Detailed rules for the implementation of the Notice on Several Issues Concerning the Participation of Foreign Employees in the Basic Medical Insurance for Urban Employees in this Municipality

In order to do a good job in the participation of foreign employees in the basic medical insurance for urban employees in this Municipality, according to the Measures of Shanghai Municipality on the Basic Medical Insurance for Urban Employees and the Notice on Several Issues Concerning the Participation of Foreign Employees in the Basic Medical Insurance for Urban Employees in this Municipality (Hu Fu Fa [211] No.27

I. Scope of application

These Detailed Rules are applicable to non-urban migrant workers (hereinafter referred to as migrant workers) who have established labor relations with employers in this Municipality and paid basic medical insurance premiums in accordance with the provisions of Article 2 of the Notice.

ii. management of personal medical account (for outpatient use)

(1) the funds of personal medical account (for outpatient use) are included. The basic medical insurance premiums paid by foreign employees are all included in my personal medical account (for outpatient use only). Among them, from 211 to 214, if the monthly basic medical insurance premium paid by individuals is lower than that of 3 yuan, the inclusion standard shall be implemented according to the monthly 3 yuan; The difference between the individual payment and the inclusion standard is included in the basic medical insurance premium paid by the employer.

the municipal medical insurance affairs management center (hereinafter referred to as the municipal medical insurance center) shall, according to the prescribed inclusion criteria, include funds in the personal medical accounts of foreign employees (for outpatient service only). The funds included can be liquidated according to the change of the payment base of foreign employees in last month, and those less included will be supplemented and those more included will be deducted.

after the employer and foreign employees pay back the unpaid medical insurance premiums, the municipal medical insurance center will supplement the funds to the individual medical accounts of foreign employees (for outpatient use only) according to the prescribed inclusion criteria.

(2) the use of personal medical accounts (for outpatient use only). Foreign employees may, according to the provisions of the Notice, use personal medical account (special for outpatient service) to pay the outpatient emergency medical expenses that meet the requirements of the basic medical insurance in this Municipality, and the expenses of purchasing drugs at designated retail pharmacies.

(3) cancellation of personal medical account (for outpatient use only). If a foreign employee dies or goes abroad (leaves the country) to settle down while on the job, his personal medical account (special for outpatient service) shall be cancelled.

after the cancellation of the personal medical account (for outpatient use only), the district and county medical insurance affairs centers (hereinafter referred to as the district and county medical insurance centers) will liquidate the remaining funds of the personal medical account (for outpatient use only), and the remaining funds after liquidation will be returned to the individual in cash.

(4) transfer of personal medical account (for outpatient use only). If the labor relations of foreign employees are transferred from this city to other provinces and cities, the transfer of personal medical accounts (for outpatient use only) shall be handled in accordance with the provisions of the Notice on Several Issues Concerning the Transfer and Continuation of Basic Medical Insurance Relations in this City (No.69 [21] of Shanghai People's Society).

(5) the establishment and activation of individual medical accounts (for outpatient use only), the stop and recovery of funds, and interest calculation, etc. In accordance with the "On Printing and Distributing <: Measures of Shanghai Municipality on the Administration of Individual Medical Accounts of Basic Medical Insurance for Urban Employees (Trial) >: Notice "(Shanghai medical insurance [2] No.47).

III. Medical insurance benefits

(1) From the second month after participating in the medical insurance for urban workers in this city, foreign employees can enjoy medical treatment in the inpatient and emergency observation room, and use funds from personal medical accounts (for outpatient use only).

(II) Medical treatment in hospitalization and emergency observation room

The medical expenses incurred by foreign employees in hospitalization or in emergency observation room shall be set with minimum threshold and maximum payment limit, which shall be implemented in accordance with the relevant provisions of medical insurance for urban workers in this Municipality.

85% of the medical expenses incurred by foreign employees in hospitalization or in emergency observation room within one year, which cumulatively exceeds Qifubiaozhun to the maximum payment limit, shall be paid by the basic medical insurance pooling fund; 8% of the medical expenses above the maximum payment limit shall be paid by the local supplementary medical insurance fund. The rest shall be borne by the foreign employees themselves.

(3) migrant workers will not enjoy outpatient serious illness, family bed medical treatment, and various medical insurance burden reduction treatments for the time being.

(4) employers and foreign employees who should pay medical insurance premiums will stop enjoying medical insurance benefits from the next month if they fail to pay or pay in full. After the employer and foreign employees pay the medical insurance premium in full, they will resume the medical insurance benefits from the next month, and the medical expenses incurred during the period of stopping the treatment will be borne by the employer.

IV. Payment Management

The medical treatment items, medical service facilities, drug use scope and payment standards of foreign employees shall be implemented in accordance with the relevant provisions of the medical insurance for urban employees in this Municipality.

V. Medical Vouchers of Foreign Employees

(1) Foreign employees use social security cards (special for medical insurance) (hereinafter referred to as medical insurance cards) as medical vouchers, and do not use the Shanghai Basic Medical Insurance Emergency Medical Record Book (self-management) for the time being.

(2) The daily issuance of medical insurance cards is the responsibility of the county medical insurance center where the employer is located. District and county medical insurance centers issue medical insurance cards to foreign employees through employers.

(3) The procedures for reporting the loss or loss of the medical insurance card after it is damaged or lost shall be implemented in accordance with the relevant provisions of this Municipality.

VI. Sporadic reimbursement of medical expenses

During working in other provinces and cities, the medical expenses incurred by foreign employees in emergency hospitalization in local designated medical institutions for medical insurance shall be paid in advance by them personally, and afterwards, they can apply for reimbursement of medical expenses that meet the requirements of basic medical insurance to the neighboring district and county medical insurance centers with relevant information.

VII. Others

(1) The annual medical insurance for foreign employees and the settlement management of medical expenses shall be implemented in accordance with the relevant provisions of this Municipality on medical insurance for urban employees.

(2) The subsidy funds for daily medical expenses in the original Comprehensive Insurance Card for Foreign Employees in Shanghai will continue to be used in accordance with the Implementation Opinions on Comprehensive Insurance Subsidies for Daily Medical Expenses for Foreign Employees in Shanghai (Hu Labor Insurance No.12 [25]).

(3) These detailed rules will be implemented from July 1st, 211, and the validity period will be five years from the date of implementation.

Supplement: the starting point for hospitalization expenses is 1,5 yuan, and those that exceed can be reported 85%, and those that exceed 28, yuan can be reported 8%.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.