Extended knowledge about Tianjin Basic Medical Plus Accident Insurance

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Chapter I General Provisions

Article 1 In order to protect the basic medical insurance enrollees to get treatment and assistance after accidental injuries, to reduce the risk of accidental injuries to the family and society, and to promote the stability and harmony of the family and the society, in accordance with the "Opinions of the People's Government of the Municipality of the City of the City of the City of the basic medical insurance system on the improvement of the city's basic medical insurance system" (Jinzhengfa [ 2010] No. 52), the formulation of this provision.

Article 2 These provisions shall apply to the participants of the basic medical insurance for urban workers and urban and rural residents of the city (hereinafter referred to as: the participants).

The accidental injury referred to in these regulations means the injury, disability or death of the insured person caused by a sudden, external and unintended accident. Exceptions are made for injuries caused by floods, earthquakes and other great natural disasters.

Article 3 The establishment and implementation of the basic medical insurance accidental injury additional insurance (hereinafter referred to as: accidental injury insurance) system shall be guided by the following basic principles:

(1) Adherence to the reciprocity of rights and obligations. The standard of payment is in line with the level of financing, and the focus is on protecting accidental injury medical payment and accidental disability and death payment.

(2) Adhering to the "to determine expenditure with income, income and expenditure balance". The accidental injury insurance funds are entrusted to management, commercial operation, separate accounting, independent accounting.

(3) Adhere to the basic medical insurance system. Accidental injury insurance in the fund-raising, insurance payments, administration and management and urban workers and urban and rural residents of the basic medical insurance system to dovetail. Accidental injury insurance coverage of medical expenses, no longer included in the basic medical insurance fund to pay the scope.

Article 4 The accidental injury insurance system is a government-led supplemental medical insurance system entrusted to insurance companies for operation and management, the establishment, operation and supervision of which shall be carried out in accordance with these provisions.

Chapter II Management and Administration

Article 5 The municipal human resources and social security administration department (hereinafter referred to as: the municipal human resources and social security department) is in charge of accidental injury insurance; the municipal finance department is responsible for the sound improvement of the financial system of accidental injury insurance funds and supervision and management; the Municipal Social Insurance Fund Management Center (hereinafter referred to as: the Municipal Social Insurance Center) is responsible for the appropriation of funds of the accidental injury insurance and the implementation of the operation of the entrusted insurance company. Implementing the guidance and supervision of the handling business of the entrusted insurance company.

Article 6 The Tianjin Municipal Service Center for Basic Medical Insurance Accidental Injury Supplementary Insurance (hereinafter referred to as "the Municipal Service Center") shall be established and be responsible for the unified handling of the accidental injury insurance.

The Municipal Service Center accepts the business guidance of the Municipal Social Security Center, and is responsible for the review of declaration materials and information entry. The Municipal Service Center has set up a telephone consulting service department, which is ready to receive reports and business consultation.

Article 7: The insurance companies set up service outlets in the streets and townships, and comprehensive service outlets in the social security branches of each district and county. The street and township service outlets accept accidental injury declarations and are responsible for handling them. The comprehensive service outlets, while accepting accidental injury declarations, accept accidental injury cases forwarded by the street and township service outlets in their respective districts and counties and summarize the statistics.

Article 8: The comprehensive service outlets will report the accidental injury cases forwarded by the street and township service outlets to the municipal service centers in a timely manner. Municipal service centers review the entry in accordance with the prescribed procedures.

Chapter III Insurance Coverage and Insurance Benefits

Article 9 In the event of accidental injury to a participant, the entrusted insurance company shall pay in accordance with the standards and objects determined in accordance with the provisions of this article:

(1) for accidental injury to a participant;

(2) for accidental disability to a participant;

(3) for accidental death to the participant's legal beneficiaries;

(3) for accidental death to the participant's legal beneficiaries. the legal beneficiary of the participant.

Article 10 The insured person is not liable for any of the following circumstances:

(1) concealment or fraud;

(2) self-inflicted injury, self-injury, or suicide;

(3) the legal beneficiary's subjective intent to cause the insured person's death or disability;

(4) driving under the influence of alcohol, driving without a license, driving with invalid license, or driving a motor vehicle without a valid driving license. (v) Injury caused by drunkenness, drug addiction, or accidental injury caused by being under the influence of alcohol, drugs, or controlled substances;

(vi) Accident caused by abortion, childbirth, food poisoning, medical malpractice, medical treatment and care received or self-treated, as well as miscarriage caused by non-accidental injuries;

(vii) Miscarriage caused by violation of laws and regulations on public security administration resulting in accidental injury;

(viii) where the liability for compensation should be borne by a third party;

(ix) where the liability for compensation should be borne by the Workers' Compensation Insurance Fund;

(x) where the medical expenses for accidental injuries occur outside the country.

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