Provisions of Shanghai Municipality on the Use of Social Security Cards

Detailed rules for the implementation of the notice on several issues concerning the participation of foreign workers in the basic medical insurance for urban workers in this Municipality

In order to do a good job for foreign workers to participate in the basic medical insurance for urban workers in this Municipality (hereinafter referred to as the medical insurance for urban workers), these rules are formulated according to the Measures of Shanghai Municipality on Basic Medical Insurance for Urban Workers and the Notice on Several Issues Concerning Foreign Workers' Participation in the Basic Medical Insurance for Urban Workers in this Municipality (No.2011,hereinafter referred to as the Notice).

I. Scope of application

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

Second, the personal medical account (outpatient) management

(a) personal medical account (outpatient) funds included. All the basic medical insurance premiums paid by foreign employees are included in my personal medical account (for outpatient use only). Among them, from 20 1 1 to 20 14, if the monthly basic medical insurance premium paid by individuals is lower than that of 30 yuan, the inclusion standard shall be implemented according to the monthly 30 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, in accordance with the prescribed inclusion criteria, incorporate funds into the personal medical accounts of foreign personnel (for outpatient use only). The included funds can be liquidated according to the change of the payment base of foreign employees last month, and the less included funds will be supplemented and the more included funds 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) in accordance with the prescribed inclusion criteria.

(two) the use of personal medical accounts (outpatient). Migrant workers can use personal medical accounts (special for outpatient service) to pay the outpatient emergency medical expenses in accordance with the provisions of the basic medical insurance in this Municipality, as well as the expenses for purchasing medicines in designated retail pharmacies.

(3) Cancellation of personal medical account (for outpatient use only). If a foreign employee dies or settles abroad during his/her employment, his/her personal medical account (for outpatient service only) will be cancelled.

After the cancellation of the personal medical account (outpatient service), the remaining funds of the personal medical account (outpatient service) shall be liquidated by the county medical insurance affairs center (hereinafter referred to as the county medical insurance center), and the remaining funds after liquidation shall be returned to the individual in cash.

(four) personal medical account transfer (outpatient use). If the labor relations of foreign workers 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 (Shanghai People's Society [2010] No.69).

(five) the establishment and opening of personal medical accounts (for outpatient service), the cessation and recovery of funds, and interest. According to the Notice on Printing and Distributing (No.47 [2000] of Shanghai Medical Insurance).

Third, medical insurance benefits.

(a) from the second month of participating in the medical insurance for urban workers in this Municipality, foreign employees can enjoy the medical treatment of hospitalization and emergency observation room, as well as the use of personal medical account (special for outpatient service) funds.

(2) Medical treatment in the inpatient and emergency observation room.

For the medical expenses incurred in the hospitalization or emergency observation room of foreign personnel, the Qifubiaozhun and the maximum payment limit shall be set, and the Qifubiaozhun and the maximum payment limit shall be implemented in accordance with the relevant provisions of the medical insurance for urban workers in this Municipality.

If the medical expenses incurred by foreign personnel in hospitalization or emergency observation room within one year exceed the Qifubiaozhun to the maximum payment limit, 85% will be paid by the basic medical insurance pooling fund; 80% of the medical expenses above the maximum payment limit shall be paid by the local supplementary medical insurance fund. The remaining expenses shall be borne by the foreign employees themselves.

(three) foreign employees temporarily do not enjoy outpatient serious illness, family bed medical treatment, as well as various types of medical insurance burden reduction treatment.

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

Fourth, payment management.

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

V. Physical examination certificate of foreign employees

(a) migrant workers use the social security card (special for medical insurance) (hereinafter referred to as the medical insurance card) as a medical certificate, and temporarily do not use the "Shanghai basic medical insurance outpatient and emergency medical record book (self-management)".

(two) 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.

(three) 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.

Six, sporadic medical expenses reimbursement

The medical expenses incurred by foreign employees in emergency hospitalization in local designated medical institutions during their work in other provinces and cities shall be paid in advance by foreign employees, and afterwards, they may apply to the neighboring county medical insurance centers for reimbursement of medical expenses that meet the requirements of basic medical insurance based on relevant information.

Seven. others

(a) the annual medical insurance for migrant workers and the management of medical expenses settlement shall be implemented in accordance with the relevant provisions of the medical insurance for urban workers in this Municipality.

(II) The subsidy funds for daily medical expenses in the original comprehensive insurance card for foreign employees in Shanghai shall continue to be used in accordance with the Implementation Opinions on Daily Medical Expenses Subsidies for Comprehensive Insurance for Foreign Employees in Shanghai (No.200 1). [2005] 12).

(3) These Detailed Rules shall be implemented from July 20 1 1 year to July 1 year, and shall be valid for 5 years from the date of implementation.

Supplement: The starting point of hospitalization fee is 1.500 yuan. If it exceeds 85%, it can be reported if it exceeds 280,000.

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