There should be no special provision for medical insurance. You can have a look at the following terms. I hope it will help you

Measures of Shanghai Municipality on Basic Medical Insurance for Urban Employees

(Promulgated by Order No.92 of Shanghai Municipal People's Government on October 2, 2)

Chapter I General Provisions

Article 1 (Purpose and Basis)

In order to ensure the basic medical needs of employees, according to the implementation plan of the State Council Municipality on Implementing the Decision on Establishing the Basic Medical Insurance System for Urban Employees,

article 2 (scope of application)

these measures are applicable to the basic medical insurance and related management activities of urban enterprises, organs, institutions, social organizations and private non-enterprise units (hereinafter referred to as employers) and their employees within the scope of this municipality.

the employees mentioned in these measures include on-the-job employees, retirees and other insured persons.

article 3 (administrative department)

medical insurance bureau (hereinafter referred to as the municipal medical insurance bureau) is the administrative department in charge of basic medical insurance in this municipality and is responsible for the unified management of basic medical insurance in this municipality. The district and county medical insurance offices (hereinafter referred to as the district and county medical insurance offices) are responsible for the management of basic medical insurance within their respective jurisdictions.

the municipal departments of health, labor and social security, finance, auditing, drug supervision and civil affairs shall, according to their respective responsibilities, coordinate in the management of basic medical insurance.

the social insurance agency in this municipality is responsible for the collection and payment of medical insurance premiums.

Shanghai Medical Insurance Affairs Management Center (hereinafter referred to as the Municipal Medical Insurance Center) is the medical insurance agency in this Municipality, which is responsible for the settlement and disbursement of medical expenses and the management of individual accounts of basic medical insurance (hereinafter referred to as individual medical accounts).

Chapter II Registration and Payment

Article 4 (Registration Procedures)

The employer shall, in accordance with the provisions of the Municipal Medical Insurance Bureau, go through the registration procedures for basic medical insurance with the designated social insurance agency; Among them, the newly established employer shall go through the registration formalities of basic medical insurance within 3 days from the date of establishment.

if the employer terminates or changes the registered items of the basic medical insurance according to law, it shall, within 3 days from the date of the relevant situation, go through the formalities of cancellation or change of registration with the original registration authority.

when handling the formalities specified in the first two paragraphs of this article, the social insurance agency shall conduct an audit according to the requirements of the municipal medical insurance bureau, and inform the municipal medical insurance bureau of the registration, change of registration or cancellation of registration of the employer in a timely manner in accordance with the provisions.

Article 5 (Calculation Method and Payment Proportion of Employees)

The payment base of on-the-job employees is their average monthly salary in the previous year. My average monthly salary in the previous year exceeded 3% of the average monthly salary of employees in this city in the previous year, and the excess was not included in the payment base; If it is lower than 6% of the average monthly salary of employees in this Municipality in the previous year, 6% of the average monthly salary of employees in this Municipality in the previous year shall be the payment base.

On-the-job employees should pay the basic medical insurance premium at the rate of 2% of their payment base. Retirees do not pay the basic medical insurance premium.

Article 6 (Calculation Method and Payment Proportion of Employer)

The employer's payment base is the sum of the employee's payment bases.

the employer shall pay the basic medical insurance premium at the rate of 1% of its payment base, and pay the local additional medical insurance premium at the rate of 2% of its payment base.

article 7 (channels for allocating medical insurance premiums)

medical insurance premiums paid by employers shall be allocated according to the channels stipulated by the financial department.

article 8 (administration of collection and payment)

the calculation and payment procedures of the amount paid by the employing units and employees on the job and the handling of disputes over collection and payment shall be carried out in accordance with the relevant provisions on the administration of collection and payment of social insurance premiums.

chapter iii individual medical accounts, pooling funds and additional funds

article 9 (basic medical insurance fund)

the basic medical insurance fund consists of pooling funds and individual medical accounts.

the basic medical insurance premium paid by the employer shall be included in the individual medical account in accordance with the provisions of the second and third paragraphs of Article 11 of these Measures, and the rest shall be included in the overall fund.

article 1 (establishment of individual medical accounts)

after the employer has gone through the registration formalities of basic medical insurance and paid the medical insurance premium according to the regulations, the municipal medical insurance center shall establish individual medical accounts for employees.

article 11 (funds included in individual medical accounts)

all the basic medical insurance premiums paid by employees are included in their individual medical accounts.

The basic medical insurance premium paid by the employer shall be included in the individual medical accounts of employees in the following proportions:

(1) For those under 34 years old, it shall be .5% of the average annual salary of employees in this Municipality in the previous year;

(2) For those aged 35 to 44, 1% of the average annual salary of employees in this Municipality in the previous year;

(3) 1.5% of the average annual salary of employees in this city in the previous year for those aged 45 to retirement.

The basic medical insurance premium paid by the employer shall be included in the personal medical account of retirees according to the following proportions:

(1) For those who retire to the age of 74, it shall be 4% of the average annual salary of employees in this Municipality in the previous year;

(2) 4.5% of the average annual salary of employees in this city in the previous year if they are over 75 years old.

Article 12 (Discontinuation of Counting Funds in Individual Medical Accounts)

If an employee should pay but fails to pay the basic medical insurance premium or stops enjoying the basic old-age insurance benefits, he shall stop counting the funds according to the provisions of Paragraph 2 or Paragraph 3 of Article 11 of these Measures.

article 13 (use and interest calculation of funds in individual medical accounts)

funds in individual medical accounts are owned by individuals, which can be carried over from year to year and inherited according to law.

individual medical account funds are divided into the funds included in the current year and the balance funds over the years.

the year-end funds in the individual medical account shall bear interest according to relevant regulations and be included in the individual medical account.

article 14 (inquiry of funds in individual medical accounts)

employees can inquire about the calculation and expenditure of funds in their individual medical accounts, and the municipal medical insurance bureau, the county medical insurance office and the municipal medical insurance center shall provide convenience for employees to inquire.

article 15 (additional funds)

all the local additional medical insurance premiums paid by the employer shall be included in the local additional medical insurance fund (hereinafter referred to as the additional fund).

chapter iv medical treatment and provision of medical services for employees

article 16 (definition of designated medical institutions and designated retail pharmacies)

the designated medical institutions mentioned in these measures refer to medical institutions that have obtained the practice license with the approval of the administrative department of health and have been approved by the municipal medical insurance bureau to establish the settlement relationship of basic medical insurance.

the designated retail pharmacies mentioned in these measures refer to pharmaceutical retail enterprises that have obtained business qualifications with the approval of the pharmaceutical supervisory and administrative department and have been approved by the municipal medical insurance bureau to establish the settlement relationship of basic medical insurance.

Article 17 (Service Requirements of Designated Medical Institutions and Designated Retail Drugstores)

Designated medical institutions and designated retail pharmacies shall provide services for their employees, and apply for medical expenses settlement according to the basic medical insurance diagnosis and treatment items, medical service facilities, medication scope and payment standards.

article 18 (diagnosis and treatment items, medical service facilities, scope of medication and payment standards)

the provisions on diagnosis and treatment items, medical service facilities, scope of medication and payment standards of basic medical insurance in this municipality shall be formulated by the municipal medical insurance bureau jointly with relevant departments in accordance with state regulations.

Article 19 (Medical Treatment and Dispensing for Employees)

Employees may go to designated medical institutions within this Municipality for medical treatment.

employees can fill prescriptions at designated medical institutions or at designated retail pharmacies according to regulations.

employees whose places of employment or residence are in other provinces and cities, or who are in emergency in other provinces and cities, can go to local medical institutions for medical treatment.

Article 2 (Medical Insurance Voucher)

Employees shall show their medical insurance vouchers when seeking medical treatment at designated medical institutions in this Municipality and dispensing medicines at designated retail pharmacies.

designated medical institutions or retail pharmacies shall verify the medical insurance certificates of employees.

no individual may falsely use, forge, alter or lend medical insurance vouchers.

chapter v payment of medical expenses

article 21 (conditions for employees to enjoy basic medical insurance benefits)

employees can enjoy basic medical insurance benefits if employers and their employees pay medical insurance premiums in accordance with regulations; Workers who fail to pay medical insurance premiums cannot enjoy basic medical insurance benefits.

if the employer applies for holdover of medical insurance premiums in accordance with relevant regulations, employees will not stop enjoying basic medical insurance benefits during the approved holdover period.

the employer and its employees who should pay the medical insurance premium but have not paid it can continue to enjoy the basic medical insurance benefits only after paying the medical insurance premium in full.

if the employer and its employees have paid medical insurance premiums for more than 15 years (including deemed payment years), employees can enjoy basic medical insurance benefits after retirement. As the calculation of the payment period, it shall be stipulated separately by the Municipal Medical Insurance Bureau.

retirees who have enjoyed basic medical insurance benefits according to relevant regulations before the implementation of these measures are not subject to the restrictions stipulated in this article.

article 22 (outpatient emergency medical expenses of on-the-job workers)

expenses incurred by on-the-job workers in outpatient emergency medical treatment or dispensing medicines at designated retail pharmacies other than those stipulated in articles 24 and 25 of these measures shall be paid by their personal medical account funds. The insufficient part shall be paid according to the following provisions (excluding the expenses incurred in dispensing medicines at designated retail pharmacies):

(1) Those who were born before December 31, 1955 and joined the work before December 31, 2 shall be paid by individuals 1% of the average annual salary of employees in this city in the previous year, and 7% of the medical expenses for the excess part shall be paid by additional funds, and the rest shall be borne by on-the-job employees.

(2) Those who were born from January 1, 1956 to December 31, 1965 and joined the work before December 31, 2 will be paid by individuals to 1% of the average annual salary of employees in this city in the previous year, and 6% of the medical expenses in excess will be paid by the additional fund, and the rest will be borne by the employees on the job.

(3) Those who were born after January 1, 1966 and joined the work before December 31, 2 will be paid 1% of the average annual salary of employees in this city in the previous year by individuals, 5% of the medical expenses in excess will be paid by the additional fund, and the rest will be borne by the employees on the job.

(4) Those who join the work after January 1, 21 shall be borne by the employees on the job.

article 23 (outpatient emergency medical expenses for retirees)

expenses incurred by retirees for outpatient emergency medical treatment or dispensing medicines at designated retail pharmacies other than those stipulated in articles 24 and 26 of these measures shall be paid by their personal medical account funds. The insufficient part shall be paid according to the following provisions (excluding the expenses incurred in dispensing medicines at designated retail pharmacies):

(1) For those who have gone through retirement procedures before December 31, 2, they shall be paid by individuals to 2% of the average annual salary of employees in this city in the previous year, and for those who are in outpatient and emergency departments of first-class medical institutions, 9% of the excess medical expenses shall be paid by additional funds; In the outpatient emergency of secondary medical institutions, more than 85% of the medical expenses are paid by the additional fund; In the outpatient emergency of tertiary medical institutions, more than 8% of the medical expenses are paid by the additional fund; The rest is borne by retirees.

(2) For those who were born before December 31st, 1955, joined the work before December 31st, 2, and went through retirement formalities after January 1st, 21, the individual will pay 5% of the average annual salary of employees in this city in the previous year, and for those who are in outpatient and emergency treatment in a first-class medical institution, 85% of the excess medical expenses will be paid by the additional fund; In the outpatient emergency of secondary medical institutions, more than 8% of the medical expenses are paid by the additional fund; In the outpatient emergency of tertiary medical institutions, more than 75% of the medical expenses are paid by the additional fund; The rest is borne by retirees.

(3) Those who were born from January 1, 1956 to December 31, 1965, joined the work before December 31, 2, and went through retirement formalities after January 1, 21, will be paid by individuals to 5% of the average annual salary of employees in this city in the previous year, and 7% of the medical expenses for outpatient emergency treatment in first-class medical institutions will be paid by additional funds; In the outpatient emergency of secondary medical institutions, more than 65% of the medical expenses are paid by the additional fund; In the outpatient emergency of tertiary medical institutions, more than 6% of the medical expenses are paid by the additional fund; The rest is borne by retirees.

(4) Those who were born after January 1, 1966, joined the work before December 31, 2, and went through retirement formalities after January 1, 21, will be paid 5% of the average annual salary of employees in this city in the previous year by individuals, and 55% of the excess medical expenses will be paid by the additional fund in the first-class medical institutions for outpatient emergency treatment; In the outpatient emergency of secondary medical institutions, more than 5% of the medical expenses are paid by the additional fund; In the outpatient emergency of tertiary medical institutions, more than 45% of the medical expenses are paid by the additional fund; The rest is borne by retirees.

(5) For those who took part in the work after January 1, 21 and went through retirement formalities afterwards, 1% of the average annual salary of employees in this city in the previous year was paid by individuals, and 55% of the medical expenses for outpatients and emergency departments in first-class medical institutions were paid by additional funds; In the outpatient emergency of secondary medical institutions, more than 5% of the medical expenses are paid by the additional fund; In the outpatient emergency of tertiary medical institutions, more than 45% of the medical expenses are paid by the additional fund; The rest is borne by retirees.

article 24 (medical expenses for outpatient serious illness and family sickbed)

85% of the medical expenses incurred by employees in outpatient dialysis for severe uremia, chemotherapy for malignant tumor and radiotherapy (hereinafter referred to as outpatient serious illness medical treatment) shall be paid by the overall fund; For retirees, 92% will be paid by the overall fund. The rest shall be paid by the surplus funds of individual medical accounts over the years, and the insufficient part shall be borne by the employees.

8% of the medical expenses incurred by employees' family beds shall be paid by the overall fund, and the rest shall be paid by the surplus funds of individual medical accounts over the years, and the insufficient part shall be borne by employees.

Article 25 (Hospitalization and Emergency Observation Room Medical Expenses of On-the-job Employees)

The medical expenses incurred by on-the-job employees in hospitalization or observation in emergency observation room and paid by the pooling fund shall be deductible. Qifubiaozhun is 1% of the average annual salary of employees in this city in the previous year.

85% of the medical expenses incurred by on-the-job employees in hospitalization or observation in emergency observation room within one year, which cumulatively exceeds Qifubiaozhun, shall be paid by the overall fund.

the medical expenses incurred by the employees below the qifubiaozhun and the remaining medical expenses paid by the overall fund shall be paid by the surplus funds of individual medical accounts over the years, and the insufficient part shall be borne by the employees.

article 26 (medical expenses of retirees in hospitalization and emergency observation room)

the medical expenses incurred by retirees in hospitalization or observation in emergency observation room and paid by the pooling fund shall be set with the minimum payment standard. For those who retire before December 31, 2, the Qifubiaozhun is 5% of the average annual salary of employees in this city in the previous year; Worked before December 31, 2 and retired after January 1, 21