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Implementation Scheme of Shanghai Municipality for Carrying out the Decision of the State Council Regarding
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| (Adopted on September 22, 2000 at the 22nd Session of the Standing
Committee of the 11th Shanghai Municipal People' s Congress) In order to perfect the cities and towns staff' s and workers' medical insurance system of this Municipality, this Implementation Scheme is formulated in accordance with the Decision of the State Council Regarding the Establishment of Cities' and Towns' Staff' s and Workers' Basic Medical Insurance System and in light of the actual situation of this Municipality. I. Main Task and Principle of this Reform 1. Main Task A social medical insurance system to ensure the staff' s and workers' basic medical demands is to be established depending on the bearable capacity of public finance, enterprises and individual persons so as to meet the requirements of the socialist market economic system. 2. Principle Efforts shall be made to match the level of medical insurance with the development of productive force in the primary stage of socialism. All the cities and towns employer-units and their staff and workers shall take out medical insurance. The expenditures of medical insurance are jointly borne by the employer-units and the staff and workers. The medical insurance fund shall be a combination of social overall fund and personal accounts. The smooth transition of old and new medical insurance systems shall be realized. A staff members' and workers' medical security system with social medical insurance as the main part and multiple guarantee modes as supplements shall be established. II. Main Contents of this Reform The cities and towns staff members' and workers' basic medical insurance system and local additional medical insurance system are to be established. The cities and towns enterprises, organs, institutions, mass organizations and non-enterprise units run by local people (hereinafter jointly called employer-units) of this Municipality and their staff and workers are all covered in the basic medical insurance and local additional medical insurance. The medical insurance of the cities and towns self-employed workers, economic organization proprietors, and their practitioners and the professional persons shall be carried out by using these stipulations as reference. 1. Basic Medical Insurance (1) Payment proportion Employer-units shall monthly pay an account equal to 10 per cent of their total salaries and wages of the incumbent staff and works. The incumbent staff and workers shall pay monthly fees equal to 2 per cent of their salaries and wages. The retired personnel are not required to pay. Those who fail to pay what should have been paid shall not enjoy the medical insurance treatment. (2) Set-up of the overall fund and personal accounts The basic medical insurance fund consists of the overall fund and the personal accounts. About 70 per cent of the payment made by the employer-units are used to set up the overall fund. The fees paid by the staff and workers are all charged to their personal accounts. About 30 per cent of the payment made by the employer-units are charged to the personal accounts in the following different proportions: The incumbent staff and workers: those under 34 years old shall have their personal payments plus 0.5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year; those between 35 to 44 years old shall have their personal payments plus 1 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year; those 45 years to retirement age shall have their personal payments plus 1.5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. Retired personnel: those from retirement age to under 74 years old shall have 4 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year; those above 75 years old shall have 4.5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. (3) Coverage of the Overall Fund The overall fund covers the medical expenses of hospitalization (including the stay for observation in emergency rooms) and outpatient serious illnesses (including severe uremic dialysis, malignant tumor chemotherapy and radiotherapy.) A. Hospitalization medical expenses: There are a disbursement threshold and a disbursement maximum of the overall fund. The disbursement threshold for incumbent staff and workers is 10 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. The disbursement threshold for retired personnel is divided into three categories: (a) For those retired before December 31, 2000, it is 5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. (b) For those employed before December 31, 2000, and retired after January 1, 2001, it is 8 per cent of the staff and workers' average annual salaries and wages of this Municipality in the previous year. (c) For those employed after January 1, 2001, and retired afterwards, it is 10 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. The disbursement maximum of the overall fund is 4 times the staff' s and workers' average annual salaries and wages of this Municipality in the previous year. Of the medical expenses above the disbursement threshold and under the disbursement maximum, 85 per cent for incumbent staff and workers and 92 per cent for retired personnel shall be derived from the overall fund. B. Medical expenses of outpatient serious illnesses: The overall fund shall cover 85 per cent of the expenses for incumbent staff and workers and 92 per cent for retired personnel. The disbursement of the overall fund shall be brought into the maximum disbursement limits. (4) Coverage of Personal Accounts The personal account covers staff' s and workers' general outpatient and emergency medical expenses and the medical expenses borne by the staff and workers themselves according to the provisions of rules. Among them, the fund charged in the current year to personal accounts can only be used for general outpatient and emergency medical expenses. The personal account balance of past years can be used for general outpatient and emergency medical expenses and those expenses borne by staff' s and workers themselves according to the provisions of rules. With economic development, the proportions of employer-units' payment, incumbent staff' s and workers' payment and overall fund disbursement may be readjusted appropriately. 2. Local additional medical insurance (1) Payment Proportion The employer-units shall pay a sum equal to 2 per cent of their incumbent staff' s and workers' total salaries and wages along with the payment of the basic medical insurance premiums. The local additional medical insurance premiums paid by the employer-units are all included in the local additional medical insurance fund. (2) Coverage of Local Additional Medical Insurance Fund The local additional medical insurance fund covers the staff' s and workers' general outpatient and emergency medical expenses after depletion of personal accounts and the medical expenses above the maximum disbursement limit of the overall fund. A. General Outpatient and Emergency Medical Expenses (a) For the elderly who have completed the retiring formalities before December 31, 2000, the general outpatient emergency medical expenses are subtracted first from personal accounts and, after depletion of personal accounts, paid again by the individual persons up to an amount equivalent to 2 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 85 per cent of the excess covered by the local additional medical insurance fund. (b) For the middle-aged who were born before December 31, 1955, when in employment, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of personal accounts, paid again by the individual persons up to an amount equivalent to 10 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 70 per cent of the excess covered by the local additional medical insurance fund. After retirement, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of the personal accounts, paid again by the individual persons up to an amount equivalent to 5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 80 per cent of the excess covered by the local additional medical insurance fund. (c) For the middle-aged who were born between January 1, 1956 and December 31, 1965, when in employment, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of the personal accounts, paid again by the individual persons up to an amount equivalent to 10 per cent of the staff' s and worker' s average annual salaries and wages of this Municipality in the previous year, and then about 60 per cent of the excess covered by the local additional medical insurance fund and wages of this Municipality. After retirement, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of the personal accounts, paid again by the individual persons up to an amount equivalent to 5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 65 per cent of the excess covered by the local additional medical insurance fund. (d) For the middle-aged who were born after January 1, 1966 and employed before December 31, 2000, when in employment, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of the personal accounts, paid again by the individual persons up to an amount equivalent to 10 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 50 per cent of the excess covered by the local additional medical insurance fund. After retirement, the general outpatient and emergency medical expenses are subtracted first from the personal accounts and, after depletion of the personal accounts, paid again by the individual persons up to an amount equivalent to 5 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 50 per cent of the excess covered by the local additional medical insurance fund. (e) For the young newly-employed after January 1, 2001, when in employment, the general outpatient and emergency medical expenses are subtracted from the personal accounts and, after depletion of their personal accounts, paid again by the individual persons. After retirement, the general outpatient and emergency medical expenses are subtracted first from their personal accounts and, after depletion of their personal accounts, paid again by the individual persons up to an amount equivalent to 10 per cent of the staff' s and workers' average annual salaries and wages of this Municipality in the previous year, and then about 50 per cent of the excess covered by the local additional medical insurance fund. B. Medical Expenses above the Maximum Disbursement Limit of the Overall Fund Of the staff' s and workers' medical expenses that exceed the maximum disbursement limit of the overall fund, about 80 per cent will be covered by the local additional medical insurance fund. With economic development, the employer-units' payment proportion of the local additional medical insurance and the disbursement proportion of the local additional medical insurance fund shall be readjusted appropriately. III. Supplementary Measures of this Reform 1.The municipal public finance shall inject a certain amount of funding into the local additional medical insurance fund to ensure its disbursement capacity. 2. The incumbent staff' s and workers' salaries and wages, the retired personnel' s old-age pension and the related social security standards shall be readjusted appropriately employer-units. 3. To encourage the employer-units to set up staff members' and workers' medical mutual aid fund, to develop additional medical insurance, to foster commercial medical insurance market, to perfect social medical aid and provide diversified medical security. 4. To actively carry out the Guiding Directions for the Reform of Cities and Towns Medical and Health System issued by the State Council System Restructuring Office and other departments and transmitted by the General Office of the State Council, pushing forward simultaneously three reforms of medical insurance, medical health and pharmaceutical systems, effectively introducing competitive mechanism, providing better medical services at lower medical expenses, and promoting the coordinated development of medical insurance and medical and health undertakings. IV. Organization and Implementation of this Reform 1. The reform of medical insurance system has much to do with policies, involving vast numbers of staff' s and workers' vital interests, and relating to national economic development and social stability. Governments at all levels shall earnestly enhance leadership, unify ideas, deepen understanding, and do well in publicity and political ideological work so that the mass of staff and workers and all circles of society will give active support to, and take part in, the reform. 2. Relevant departments shall lose no time studying, drafting and working out policy measures, operational procedures and the basic medical insurance service administration supplementing this Scheme and accelerate the construction of computer system of medical insurance socialized administration in order to ensure the smooth progression of the medical insurance system reform. 3. With full knowledge of the complexity and difficulty, this Scheme shall be carried out in an active and safe way, promoting and realizing stage by stage the socialized administration of medical insurance to ensure the smooth transition of the old and new medical insurance systems. |
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