chapter I general provisions article 1 in order to promote the reform of the medical insurance system, ensure that employees and retirees of enterprises get basic medical care when they are seriously ill, and balance the burden of medical expenses of enterprises, these provisions are formulated in accordance with the principles of the state on the reform of the medical insurance system for employees and combined with the actual situation of this municipality. Article 2 These Provisions shall apply to the local urban enterprises (hereinafter referred to as enterprises) of cities, districts and counties within the administrative area of this Municipality, their employees and retirees (including retired employees who receive monthly living expenses, the same below). Article 3 The social co-ordination of medical expenses for serious illness of enterprise employees and retirees (hereinafter referred to as co-ordination of medical expenses for serious illness) shall be managed by districts and counties. Enterprises and their employees and retirees who are included in the prescribed scope shall participate in the overall planning of serious illness medical expenses in the regions and counties where the enterprises are located. Article 4 The principles of overall planning of medical expenses for serious illness are: mutual assistance and mutual aid, with risks borne; Insurance basic medical care to overcome waste; The state, enterprises and individuals should bear a reasonable burden. Fifth serious illness medical expenses to co-ordinate the implementation of the fund system. Districts and counties set up a fund to co-ordinate medical expenses for serious illness, and the whole city set up a fund to co-ordinate medical expenses for serious illness.

The pooling fund for serious illness medical expenses is raised according to the principle of "fixed income by expenditure, with a slight balance and some reserves", and is earmarked for the expenditure of serious illness medical expenses. The overall adjustment fund for serious illness medical expenses is extracted from the overall fund for serious illness medical expenses, which is earmarked for the balance and adjustment of the collection and use of the overall fund for serious illness medical expenses between districts and counties. Article 6 The medical expenses incurred by employees and retirees for one-time hospitalization due to illness or non-work-related injury or the accumulated medical expenses within 3 days exceed 2, yuan, which belongs to the overall scope of serious illness medical expenses.

However, the medical expenses incurred under any of the following circumstances do not belong to the overall scope of serious illness medical expenses:

(1) those who go to a non-designated hospital without approval (except for emergency rescue);

(2) Suffering from occupational diseases, work-related injuries or relapse of work-related injuries;

(3) Injuries caused by traffic accidents;

(4) I have caused injury due to my violation of the law;

(5) food poisoning caused by a liability accident;

(6) treatment due to suicide (except psychotic episode);

(7) Injuries caused by medical accidents;

(8) according to the provisions of the state and this Municipality, medical expenses should be paid by themselves. Chapter ii fund raising article 7 payment standards and expenses:

(1) enterprises (excluding foreign-invested enterprises) pay 6% of the average monthly salary of employees in the whole city in the previous year, and pay the overall medical expenses for serious illness on a monthly basis according to the number of employees in the enterprise. Among them, 2.5% is under welfare expenses; 3.5% is under the management fee-labor insurance fee.

(2) 2.5% of the average monthly salary of the employees of foreign-invested enterprises in the city in the above years, and the monthly medical co-ordination fee for serious illness shall be paid according to the number of Chinese employees in the enterprise, and the following expenses shall be paid.

(3) when the average monthly salary of enterprise employees is less than 1% of the average monthly salary of employees in the whole city, 9% of the average monthly salary of employees in the whole city shall be taken as the base, and the medical co-ordination fee for serious illness shall be paid according to the provisions in items (1) and (2) of this article.

(4) Employees and retirees pay 1% of the average monthly salary of employees in the whole city in the above-mentioned years on a monthly basis, and the enterprise will withhold it from employees' wages and pension insurance for retirees. Article 8 The overall medical expenses for serious illness paid by enterprises, employees and retirees shall be withheld on behalf of the enterprise's bank, and specially deposited into the "special account for social overall medical expenses for serious illness" opened by the district and county social insurance fund management institutions in the bank. The fund is earmarked for special purposes, and no department, unit or individual may misappropriate it. Ninth district and county social insurance fund management institutions to collect serious illness medical expenses as a whole fund, according to the monthly collection of 1% to the municipal social insurance fund management center to pay serious illness medical expenses as a whole transfer fund. Chapter III Medical Management Article 1 The designated hospital system shall be implemented for serious illness medical treatment. Workers and retirees go to designated hospitals for medical treatment with the Medical Insurance Card. If it is really necessary to be transferred for treatment, it shall go through the examination and approval procedures for transfer.

The measures for the administration of designated hospitals shall be formulated by the Municipal Labor Bureau in conjunction with the Municipal Health Bureau. Eleventh employees and retirees who really need to do special examination, special treatment or use expensive drugs shall go through the relevant examination and approval procedures, and the employees and retirees shall bear part of the expenses. Specific measures shall be formulated by the Municipal Labor Bureau in conjunction with the Municipal Health Bureau. Chapter IV Fund Payment Article 12 Medical expenses for serious illness shall be paid by the fund as a whole, and the method of grading calculation and cumulative payment shall be adopted.

For the part where the medical expenses are more than 2, yuan, the specific standards are as follows:

(1) 9% of the part where the medical expenses are more than 2, yuan but less than 5, yuan;

(2) 85% shall be paid for the part of more than 5, yuan and less than 1, yuan;

(3) 8% will be paid for the part between 1, yuan and 3, yuan;

(4) 85% of the portion between 3, yuan and 5, yuan;

(5) 9% shall be paid for the part of 5, yuan or more.

the term "above" in the preceding paragraph does not include this number, and "below" includes this number. Thirteenth serious illness medical expenses reimbursement, by the enterprise to fill in the "serious illness medical expenses social pooling fund disbursement approval form", reported to the district and county social insurance fund management institutions for review and disbursement.