Legal objectivity:

The "Trial Measures for Basic Medical Insurance for Urban Residents in Shanghai" was promulgated and implemented, which stipulated that it should be paid from the industrial injury insurance fund; Should be borne by a third person; Should be borne by the public health; Medical expenses incurred in the four cases of overseas medical treatment are not included in the payment scope of residents' medical insurance fund. According to the regulations, the registration and payment period of residents' medical insurance is from October to December every year. According to the annual payment, the insured shall enjoy the corresponding residents' medical insurance benefits from January 1st to December 31st of the following year. After the registration payment period expires, people who meet the requirements of residents' medical insurance can participate in the insurance halfway. Midway insured persons (except newborns) shall pay according to the annual standard, and can enjoy the residents' medical insurance benefits after waiting for 3 months. The funds other than the individual contributions of the insured (excluding college students, the same below) shall be shared by the municipal, district and county finance in a ratio of 1: 1. The insured funds for severely disabled people in cities and towns shall be borne by the disabled employment security fund for two thirds and the social welfare lottery public welfare fund for one third according to the stipulated age-group financing standard. Primary and secondary school students and infants can seek medical treatment at the designated community health service center (or a first-class medical institution), or they can choose a second-and third-class designated medical institution for medical treatment as needed. Insured persons other than primary and secondary school students and infants can seek medical treatment at the designated community health service center (or first-class medical institution) in the city; Because of illness need referral treatment, must go through the referral procedures, to the second and third level medical insurance designated medical institutions for medical treatment; Need emergency and hospitalization, you can go to the city's medical insurance designated medical institutions for medical treatment. Family members of the insured who enjoy the minimum living guarantee for urban residents in this city shall be given appropriate subsidies within the threshold for outpatient and emergency treatment and hospitalization; The urban severely disabled persons among the insured shall be fully subsidized within the Qifubiaozhun for outpatient and emergency treatment and hospitalization. Attachment: Trial Measures for the Basic Medical Insurance for Urban Residents in Shanghai (full text) Article 1 (Purpose and Basis) In order to ensure the basic medical care for urban residents in this city, these Trial Measures are formulated in accordance with the Guiding Opinions of the State Council on Launching the Pilot Project of Basic Medical Insurance for Urban Residents (Guo Fa [27] No.2) and in light of the actual situation. Article 2 (Applicable Object) Anyone who has not participated in the basic medical insurance for urban workers, the medical insurance for small towns and the new rural cooperative medical system in this Municipality and meets one of the following conditions may participate in the basic medical insurance for urban residents (hereinafter referred to as "residents' medical insurance"). (a) with the city's urban household registration, over the age of 18; (two) primary and secondary school students and infants with household registration in this city; (three) according to the actual situation, you can refer to other personnel who apply these measures. Article 3 (Administrative Department) The Municipal Medical Insurance Bureau is the administrative department in charge of medical insurance for residents in this Municipality, and is responsible for formulating and organizing the implementation of medical insurance policies for residents in this Municipality. The district and county medical insurance offices are responsible for the management of residents' medical insurance within their respective jurisdictions. Municipal finance, civil affairs, education, labor security, health, public security and other departments, as well as social organizations such as the Municipal Red Cross Society and the Municipal Federation of Disabled Persons, shall, in accordance with their respective responsibilities, coordinate in the management of residents' medical insurance. The municipal medical insurance affairs management center and the district and county medical insurance affairs centers (hereinafter referred to as "handling institutions") are specifically responsible for the registration, examination, collection and settlement of residents' medical insurance. The municipal medical insurance supervision and inspection office is responsible for the supervision and inspection of residents' medical insurance. Article 4 (Registration and Payment) The registration and payment period of residents' medical insurance is from October 1st to December 2th every year. The insured shall pay the annual fee and enjoy the corresponding residents' medical insurance benefits from January 1st to December 31st of the following year. During the registration and payment period, the registration and payment procedures for students and children in the park (institute) shall be handled by the school and child care institutions. Other personnel hold their ID cards, household registration books and other relevant documents, and go through the registration and payment procedures at the agency where the household registration is located. Article 5 (Fund Raising) The residents' medical insurance fund consists of individual contributions, government financial subsidies, employee medical insurance fund transfer and special funds. The financing standard and individual payment standard of residents' medical insurance fund are determined according to the different ages of the insured, tentatively as follows: (1) For people over 7 years old, the financing standard is 1,5 yuan per person per year, of which individual payment is 24 yuan; (two) people over the age of 6 and under the age of 7, the financing standard is 12 yuan per person per year, of which the individual pays 36 yuan; (three) more than 18 years of age, less than 6 years of age, the funding standard of 7 yuan per person per year, of which individuals pay 48 yuan; (four) primary and secondary school students and infants, the funding standard is 26 yuan per person per year, of which the individual pays 6 yuan. The funds other than the individual contributions of the insured shall be paid by the government financial subsidy funds. Specific measures shall be formulated separately by the Municipal Medical Insurance Bureau and the Municipal Finance Bureau. The financing standard of residents' medical insurance fund and individual payment standard shall be adjusted in a timely manner according to the principle of fund balance and the use of economic and social development and medical expenses, and shall be agreed by the relevant departments such as the Municipal Medical Insurance Bureau and the Municipal Finance Bureau, and promulgated and implemented after being reported to the municipal government for approval. Article 6 (Fund Management) The management of residents' medical insurance funds shall be implemented in accordance with the relevant provisions of the state and this Municipality on the management of social insurance funds. The residents' medical insurance fund shall be incorporated into the financial special account of the social security fund, under unified management, with separate accounts and special funds, and shall be subject to the supervision of the financial and auditing departments in accordance with regulations. Article 7 (Medical Insurance Treatment) The medical expenses incurred by the insured in the outpatient emergency (including family sickbeds) and hospitalization (including the emergency observation room for observation in the hospital) that conform to the provisions of these Measures shall be paid by the residents' medical insurance fund according to the following proportions, and the rest shall be borne by the insured personally: (1) For those over 7 years old, 7% shall be paid for hospitalization and 5% for outpatient emergency; (two) people over the age of 6 and under the age of 7, 6% for hospitalization and 5% for outpatient emergency; (three) more than 18 years of age, less than 6 years of age, hospitalization payment of 5%, outpatient emergency medical expenses accumulated more than 5% of 1 yuan; (four) primary and secondary school students and infants, hospitalization pay 5%, outpatient emergency pay 5%. The insured outpatient service in the community health service center (or a medical institution) for medical treatment, 6% paid by the residents' medical insurance fund. Article 8 (Management of Medical Treatment) Insured persons shall seek medical treatment with the Social Security Card (or Medical Insurance Card), Shanghai Basic Medical Insurance Emergency Medical Record Book and relevant vouchers. Primary and secondary school students and infants can seek medical treatment at the designated community health service center (or the first-class medical institution), and they can also choose the second-and third-class medical institutions to seek medical treatment nearby because of their illness. Measures for the administration of hospitalization shall be formulated separately by the Municipal Medical Insurance Bureau in conjunction with relevant departments. Insured persons other than primary and secondary school students and infants can seek medical treatment at the designated community health service centers (or first-class medical institutions) in the city. If they need to be referred for treatment due to illness, they must go through the referral procedures and go to the designated medical institutions for medical treatment at the second and third levels. Emergency and hospitalization can go to the designated medical institutions for medical treatment. Article 9 (Payment Management) The diagnosis and treatment items, medical service facilities, scope of medication, payment standards and management of designated medical institutions of residents' medical insurance shall be implemented with reference to the relevant provisions of the basic medical insurance for urban workers in this Municipality. Article 1 (Cases of Non-payment) The residents' medical insurance fund will not pay the insured in any of the following circumstances: (1) Medical expenses incurred abroad or abroad; (2) Medical expenses incurred in non-designated medical institutions in this Municipality; (three) medical expenses that do not meet the requirements of medical insurance diagnosis and treatment items, medical service facilities, drug use scope and payment standards; (4) Medical expenses incurred due to suicide, self-mutilation, fighting, drug abuse, medical accidents and traffic accidents, and medical expenses that should be borne by a third party according to law; (5) Other circumstances stipulated by this Municipality. Article 11 (Settlement of Expenses) If the medical expenses incurred by the insured in the designated medical institutions of this Municipality fall within the scope of payment by the residents' medical insurance fund, they shall be accounted for by the designated medical institutions of medical insurance, and the residents' medical insurance fund shall pay them in accordance with the provisions. If the insured fails to go through the referral procedures or does not carry the medical certificate, the medical expenses incurred in the outpatient service of the designated medical institutions in this Municipality will not be paid; After the medical expenses incurred in emergency medical treatment are paid by individuals in cash, they can apply for reimbursement to the agency in accordance with the regulations within 3 months with their medical treatment vouchers, medical expense receipts and relevant medical history materials. If the number of medical visits or medical expenses of the insured is abnormal, the municipal medical insurance supervision and inspection office can change the way of payment, and the medical expenses will be paid by the individual in cash first, and after examination, the medical expenses that meet the requirements will be reimbursed. Article 12 (Prohibited Acts) No unit or individual may falsely use, forge, alter or lend medical certificates. No designated medical institution or individual may settle or reimburse medical expenses by forged or altered accounts, materials, outpatient and emergency prescriptions, medical expense documents and other improper means. Article 13 (Non-repeated Treatment) After the insured enjoys the medical insurance benefits stipulated in these Measures, they will no longer enjoy the labor insurance benefits of the supporting unit and other basic medical insurance benefits stipulated by this Municipality. Article 14 (Merged Objects) The urban elderly, the elderly survivors of employees, the severely disabled people in cities and towns, primary and secondary school students and infants who have enjoyed the basic medical insurance benefits in this Municipality shall be included in the coverage of the basic medical insurance for urban residents. The specific connection with these measures shall be formulated separately by the Municipal Medical Insurance Bureau in conjunction with relevant departments. Article 15 (Helping Subsidies) The insured persons belong to family members who enjoy the minimum living guarantee for urban residents in this Municipality, and the individual contributions may be appropriately reduced or exempted, and the reduced or exempted part shall be borne by special funds. Specific measures shall be formulated separately by the Municipal Civil Affairs Bureau in conjunction with relevant departments. Article 16 (Legal Liability) If a designated medical institution or individual violates the provisions of these Measures or causes the loss of residents' medical insurance fund by other improper means, the Municipal Medical Insurance Bureau shall order it to make corrections within a time limit, recover the relevant medical expenses already paid, and deal with them in accordance with the relevant provisions of the state and this Municipality. For designated medical institutions with serious violations, the Municipal Medical Insurance Bureau may suspend the settlement relationship with them. If a crime is constituted, criminal responsibility shall be investigated according to law. Medical insurance agency staff illegal operation caused by the loss of residents' medical insurance fund, the Municipal Medical Insurance Bureau shall recover the loss of residents' medical insurance fund. At the same time, the responsible individuals shall be given administrative sanctions according to law; If a crime is constituted, criminal responsibility shall be investigated according to law. Article 17 (Interpretation Department) The Municipal Medical Insurance Bureau shall be responsible for the interpretation of these Trial Measures. Article 18 (Implementation Date) These Trial Measures shall be implemented as of January 1, 28.