Measures of Suzhou Municipality for the Administration of Social Basic Medical Insurance Chapter VII

Article 33 The channels for the employer to pay medical insurance premiums are as follows: the administrative organs and institutions with full financial allocation are included in the departmental budget of the unit, and the funds are included in the local financial budget arrangement; Other institutions and social organizations according to the original funding channels to solve; Enterprises are charged from the cost. Social insurance premiums paid by insured individuals are not subject to personal income tax.

Article 34 Medical insurance premiums for employees shall be collected by local tax authorities and social security institutions on a monthly basis.

Employers and their employees shall pay medical insurance premiums in full and on time in accordance with the regulations. The employing unit shall regularly announce the payment of medical insurance premiums to employees and accept the supervision of trade unions and employees.

When the enterprise is revoked, merged, merged, transferred, leased, contracted, etc. The receiving or continuing operator shall bear the medical insurance responsibility of its employees and pay the medical insurance premium of its employees in time. Bankrupt enterprises should give priority to paying off unpaid medical insurance premiums according to regulations.

The medical insurance premium for flexible employees shall be paid monthly by entrusting the bank to withhold, and the 25th of each month is the deadline for withholding. If the bank can't deduct it normally due to insufficient deposits, the payment will be suspended in the current month.

If the employer fails to pay and withhold medical insurance premiums in full according to the regulations, the collection department shall order it to pay within a time limit; Fails to pay, in addition to repay the outstanding principal, from the date of default, a daily surcharge of 2‰, which will be incorporated into the basic medical insurance fund.

Thirty-fifth community labor and social security service stations, schools and kindergartens are the agencies for medical insurance for residents and students, and are responsible for the registration of insurance and the collection of medical insurance premiums. Among them, the community labor security service station is the agency for medical insurance for community residents and children; Schools and nurseries are the agencies of student medical insurance.

Medical insurance premiums for residents and students are collected annually. Declare the payment period for residents' medical insurance from/kloc-0 to March every year; September to 1 1 declare the payment period for student medical insurance. Newborns should be born within 3 months, and their parents should go through the insurance formalities at the community labor and social security service station where the household registration is located with the newborn household registration book. In the same settlement year, the payment standard remains unchanged. The medical assistance objects newly verified by the relevant departments may go through the medical insurance and assistance registration procedures at the community labor and social security service station where the household registration is located within the settlement period.

Article 36 During the period of forming labor relations with employees, the employing unit shall participate in medical insurance for employees and pay medical insurance premiums in accordance with regulations. If the employer fails to pay the medical insurance premium according to the regulations, the employees of the unit will be suspended from enjoying the medical insurance benefits from the next month, the social insurance card will be frozen, and the account balance in the social insurance card cannot be used. The medical expenses incurred during the period of suspension shall be shared by the employer and employees according to the regulations. Residents should pay fees continuously after participating in residents' medical insurance according to regulations. During the interruption of payment, the insured residents will freeze their social insurance cards and suspend their enjoyment of medical insurance benefits; When the insurance is renewed again, the medical insurance premium during the uninsured period shall be paid by the individual according to the prescribed standards.

Thirty-seventh social medical insurance funds into the financial accounts management, earmarking, no unit or individual may misappropriate. Residents' medical insurance fund and students' medical insurance fund are managed in the same financial account. When the social medical insurance fund is insufficient to pay in the current year, it will be adjusted by the risk reserve. When the risk reserve is insufficient to pay, it shall be borne by the finance at the same level in the overall planning area.

The financial department is responsible for the special account management of the social medical insurance fund within its administrative area, and supervises the income and expenditure of the fund; The auditing department shall supervise the social medical insurance fund through auditing according to law.

Thirty-eighth the establishment of social medical insurance risk reserve, the risk reserve ratio of social medical insurance fund income of 5%. The risk reserve shall be included in the management of special financial accounts and used for special purposes.

The purpose of risk reserve is: sudden disease epidemic or natural disasters and other force majeure cause large-scale injury to the insured and medical expenses required by acute and critical patients; When the social medical insurance fund fails to meet the expenditure, it will be used for adjustment. The use of risk reserve is proposed by the administrative department of labor and social security in the overall planning area, and reported to the people's government at the same level for the record after being audited by the financial department. The specific measures shall be formulated separately by the administrative department of labor security in conjunction with the financial department.

Article 39 The social security agency shall establish personal accounts of medical insurance for the insured employees, pre-record the amount of personal accounts of the insured employees in the current year according to the regulations at the beginning of each settlement year, and settle the amount of personal accounts at the end of the settlement year according to the actual transfer and use; The actual balance of personal account bears interest according to the provisions of the state, which can be carried forward and inherited according to law. Social security institutions shall provide services for payment units and individuals to inquire about payment records or personal accounts free of charge.

The medical insurance settlement year for employees and residents is April 1 to March 3 1, and the medical insurance settlement year for students is June 1 to February 1.

Fortieth if the employer and the insured employee dissolve or terminate the labor relationship, the employer shall, in accordance with the relevant provisions, go through the formalities for retaining or transferring the medical insurance relationship with the social security agency in time.

(a) after the termination or dissolution of the labor relationship with the employer, the social security agency shall retain, transfer and continue the medical insurance relationship according to my wishes. When the social security agency handles the trans-regional transfer procedures of medical insurance relations, it will liquidate the individual accounts of the insured employees, and the actual balance of the individual accounts during the payment period will be transferred to the social security agency at the transfer place together with the individual accounts of endowment insurance; If the basic medical insurance has not been implemented in the transfer place, the social security agency will pay the actual balance of the personal account to the employee in one lump sum upon his own application, and terminate the medical insurance relationship.

(II) When employees move between the social insurance co-ordination areas of this Municipality (including county-level cities, Wuzhong District and Xiangcheng District under their jurisdiction) and Suzhou Industrial Park where the provident fund system is implemented, the medical insurance relationship can be transferred together with the endowment insurance relationship. The actual balance of individual medical insurance account and the balance of provident fund medical account shall be liquidated and transferred, and the actual payment period and deemed payment period of medical insurance (provident fund) can be calculated successively.

(three) for the insured workers transferred from other places to the overall planning areas of this Municipality, the social security agency shall handle the procedures for the continuation of the medical insurance relationship according to the insured situation confirmed by the transferred social security agency. If the actual balance of the personal account of medical insurance is transferred, it will be carried forward to the end of this settlement year after collection. When the retired soldiers are insured locally for the first time, the balance of the personal account of military medical insurance will be transferred. If the insured person who is less than 5 years away from the statutory retirement age flows across the overall planning area, he should still continue to participate in the insurance or transfer to the domicile in the original insured place.

(4) If the insured person terminates the medical insurance relationship due to death, going abroad to settle down and other reasons in the settlement year, the social security agency will liquidate his personal account, and the actual balance can be paid in one lump sum according to the regulations, and the overspent part will be made up by the individual or his family.

Forty-first insured workers to enjoy medical insurance retirement benefits, must also meet the following conditions:

(a) to receive a basic pension or pension on a monthly basis;

(2) Minimum payment period of employee medical insurance: 30 years for men and 25 years for women;

(3) The actual payment period of medical insurance within the administrative area of this Municipality must be 10 year.

Persons who meet the provisions of the preceding paragraph shall enjoy the medical insurance benefits for retirees from the month after the social security agency handles the retirement formalities; Payment period does not conform to the provisions of the preceding paragraph, when going through the retirement formalities, the insured employees and the employer shall make a one-time payment in accordance with the regulations (payment amount = the average salary of employees in the city last year at the time of retirement ×6%× insufficient payment period) before they can enjoy the medical insurance benefits for retirees, and all the medical insurance premiums paid will enter the basic medical insurance pooling fund; Do not meet the retirees' medical insurance benefits, terminate the employee medical insurance relationship.

The payment period of basic old-age insurance for employees who joined the work before July 2002 1 can be regarded as the payment period of medical insurance for employees; The medical insurance payment period after July 2002 1 only refers to the actual medical insurance payment period.

Forty-second insured persons can only enjoy one kind of social medical insurance benefits. Unemployed people can participate in employee medical insurance as flexible employees. As a flexible employee, it is indeed difficult to pay fees, and can participate in residents' medical insurance according to regulations.

After the unemployed participate in the residents' medical insurance, they will not change the form of participation within one settlement year, except for re-employment in the employer. Insured residents who participate in employee medical insurance after the employment of the employer shall enjoy employee medical insurance benefits according to the regulations from the next month after normal payment, and at the same time interrupt the enjoyment of residents' medical insurance benefits; Continuous payment to the statutory retirement age, in line with the provisions of article forty-first, can enjoy the benefits of medical insurance for retirees; Do not meet the medical insurance benefits of retirees, social security agencies to liquidate their personal accounts, the actual balance of personal accounts can be repaid to me, and the medical insurance relationship between employees is terminated accordingly; Persons who meet the requirements for participating in residents' medical insurance may participate in residents' medical insurance according to regulations.

Article 43 Relevant government departments at all levels shall prevent and investigate medical insurance fraud according to law, promptly correct and investigate medical insurance fraud, and ensure the safe operation of medical insurance funds.

The term "medical insurance fraud" as mentioned in these Measures refers to the behavior of citizens, legal persons or other organizations in the process of participating in medical insurance, paying medical insurance premiums and enjoying medical insurance benefits, implementing fraud, concealing the real situation, underpaying or defrauding medical insurance funds.

Social security agencies are responsible for reviewing the qualifications of people who enjoy medical insurance benefits, conducting daily inspections on designated units, accepting reports and complaints of social insurance fraud, investigating and collecting evidence on suspected fraud and ordering them to return illegal income, and handing over serious fraud cases to the administrative department of labor security for handling.

The administrative department of labor and social security shall, jointly with relevant departments, be responsible for investigating and handling major fraud cases, rewarding informants, and imposing administrative treatment and punishment on the parties involved in fraud cases; Cases of medical insurance fraud suspected of constituting a crime shall be handed over to the public security department for handling.

The public security department shall promptly file a case of medical insurance fraud suspected of constituting a crime handed over by the administrative department of labor and social security.

Forty-fourth any unit or individual has the right to report medical insurance violations and illegal acts of designated medical institutions, designated retail pharmacies, insured persons and staff of relevant departments. If the content of the report is true, the administrative department of labor security shall reward it according to 20% of the verified illegal amount. The reward amount is the lowest in 300 yuan, and the highest is 1000 yuan. The reward funds for reporting shall be arranged by the finance at the same level.