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Answers Provided to a Journalist, Regarding the Medical Insurance Year Change and the Related Standards Adjustments
(02.21.2008)

This April 1 initiates the third Medical Insurance Year of the Basic Medical Insurance for Urban Employees in Shanghai. A journalist had an interview with the office of the Shanghai Health Insurance Bureau regarding: the issues of the Medical Insurance Year change, the adjustments of the Individual Medical Account, the standards of clinical and emergency expenses at one’s own private cost, the deductable and the cost ceiling of the Municipal Medical Insurance Fund.

Q: When will the 2003 Medical Insurance Year begin and end?

A: It will begin at 0:00 AM on April 1, 2003 and end at 0:00 AM on March 31, 2004.

Q: What is the basis of the adjustments made to the clinical or emergency treatments at one’s own private cost, the deductable and the cost ceiling of the Municipal Medical Insurance Fund?

A: Based on the Shanghai Municipal Procedures of Basic Medical Insurance for Urban Employees, the Individual Medical Account standards of clinical and emergency expenses at one’s own private cost, the deductible of the Municipal Medical Insurance Fund and the standard of the cost ceiling shall be adjusted every year according to the average annual employee salary in Shanghai in the previous year. Last year, given the short implementation period of the Shanghai Municipal Procedures of Basic Medical Insurance for Urban Employees, only the Individual Medical Account was adjusted based on the Shanghai Municipal Procedures of Basic Medical Insurance for Urban Employees after approval by the Shanghai Municipal Government, but no adjustment was made to the clinical and emergency expenses paid at one’s own private cost, the deductible of the Municipal Medical Insurance Fund and the standard of the cost ceiling. Therefore, the related payment standards shall be adjusted simultaneously with the adjustment made to the Individual Medical Account as required.

Q: What are the standards for calculating the Individual Medical Account in the 2003 Medical Insurance Year?

A: The Individual Medical Account of any currently-employed person as a Medical Insurance participant in Shanghai is composed of the part paid by themselves and the part that is calculated according to the defined proportion of the average employee annual salary in Shanghai; the Individual Medical Account of any retiree is calculated according to the defined proportion of the average employee annual salary in Shanghai.

In the 2003 Medical Insurance Year, the base to calculate the proportion of the average employee annual salary in Shanghai complies with the Shanghai Municipal Procedures of Basic Medical Insurance for Urban Employees, specifically equaling the average employee annual salary (RMB 19,473.00) in the previous year (year 2002). Therefore, the amount contributed to the Individual Medical Account, according to the defined proportion of the average annual employee salary in Shanghai, will increase. For example, the amount for retirees aged less than 74 years will change from RMB 711.00 to RMB 779.00, growing by RMB 68.00; the amount for retirees older than 75 years of age will change from RMB 799.00 to RMB 876.00, growing by RMB 77.00.

Every currently employed person has a different actual amount in his/her Individual Medical Account because of different payment amounts, but the overall amount added into everyone's Individual Medical Account, according to the defined proportion of the average annual employee salary in Shanghai, will increase.

Q: How are the standards of clinical and emergency expenses at one’s own private cost, the deductible of the Municipal Medical Insurance Fund and the cost ceiling calculated in the 2003 Medical Insurance Year?

A: The Individual Medical Account standards of clinical and emergency expenses at one’s own private cost, the deductible of the Municipal Medical Insurance Fund and the cost ceiling in the 2003 Medical Insurance Year are calculated based on the average annual employee salary (RMB 15,420.00) in Shanghai in 2000.

For those retired before the medical reform, for those retired after the medical the reform and for the currently employed persons, the clinical and emergency expenses at one’s own private cost are RMB 308.00, RMB 771.00 and RMB 1,542.00 respectively.

The deductible of the Municipal Medical Insurance Fund is adjusted to RMB 771.00, RMB 1,234.00 and RMB 1,542.00 respectively,

and the cost ceiling of the Municipal Medical Insurance Fund is adjusted to RMB 61,680.00.

Q: Will the standards of Medical Insurance for participants change, after the Individual Medical Account, the standards of clinical and emergency expenses at one’s own private cost, the deductible of the Municipal Medical Insurance Fund and the cost ceiling are adjusted?

A: Given the acceptance of mass participants in this adjustment, the Individual Medical account is added on the basis of the average annual employee salary in Shanghai in 2002.

The standards of clinical and emergency expenses at one’s own private cost and the deductable of the Municipal Medical Insurance Fund is added on the basis of the average annual employee salary in Shanghai in 2000.

That is to say, a high base is applied in adding to the Individual Medical Account, and low base is applied in adding to the medical expenses at one’s own private cost.

In most cases in Shanghai, the amount added to the Individual Medical Account is bigger than that added to the medical expenses at one’s own private cost.

Generally, it has little impact on the Medical Insurance standards of the participant. Meanwhile, the rise of the cost ceiling of the Municipal Medical Insurance Fund can also reduce the private expenses for heavy and severe illness. The adjustment will have a certain impact on the low-income groups suffering from sickness, so the related municipal administration will help with further reducing their medical expenses by means of medical assistance measures.

Q: What specific medical assistance measures will be taken to assist the low-income groups who suffer from medical issues?

A: To reduce the medical expense costs for the low-income groups, the Shanghai administration will take further medical assistance measures including:

(1) The medical insurance institutions will help reduce the new medical expenses at one’s own private cost by adjusting the "3 Standards" for the low-income groups, to ensure every participant will not pay any extra. The subjects of expense reduction include the insurance participants from low-income families, the contracted insurance participants eligible for civil administration subsidies, and those assessed as losing full or most working ability by the Shanghai Municipal Labor Ability Assessment Center;

(2) enterprises and non-business institutions may spend less than 2% of the total salary on helping those low-income employees accumulating medical expenses at their own private cost. Presently, an Employee Medical Help Fund has been established in the majority of organizations, and the authorities and administrations in charge of the organizations support and encourage the remaining organizations to establish their own Funds as soon as possible; and

(3) if the medical expenses are still hardly affordable for the employee after the assistance of Medical Insurance and the related enterprise or non-business institution, or the related enterprise or non-business institution cannot help in certain circumstances, the Civil Administration will coordinate the related groups to provide assistance.

Q: Through which channels can employees get an in-depth understanding of the policies related to Medical Insurance?

A: The municipal and district/county medical insurance administrations will provide the ways through 3 specific channels:

(1) The consultation line of the municipal and district/county medical insurance administrations;

(2) the Shanghai Medical Insurance website: www.shyb.gov.cn, and

(3) the municipal and district/county medical service windows where medical services staff provide consultations and additionally all related written documents.