their own salary. 0.7% of the total salary of the previous year is transferred;

(3) From the age of 45 to retirement, 1% of the total salary of the previous year is transferred;

(4) After retirement and until the age of 70, 5.8% of the personal basic pension of the previous year will be transferred. If the personal basic pension is lower than the per capita basic pension of the coordinated area in the previous year, 5.8% of the per capita basic pension of the coordinated area in the previous year will be transferred. % is transferred;

(5) 6.8% of the personal basic pension of the previous year is transferred to those over 70 years old. If the personal basic pension is lower than the per capita basic pension of the coordinated area in the previous year, the above 6.8% of the annual overall regional per capita basic pension is allocated.

(3) During the period of co-payment, the basic medical insurance premium paid by the co-payer shall be divided into two parts, 50% will be transferred to the overall fund and 50% will be transferred to the personal account; after retirement, the basic medical insurance premium paid shall be paid according to the provisions of this article. Item (2) Items (4) and (5) are proportionally included.

(4) After the terminated personnel retire, they will be included in the proportion according to the purposes (4) and (5) of item (2) of this article.

(5) Personal account funds are transferred on a monthly basis.

Article 24: Personal account funds are used to pay part of the medical expenses that should be borne by individuals in general outpatient and inpatient outpatient services that are within the scope of basic medical insurance expenditures, and outpatient services for prescribed diseases.

Article 25 The principal and interest of a personal account are owned by the individual and can be carried forward for use and inherited in accordance with the law, but cannot be withdrawn in cash or used for other purposes.

Chapter 5 Basic Medical Insurance Benefits

Article 26 Insured persons shall enjoy basic medical insurance benefits from the month following the payment of basic medical insurance premiums.

Article 27 Before reaching the statutory retirement age, insured persons shall continue to participate in basic medical insurance and pay basic medical insurance premiums. When the insured reaches the statutory retirement age and retires, if the basic medical insurance payment years (including the deemed payment years) are less than 20 years, the employer or individual can continue to enjoy basic medical insurance benefits after the employer or individual makes a one-time payment of 20 years.

Article 28 People who have interrupted their participation in insurance, when they participate in insurance again, in addition to making up for the basic medical insurance premiums payable during the interruption period, they must continue to pay for six months before they can continue to enjoy the insurance. Basic medical insurance benefits.

Article 29: Insured persons can independently choose to seek medical treatment and purchase medicines at designated medical institutions determined by the medical insurance agency, including designated community health service centers (stations), or they can also go to designated pharmacies. Purchase medicines (prescription medicines must be based on prescriptions issued by designated medical institutions).

Article 30 The hospitalization medical expenses incurred by insured persons in designated medical institutions shall be handled in accordance with the following provisions:

(1) The minimum payment standard of the unified fund (hereinafter referred to as the minimum payment standard) Standard): 2,000 yuan for third-level and corresponding medical institutions, 1,500 yuan for second-level and corresponding medical institutions, and 1,000 yuan for other medical institutions. Some medical expenses below the minimum standard are borne by the individual and the employer.

The maximum payment limit for medical expenses incurred by each insured person during the year is 40,000 yuan, and the medical expenses above the maximum payment limit are settled through major disease medical subsidies. The portion above the minimum payment standard up to RMB 40,000 will be paid from the overall fund according to the prescribed proportion.

(2) A minimum payment standard is set for each hospitalization, and the maximum payment limit is calculated cumulatively on an annual basis (based on the date of discharge).

(3) Medical expenses above the minimum payment standard and below the maximum payment limit shall be borne by the overall fund and the individual respectively. Among them, the proportion of personal burdens are: above the minimum payment standard and up to 20,000 yuan, 20% is borne by current employees and co-payers and terminated personnel, and 15% is borne by retired personnel; from 20,000 yuan to 30,000 yuan, current employees and co-payers bear 15%. , terminated personnel bear 15%, retired and retired personnel bear 10%; for more than 30,000 yuan to 40,000 yuan, current employees and co-contributors and terminated personnel bear 10%, and retired and retired personnel bear 5%; in line with the requirements of the former Ministry of Labor and Personnel As stipulated in Insurance [1983] No. 3 (the same below) for veteran workers who participated in revolutionary work before the founding of the People's Republic of China, the personal burden ratio shall be halved according to retired personnel. If there are indeed difficulties, the employer shall resolve them.

Article 31 If the cumulative amount of outpatient medical expenses for specified diseases included in the overall fund payment during the year is above the minimum payment standard, it shall be handled in accordance with the relevant provisions of Article 30 of these regulations. The maximum annual payment limit for this type of patients includes outpatient and inpatient medical expenses for specified diseases.

Article 32: General outpatient medical expenses for current employees and retirees and medical expenses below the minimum payment standard paid by the unified fund shall be handled in accordance with the following regulations:

(1) The general outpatient medical expenses and medical expenses below the minimum payment standard paid by the collective fund for active employees who have established personal accounts by the employer shall be paid first from their personal accounts. If the individual's account is insufficient for payment in the current year, the employer and the individual shall agree to the same. burden. The personal burden ratio is generally 20%. If it exceeds 30%, it should be discussed and approved by the enterprise's employee representative conference and reported to the superior trade union organization for filing.

(2) For retirees who have personal accounts established by their employers, the general outpatient medical expenses and medical expenses below the minimum payment standard paid by the unified fund shall be paid from their personal accounts first. If the personal account is insufficient for the current year, the payment shall be made When the time comes, it shall be borne jointly by the employer and the individual. The personal burden ratio is generally 15%. If it exceeds 20%, it should be discussed and approved by the enterprise's employee representative conference and reported to the superior trade union organization for filing. Among them, the proportion of personal burdens for veteran workers who participated in revolutionary work before the founding of the People's Republic of China is generally 5%. If they really have difficulties, the employer will solve them.

(3) The general outpatient medical expenses of serving employees of state agencies, institutions, and social groups whose individual accounts are uniformly established by the medical insurance agency and the medical expenses below the minimum payment standard paid by the unified fund shall start with If the personal account is insufficient to pay, 20% will be borne by the individual. If the remaining part belongs to a national civil servant, it will be settled through the national civil servant medical subsidy method. For other personnel, it will be implemented according to the national civil servant medical subsidy method (their funds will be settled through the original channel ).

(4) For retirees from state agencies, public institutions, and social groups whose personal accounts are uniformly established by medical insurance agencies, the general outpatient medical expenses and the medical expenses below the minimum payment standard paid by the unified fund shall be paid first. Payment shall be made from his or her personal account. If the personal account is insufficient for payment in the current year, the individual shall bear 15%, of which veteran workers who participated in revolutionary work before the founding of the People's Republic of China shall bear 5% personally. If the remaining part is for national civil servants, it shall be settled through the national civil servants' medical subsidy method. Others Personnel shall follow the national civil servants' medical subsidy measures (the funds will be settled according to the original channels).

Article 33: The general outpatient medical expenses of co-payers and the medical expenses below the minimum payment standard paid by the unified fund shall be paid first from their personal accounts. If the individual's account is insufficient for the current year, the payment shall be made by the individual. burden.

Article 34: The ordinary outpatient medical expenses of terminated persons and the medical expenses below the minimum payment standard paid by the unified fund shall be borne by the individual.

Article 35 If an insured person is outpatient or hospitalized in a third-level or corresponding medical institution, his or her personal medical expenses shall be 120% of the prescribed ratio; If the patient is outpatient or hospitalized in other medical institutions, the personal medical expenses borne by the patient shall be 80% of the prescribed proportion.

Article 36 The personal account funds accumulated over the years can be used to pay part of the medical expenses that should be borne by the insured person in accordance with the prescribed proportion.

Article 37 If an insured person transfers to a designated medical institution outside the province (Shanghai, Beijing) due to illness with the approval of the medical insurance agency, 10% of the total medical expenses will be borne by the individual first. Afterwards, follow the relevant provisions for medical treatment in third-level and corresponding medical institutions in Articles 30 to 36 of these regulations.

Article 38 If the insured person needs to undergo high-tech, sophisticated medical equipment examination and special treatment due to illness, or uses drugs listed in the Class B list of the basic medical insurance, a certain proportion of the medical treatment shall be borne by the individual first. After paying the fee, the matter shall be handled in accordance with the relevant provisions of Articles 30 to 37 of these Regulations.

Article 39: Medical expenses incurred by insured persons due to the following circumstances are not included in the payment scope of basic medical insurance:

(1) In the drug catalog specified by the state and province , diagnosis and treatment items, and medical service facilities outside the standard scope.

(2) Seeking medical treatment or purchasing medicines in non-designated medical institutions and non-designated pharmacies without approval.

(3) Medical expenses incurred due to violations of laws, crimes, suicide, self-injury, fights, drug abuse, alcoholism, etc.

(4) Medical expenses incurred while traveling abroad or abroad.

(5) Traffic accidents, medical accidents, large-scale food poisoning and other compensation liabilities should be paid.

The medical expenses for work-related injuries and relapses of old diseases included in the work-related injury and maternity insurance for female workers, as well as the childbirth of female workers, shall be governed by the relevant provisions of work-related injury insurance and maternity insurance for female workers.

Article 40 The medical expenses incurred by insured persons due to large-scale outbreaks of infectious diseases or the impact of irresistible large-scale natural disasters shall be studied and settled by the people's government at the same level.

Article 41 In order to basically maintain the current level of medical security for employees, insured enterprises should establish supplementary medical insurance for employees on the basis of participating in basic medical insurance. In principle, employee supplementary medical insurance funds are used for the part of the medical expenses that should be borne by the employer among the medical expenses jointly borne by the employer and the individual employee. The enterprise's supplementary medical insurance premiums are included in the welfare fees payable. When the welfare fees are insufficient, the part that is less than 4% of the total wages of employees shall be included in the cost after approval by the financial department at the same level.

Article 42: National civil servants and relevant personnel managed according to the civil servant sequence shall enjoy the national civil servant medical subsidy policy on the basis of participating in basic medical insurance. The specific measures shall be implemented in accordance with the relevant provisions of the national, provincial and municipal government subsidy measures for civil servants.

Article 43 Model workers at the municipal level and above and advanced producers (workers) commended and named by the people’s governments at the municipal level and above from 1955 to 1965 are eligible for basic medical insurance Part of the medical expenses that should be borne by the individual shall be paid first from his or her personal account. If the individual's account is insufficient for payment in the current year, the employer shall pay it according to the original expenditure channel. If the employer does have difficulties, it shall be paid from the model worker medical subsidy funds. .

Article 44: The part of the medical expenses that should be borne by individuals for disabled revolutionary servicemen of Class B and above who meet the expenditure scope of basic medical insurance shall be paid first from their personal accounts. If the personal account is insufficient for the current year, payment shall be made When the payment is made, it will be settled according to the original payment channel. The people's government at the same level will help resolve the insufficient payment of medical expenses.

Article 45: The medical treatment of retired cadres and old Red Army soldiers will remain unchanged, and medical expenses will be settled according to the original funding channels. If there are any difficulties in payment, the people's government at the same level will help solve the problem. Among them, the source of medical funds for retired cadres of enterprises at the city level is still in accordance with the relevant provisions of the "Implementation Measures for the "Two Fees" Guarantee Mechanism for Retired Cadres of Enterprises at the City Level".

Article 46 The medical expenses for immediate family members supported by enterprise employees shall be handled by the employer in accordance with the original regulations. The overall medical care for children of state agencies and institutions is managed by medical insurance agencies.

Article 47 The medical expenses of college students who were previously covered by publicly funded medical care shall be allocated by the finance department in accordance with prescribed standards and managed by the institution where they are located.

Article 48 Medical expenses incurred before the implementation of these regulations shall be settled by the original unit through the original channels.

Chapter 6 Major Illness Medical Subsidy

Article 49 The major illness medical subsidy fund consists of the following two parts:

(1) From the government A portion of the subsidy shall be withdrawn from the 0.5% subsidy of the total wages of insured employees in the overall planning area this year;

(2) The insured persons (including retired personnel) shall pay an appropriate part, tentatively, each person shall pay 36 per year Yuan, approved extremely poor employees will be exempted from payment.

The critical illness medical subsidy fund is managed and paid by the medical insurance agency.

Article 50 The proportion of medical expenses incurred by each insured person exceeding 40,000 yuan in a year shall be borne by the individual: 12% for third-level and corresponding medical institutions, and 12% for second-level and corresponding medical institutions. 10%, and other medical institutions 8%. The remaining medical expenses will be paid from the critical illness medical subsidy fund.

Article 51 If an employer employee suffers from a serious illness or a long-term illness, and the medical expenses borne by the individual in that year exceed his or her family income in that year (deducting the minimum living security standard for urban residents in this city), the amount shall be borne by The employer or the receiving management unit will provide subsidies.

Chapter 7 Basic Medical Insurance Services and Management

Article 52 Medical institutions that have been approved by the health administrative departments at all levels and have obtained the "Medical Institution Practice License" have been approved by the military Military medical institutions that are approved by the competent department to be qualified to provide external services and have obtained practice licenses through changes in registration by the local health administrative department; drug retail pharmacies that are approved by the drug supervision and administration department and hold a "Pharmaceutical Business Enterprise License" and a "Business License" , can apply to the labor and social security department for designated qualifications. The labor and social security department will review and determine the qualifications of the designated medical institutions and designated pharmacies, and the medical insurance agency will determine the qualifications and issue them to the public.

Article 53: Medical insurance agencies should sign basic medical insurance service contracts with medical institutions and pharmacies that have obtained designated qualifications, clarifying the responsibilities, rights and obligations of both parties.

Article 54: Establish a system for separate accounting and separate management of medicines, form a competition mechanism for medical services and drug circulation, and reasonably control the level of medical expenses; strengthen the internal management of medical institutions and pharmacies, and strictly follow the health regulations Provide medical services according to the technical specifications for medical diagnosis and treatment prescribed by the administrative department to ensure the quality of medical treatment and drugs.

Article 55 Designated medical institutions and designated pharmacies must strictly implement the charging standards and drug prices stipulated by the price department. If the standards and scope of the basic medical insurance are exceeded, the overall fund will not pay. Anyone who violates the charging standards for basic medical insurance services and prescribed drug prices will be dealt with in accordance with the relevant provisions of the Price Law of the People's Republic of China.

Article 56: Basic medical insurance certificates (cards) shall be uniformly issued by the medical insurance agency. Insured persons seek medical treatment and purchase medicines with their basic medical insurance certificates (cards), which should be verified by designated medical institutions and designated pharmacies.

Article 57 When an insured person is hospitalized, the designated medical institution shall collect an advance payment equivalent to the remaining portion of the overall fund allocation.

Article 58 The hospitalization medical expenses paid by the overall pool fund shall be settled on a monthly basis by the medical insurance agency and the designated medical institution.

It is stipulated that outpatient medical expenses for various diseases shall be paid in advance by the insured person and the employer, and then settled regularly to the medical insurance agency.

Article 59: Establish a basic medical insurance fund supervision organization with the participation of representatives from relevant government departments, employer representatives, medical institution representatives, trade union representatives and relevant experts, and strengthen the supervision of basic medical insurance funds through regular inspections and other forms. Supervision of the collection, management and payment of basic medical insurance funds.

Article 60 The labor and social security department shall, in conjunction with the health, drug supervision, finance, price and other departments, inspect and assess the basic medical insurance services and management of designated medical institutions and designated pharmacies. For designated medical institutions and designated pharmacies that violate regulations, the labor and social security department may order them to make corrections within a time limit, depending on different circumstances, until their designated qualifications are cancelled.

Article 61 Medical insurance agencies should establish corresponding basic medical insurance management and inspection organizations, formulate specific management measures and assessment methods, conduct supervision and inspection of designated medical institutions and designated pharmacies every quarter, and promptly Discover and solve problems, announce the inspection results to the public, and gradually standardize the basic medical insurance service behavior of designated medical institutions and designated pharmacies.

Article 62 The drug regulatory department shall, in accordance with relevant national and provincial regulations, organize relevant departments to formulate measures for handling drug accidents when purchasing drugs in designated pharmacies.

Article 63 Employers and insured persons may not refuse to pay, default on, or underpay basic medical insurance premiums by concealing total wages for any reason. Refusal to pay, late payment, underpayment of basic medical insurance premiums or other violations of these regulations shall be dealt with by the labor and social security department or local taxation department in accordance with the relevant provisions of the "Interim Regulations on the Collection and Payment of Social Insurance Premiums".

Article 64: Insured persons use unfair means to borrow or falsely use basic medical insurance certificates (cards) or forge or alter prescriptions, expense receipts and other vouchers to falsely claim basic medical insurance funds. , in addition to recovering the corresponding funds, if the circumstances are serious, they will be notified, their basic medical insurance certificate (card) will be withdrawn, and their enjoyment of basic medical insurance benefits will be suspended.

Any unit or individual who violates disciplines and laws in the basic medical insurance shall be held accountable by the relevant departments for the administrative, economic and legal responsibilities of the responsible persons and leaders depending on the severity of the case.

Chapter 8 Supplementary Provisions

Article 65 The Municipal People’s Government may, based on the development of the national economy and the operation of the basic medical insurance system, and with the approval of the provincial government, regulate the payment of medical insurance premiums. The proportion, minimum payment standard, maximum payment limit and government subsidies will be adjusted accordingly.

Article 66: Basic medical insurance diagnosis and treatment items, payment ratios for Category B drugs and service facility standards, transfers, referrals and related items’ approval and reimbursement measures shall be separately formulated by the municipal labor and social security department .

Article 67 The municipal labor and social security department shall formulate implementation details and relevant supporting policies in accordance with these regulations.

Article 68 The Hangzhou Municipal Labor and Social Security Department is responsible for the interpretation of these regulations.

Article 69 These regulations will come into effect on April 1, 2001.