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Provisions on Basic Medical Insurance of Beijing Municipality
(Promulgated by Order No. 68 of the People's Government of Beijing Municipality on February 20, 2001, revised for the first time according to Order No. 141 of the People's Government of Beijing Municipality on December 1, 2003 and amended for the second time according to Order No. 158 of the People's Government of Beijing Municipality on June 6, 2005)
| | 北京市基本医疗保险规定
（2001年2月20日北京市人民政府第68号令公布 根据2003年12月1日北京市人民政府第141号令第一次修改 根据2005年6月6日北京市人民政府第158号令第二次修改）
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Contents
| | 目录
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Chapter I General Provisions
| | 第一章 总则
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Chapter II Basic Medical Insurance Fund
| | 第二章 基本医疗保险基金
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Chapter III Individual Accounts for Basic Medical Insurance
| | 第三章 基本医疗保险个人帐户
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Chapter IV Benefits of Basic Medical Insurance
| | 第四章 基本医疗保险待遇
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Chapter V Supplementary Medical Insurance
| | 第五章 补充医疗保险
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Chapter VI Medical Treatment Administration
| | 第六章 医疗管理
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Chapter VII Organization, Administration and Supervision
| | 第七章 组织管理和监督
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Chapter VIII Legal Responsibilities
| | 第八章 法律责任
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Chapter IX Supplementary Provisions
| | 第九章 附则
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Chapter I General Provisions
| | 第一章 总则
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Article 1 According to relevant provisions of the State combined with the specific conditions of Beijing, these provisions are hereby formulated for the purpose of ensuring that employees and retired people get basic medical treatment and benefits from medical insurance when suffering from illnesses.
| | 第一条 为了保障职工和退休人员患病时得到基本医疗，享受医疗保险待遇，根据国家有关规定，结合本市实际情况，制定本规定。
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Article 2 These provisions apply to all employing units, including enterprises, public authorities, institutions, social organizations and private non-enterprise units (hereinafter referred to as employing units) in cities and towns within this municipal administrative region, and employees and retired persons from those employing units. The exact time for the employing units and their employees and retired persons to participate in the basic medical insurance shall be set by the municipal labor and social security administrative department (hereinafter referred to as "municipal labor security administrative department").
| | 第二条 本市行政区域内的城镇所有用人单位，包括企业、机关、事业单位、社会团体、民办非企业单位（以下简称用人单位）及其职工和退休人员适用本规定。
用人单位及其职工和退休人员参加基本医疗保险的具体时间由市劳动和社会保障行政部门（以下简称市劳动保障行政部门）规定。
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Article 3 The municipal labor security administrative department shall be responsible for the work of medical insurance throughout the municipality, organizing to implement the system of medical insurance as well as the administration, supervision and inspection of the work of medical insurance.
The labor security administrative department of every district and county shall be responsible for the administration, supervision and inspection of the work of medical insurance within their respective administrative region.
Specific work of medical insurance shall be handled by social insurance agencies established respectively by the municipal labor security administrative department of each city, district, and county.
| | 第三条 市劳动保障行政部门主管全市医疗保险工作，组织实施医疗保险制度，负责医疗保险工作的管理和监督检查。
区、县劳动保障行政部门负责本行政区域内医疗保险工作的管理和监督检查。
市和区、县劳动保障行政部门设立的社会保险经办机构，具体经办医疗保险工作。
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Article 4 The premium for basic medical insurance is to be paid by both employing units and their employees, and shall be collectively planned by the entire municipality. The basic medical insurance fund shall operate with the principle of the combination of an overall societal plan and individual accounts. The guaranteed level for basic medical insurance shall be determined in accordance with the municipality's level of production development, the financial situation and the economic capacity of the employing units and their employees.
| | 第四条 基本医疗保险费实行用人单位和职工个人双方负担、共同缴纳、全市统筹的原则。基本医疗保险基金实行社会统筹和个人帐户相结合的原则。基本医疗保险的保障水平应当与本市社会生产力发展水平以及财政、用人单位和个人的承受能力相适应。
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Article 5 The foundation of the implementation of basic medical insurance for a municipality should be based on the establishment of a system of mutual aid for large amounts of medical expenses, and measures of medical subsidy to civil servants; enterprises and institutions may set up supplementary medical insurance, and employing units and individuals are encouraged to participate in commercial medical insurance.
| | 第五条 本市在实行基本医疗保险的基础上，建立大额医疗费用互助制度，实行国家公务员医疗补助办法，企业和事业单位可以建立补充医疗保险，鼓励用人单位和个人参加商业医疗保险。
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Article 6 In accordance with the establishment of the basic medical insurance system, it is necessary to advance the reform in medical and health system cities and towns, and provide relatively high-quality medical service to employees and retired people using relatively low expenses, so as to meet the needs of the masses for basic medical service.
| | 第六条 结合基本医疗保险制度的建立，积极推进城镇医药卫生体制改革，用比较低廉的费用，为职工和退休人员提供比较优质的医疗服务，满足广大人民群众基本医疗服务的需要。
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Chapter II Basic Medical Insurance Fund
| | 第二章 基本医疗保险基金
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Article 7 The basic medical insurance fund shall maintain a balanced budget, with expenditures disbursed according to revenue levels.
| | 第七条 基本医疗保险基金应当以收定支，收支平衡。
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Article 8 The basic medical insurance fund consists of:
| | 第八条 基本医疗保险基金由下列各项构成：
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(1) premium paid by employing units for basic medical insurance;
| | （一）用人单位缴纳的基本医疗保险费；
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(2) premium paid by employees for basic medical insurance;
| | （二）职工个人缴纳的基本医疗保险费；
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(3) interests on premium for basic medical insurance;
| | （三）基本医疗保险费的利息；
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(4) surcharge for overdue premium for the basic medical insurance; and
| | （四）基本医疗保险费的滞纳金；
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(5) other financial resources to be incorporated in the basic medical insurance fund according to law.
| | （五）依法纳入基本医疗保险基金的其它资金。
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Article 9 The premium for basic medical insurance shall be paid by both employing units and employees. Employing units and employees must pay full premium on time; otherwise, the relevant individual account shall not be credited, and the medical expenses of the relevant person shall not be paid by the overall basic medical insurance fund.
| | 第九条 基本医疗保险费由用人单位和职工个人共同缴纳。用人单位和职工应当按时足额缴纳基本医疗保险费。不按时足额缴纳的，不计个人帐户，基本医疗保险统筹基金不予支付其医疗费用。
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Article 10 The premium for the basic medical insurance to be paid by an employee shall be 2% of his average monthly wage in the previous year.
Where any employee had an average monthly wage the previous year less than 60% of the average wage of all employees in the municipality the previous year, that employee shall pay his premium for basic medical insurance based on 60% of his average monthly wage the previous year.
Where any employee had an average monthly wage the previous year more than 300% of the average wage of all employees in the municipality the previous year, the amount over 300% is not subject to the premium for the basic medical insurance.
Where any employee's average monthly wage the previous year in not determinable, reference is to be made to the average wage of all employees in the municipality the previous year.
| | 第十条 职工按本人上一年月平均工资的2%缴纳基本医疗保险费。
职工本人上一年月平均工资低于上一年本市职工月平均工资60％的，以上一年本市职工月平均工资的60%为缴费工资基数，缴纳基本医疗保险费。
职工本人上一年月平均工资高于上一年本市职工月平均工资300％以上的部分，不作为缴费工资基数，不缴纳基本医疗保险费。
无法确定职工本人上一年月平均工资的，以上一年本市职工月平均工资为缴费工资基数，缴纳基本医疗保险费。
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Article 11 People who have retired before the implementation of these provisions are not required to pay premium for basic medical insurance.
Those who are employed after the implementation of these provisions, but have undergone retirement procedures according to the provisions of the State, having contributed premiums for basic medical insurance for an accumulated 25 years (for male employees) or 20 years (for female employees), and receive their basic monthly pension or retirement pay, shall enjoy the benefits for retired people from the basic medical insurance without further payment of premium for the basic medical insurance.
Where any person become employed before and retires after the implementation of these Provisions, having paid premiums for the basic medical insurance not up to the amount prescribed in the preceding paragraph, he or she is required to make a lump-sum payment for what would be paid as premium by both his employing unit and the employee himself, before he can enjoy the benefits for retired people from the basic medical insurance without further premium payments for basic medical insurance. With the approval of the labor security administrative department, an employee's continuing service or period of work that complies with the provisions of the State, shall be considered as a period of work in which the premiums for the basic medical insurance have been paid。
| | 第十一条 本规定施行前已退休的人员不缴纳基本医疗保险费。
本规定施行后参加工作，累计缴纳基本医疗保险费男满25年、女满20年的，按照国家规定办理了退休手续，按月领取基本养老金或者退休费的人员，享受退休人员的基本医疗保险待遇，不再缴纳基本医疗保险费。
本规定施行前参加工作施行后退休，缴纳基本医疗保险费不满前款规定年限的，由本人一次性补足应当由用人单位和个人缴纳的基本医疗保险费后，享受退休人员的基本医疗保险待遇，不再缴纳基本医疗保险费。经劳动保障行政部门认定，职工的连续工龄或者工作年限符合国家规定的，视同基本医疗保险缴费年限。
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Article 12 Each employing unit shall pay as the premium 9% of the total amount of all its employees' wages that are subject to premium for the basic medical insurance.
| | 第十二条 用人单位按全部职工缴费工资基数之和的9％缴纳基本医疗保险费。
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Article 13 Any change in the premium rates for the basic medical insurance shall be proposed by municipal the labor security administrative department in conjunction with the municipal finance department, and be subject to the approval by the municipal government.
| | 第十三条 基本医疗保险费缴费比例需要调整时，由市劳动保障行政部门会同市财政部门提出，报市人民政府批准。
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Article 14 Employing units shall declare on time to the social insurance agency the real average monthly wage of all their employees in the previous year. The social insurance agency shall, according to relevant provisions and after the required ratification, fix the amount that is subject to the premium for the basic medical insurance.
| | 第十四条 用人单位应当按时向社会保险经办机构如实申报职工上一年月平均工资，社会保险经办机构按照规定核定基本医疗保险缴费工资基数。
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Article 15 The social insurance agency shall authorize banks with which the employing units will have their entrusted accounts for the premiums paid by the employing units, where the collection of monthly premiums of the basic medical insurance for the agency will be conducted in the "order to collect (no period of payment)〞settlement method.
The employing units shall make payments for premiums that should be paid by their employees with the monthly withholdings from the employees' wages.
| | 第十五条 用人单位应缴纳的基本医疗保险费，由社会保险经办机构委托用人单位的开户银行以“委托银行收款（无付款期）”的结算方式按月扣缴。
职工个人应缴纳的基本医疗保险费，由用人单位按月从本人工资中代扣代缴。
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Article 16 All payment to the basic medical insurance fund shall be collectively planned by the entire municipality, managed at different levels, incorporated into the financial account of the social security fund, and managed with the receipts and expenditures separately channeled.
The basic medical insurance fund may only be used for its specific purpose. It may not be embezzled or misappropriated nor used for balancing financial revenues and expenditures.
| | 第十六条 基本医疗保险基金实行全市统筹，分级管理，全部纳入社会保障基金财政专户，实行收支两条线管理。
基本医疗保险基金要专款专用，不得挤占或者挪用，不得用于平衡财政收支。
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Article 17 Payment for the basic medical insurance fund for the current year shall gain interest according to the bank interest rate for current deposits; the part carried over from last year, including both principal and interest, shall gain interest according to the bank interest rate for three-month terms of lump-sum deposit and lump-sum withdrawal; the adopted interest rate on the deposited funds to the financial account of the social security fund shall be no lower than the bank interest rate for three-year terms of small-sum deposits and lump-sun withdrawal.
| | 第十七条 基本医疗保险基金当年筹集的部分，按银行活期存款利率计息；上年结转的基金本息，按3个月期整存整取银行存款利率计息；存入社会保障基金财政专户的沉淀基金，比照3年期零存整取储蓄存款利率计息，并不低于该档次利率水平。
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Article 18 The basic medical insurance fund shall adopt a unified social insurance budgeting system, unified financial and accounting system and unified internal auditing system.
| | 第十八条 基本医疗保险基金执行统一的社会保险预决算制度、财务会计制度和内部审计制度。
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Chapter III Individual Accounts for the Basic Medical Insurance
| | 第三章 基本医疗保险个人帐户
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Article 19 The social insurance agency shall establish an individual account of basic medical insurance (hereinafter referred to as "individual account") for each employee and retired person.
| | 第十九条 社会保险经办机构应当为职工和退休人员建立基本医疗保险个人帐户（以下简称个人帐户）。
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Article 20 A individual account consists of:
| | 第二十条 个人帐户由下列各项构成：
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(1) premium paid by the employee for the basic medical insurance;
| | （一）职工个人缴纳的基本医疗保险费；
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(2) premium paid by the employing unit that according to relevant provisions shall be transferred to the individual account;
| | （二）按照规定划入个人帐户的用人单位缴纳的基本医疗保险费；
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(3) interest on the deposit in the individual account; and
| | （三）个人帐户存储额的利息；
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(4) other financial resources that are incorporated in the individual account according to law.
| | （四）依法纳入个人帐户的其它资金。
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Article 21 The portion of the premium paid by an employing entity for the basic medical insurance shall be transferred to individual accounts according to the following standards:
| | 第二十一条 用人单位缴纳的基本医疗保险费的一部分按照下列标准划入个人帐户：
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(1) for an employee less than 35 years old, 0.8% of the employee's monthly wage subject to the payment of premium;
| | （一）不满35周岁的职工按本人月缴费工资基数的0.8%划入个人帐户；
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(2) for an employee over 35 years old and less than 45 years, 1% of the employee's monthly wage subject to the payment of premium;
| | （二）35周岁以上不满45周岁的职工按本人月缴费工资基数的1%划入个人帐户；
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(3) for an employee over 45 years, 2% of the employee's monthly wage subject to the payment of premium;
| | （三）45周岁以上的职工按本人月缴费工资基数的2%划入个人帐户；
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(4) for a retired person less than 70 years old, 4.3% of the average monthly wage of all employees in this Municipality last year; and
| | （四）不满70周岁的退休人员按上一年本市职工月平均工资的4.3%划入个人帐户；
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(5) for a retired person over 70 years old, 4.8% of the average monthly wage of all employees in this Municipality last year.
Where it is necessary to change the standards as mentioned in the preceding paragraph according to the social and economic development and the income and expenditure of the fund, the municipal labor and social security administrative department shall, jointly with the municipal public finance department, put forward a plan, submit it to the Municipal People's Government for approval and implement it after obtaining the approval thereof.
| | （五）70周岁以上的退休人员按上一年本市职工月平均工资的4.8%划入个人帐户。
前款所列标准根据社会经济发展和基金收支情况需要调整时，由市劳动保障行政部门会同市财政部门提出调整方案，报市人民政府批准后公布施行。
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Article 22 The interest on the deposit in a individual account shall be calculated for each year with reference to the bank interest rate for residents' current deposits for the same period.
| | 第二十二条 个人帐户存储额每年参照银行同期居民活期存款利率计息。
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Article 23 The principal and interest in an individual account belong to the owner of the account. They may only be used for the basic medical insurance, but may be carried forward and inherited.
In case of death of any employee or retired person, the deposited sum in the individual account of the deceased shall be transferred to the individual account of his inheritor(s); where the inheritor has not participated in the basic medical insurance, the deposited sum in the individual account of the deceased shall be paid to the inheritor on a lump-sum basis; where there is no inheritor, the deposit in the individual account of the deceased shall be incorporated in the overall basic medical insurance fund.
| | 第二十三条 个人帐户的本金和利息为个人所有，只能用于基本医疗保险，但可以结转使用和继承。
职工和退休人员死亡时，其个人帐户存储额划入其继承人的个人帐户；继承人未参加基本医疗保险的，个人帐户存储额可一次性支付给继承人；没有继承人的，个人帐户存储额纳入基本医疗保险统筹基金。
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Article 24 An unemployed person is not required to pay the premium for basic medical insurance. His individual account shall cease to be credited, but the remaining sum in the account may still be used. During the period in which he is drawing unemployment insurance money, the unemployed person may benefit from medical subsidies according to provisions regarding unemployment insurance.
| | 第二十四条 失业人员不缴纳基本医疗保险费，个人帐户停止计入，余额可继续使用。失业人员在领取失业保险金期间，按照失业保险规定享受医疗补助待遇。
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Article 25 In case of a change in residency within a district or county for a person having participated in the basic medical insurance, only his basic medical insurance credentials are to be transferred while the deposit in his individual account shall not be transferred. In the case where a change in residency takes place outside the district, county or region encompassed by the overall arrangement, both the basic medical insurance credentials and the deposit in the individual account shall be transferred.
| | 第二十五条 参加基本医疗保险的人员在参保的区、县内流动时，只转移基本医疗保险关系，不转移个人帐户存储额；跨区、县或者跨统筹地区流动时，转移基本医疗保险关系，同时转移个人帐户存储额。
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Chapter IV Benefits of the Basic Medical Insurance
．．．．．． | | 第四章 基本医疗保险待遇
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