Implementation Details for the Basic Medical Insurance System for Urban and Rural Residents

Article 1: These Implementation Rules are formulated based on the "Measures for Basic Medical Insurance for Urban and Rural Residents" and relevant national and municipal regulations, taking into account the specific conditions of our city.

Article 2: Eligibility Criteria for Participation in the City's Basic Medical Insurance for Urban and Rural Residents:

(1) Urban and rural residents of this city who are 60 years old or older for men and 50 years old or older for women, and who do not have any other basic medical insurance coverage (hereinafter referred to as "urban and rural elderly"), as well as the following individuals:

1. Retired personnel who receive medical benefits under the city's medical assistance policy for urban and rural social assistance recipients;

2. Retired and active community leaders who currently receive medical benefits under the city's medical assistance policy for urban and rural social welfare recipients;

3. Individuals who have completed retirement procedures in another region and do not have basic medical insurance, but have obtained Beijing residency upon moving to the city;

4. Supporting individuals who have retired while residing outside the city, returned to Beijing to obtain local household registration (hukou), and their spouses;

(II) Urban and rural residents of this city who are male, aged 16 to under 60, or female, aged 16 to under 50, and who do not have any other basic medical insurance coverage (hereinafter referred to as residents of working age);

(3) Students with Beijing household registration who are enrolled full-time at regular institutions of higher education (including private universities), research institutes, general primary and secondary schools, and secondary vocational schools (including specialized secondary schools, technical schools, and vocational high schools) within the administrative area of this city; as well as non-student children and adolescents with Beijing household registration who are not currently enrolled in school (including children attending daycare centers, scattered infants and toddlers, and other non-school-age children under 16 years old). Additionally, this includes full-time, non-working, non-local students pursuing regular higher education at full-time institutions of higher education (including private universities) and research institutes located within the city’s administrative boundaries—such as Hong Kong, Macao, and Taiwan students studying in Beijing—and who do not have any other basic medical insurance coverage (hereinafter referred to as "student children"). This category also covers the following individuals who lack other forms of basic healthcare coverage:

1. Students with household registration in this city who are studying in other provinces, cities, or overseas, as well as in Hong Kong, Macao, and Taiwan.

2. Junior high school graduates under 18 years old with local household registration, as well as high school graduates under 22 years old who are repeat students;

3. Children of students whose one parent has Beijing household registration (excluding embassy office registrations, student collective household registrations, and similar cases);

4. Students enrolled in ethnic minority classes established at schools in this city, approved by relevant national and municipal authorities, as well as students studying at Tibetan secondary schools;

5. Minor children of former educated youth and military family members who are not registered residents of this city;

6. Minor children of postdoctoral researchers stationed at postdoctoral workstations in Beijing, as well as accompanying children of individuals holding valid Work and Residence Permits;

7. Children of overseas Chinese who are receiving compulsory education in Beijing, as well as children of Taiwanese investors and their employees (Taiwanese compatriots) residing in Beijing;

(4) Spouses of residents with household registration in this city who reside outside the city and do not have any other basic medical insurance coverage;

(5) Spouses of deceased retired cadres from municipal (district)-level units in this city who are currently unemployed and do not have any other basic medical insurance coverage;

(6) Foreign nationals who have obtained the "Foreigner's Permanent Residence ID Card" in this city and do not have any other basic medical insurance coverage;

(7) Experts selected for national programs such as the "Thousand Talents Plan," the "Ten Thousand Talents Plan," municipal-level initiatives aimed at attracting high-caliber overseas talent, overseas high-level talent entrepreneurship support programs, and Beijing Zhongguancun's "High-Level Talent Gathering Project," as well as spouses and minor children of individuals holding an A-type Foreigner Work Permit who do not have access to other basic medical insurance coverage.

Article 3: Ordinary institutions of higher education refer to universities, independently established colleges, higher vocational schools, and other institutions—including independent colleges and branch campuses, as well as specialized diploma programs—that have been approved according to nationally mandated establishment standards and approval procedures. These institutions primarily enroll high school graduates through the nationwide unified entrance examination for general higher education and offer full-time degree programs. This definition excludes adult education programs as well as institutions providing distance learning, continuing education, online courses, part-time studies, or those delivered via radio and television.

Article 4: When insured individuals covered under Article 2 of these Detailed Rules complete the enrollment and payment procedures, they must submit, in addition to their personal electronic photo, the following relevant documents separately:

(1) Individuals who have completed retirement procedures in another city and do not have basic medical insurance, but have obtained Beijing household registration upon moving to the city, must submit their household registration book and a certificate of non-coverage of basic medical insurance issued by the local human resources and social security department at or above the county level.

(II) Individuals who have retired after completing retirement procedures in another region and subsequently returned to Beijing to obtain local household registration, along with their spouses, must submit their own household registration book, a household registration transfer certificate issued by the public security department, and marriage proof.

(3) Students with household registration in this city who are studying in other provinces, cities, or overseas regions—including Hong Kong, Macao, and Taiwan—and do not have basic medical insurance should submit their household registration book, a certificate of enrollment issued by their school, and a commitment letter confirming their lack of basic medical coverage.

(4) Junior high school graduates from previous years who are residents of this city and under 18 years old, as well as high school graduates from previous years who are under 22 years old, must submit their household registration book, the admission ticket for this year’s middle or high school entrance exams, and a commitment letter confirming they do not have basic medical insurance coverage.

(5) Students and children with out-of-city household registration whose parent has local household registration in this city should submit their own household registration book, birth certificate, and additional relevant documents for the father (or mother).

(6) Minor children of military family members who are not registered residents of this city must submit their own household registration book and a certificate issued by the political department of a unit at regimental level or above within the military.

(7) For the minor children of postdoctoral researchers stationed at postdoctoral workstations in Beijing, please submit the researcher’s household registration book, birth certificate, and the admission letter issued by the Office of the National Postdoctoral Administration Committee. For children accompanying individuals holding a valid Work-Residence Permit, please provide the child’s household registration book, birth certificate, and the parent’s Work-Residence Permit, which must clearly list information about the child.

(8) Spouses with out-of-town household registrations who are residents of this city must submit the household registration books of both spouses, the marriage certificate, and a commitment letter confirming they do not have basic medical insurance coverage.

(9) Overseas Chinese children receiving compulsory education in Beijing must submit proof of their parent(s)' overseas Chinese status, the "Certificate for Overseas Chinese Children Coming to Beijing for Compulsory Education," and other relevant documents. For children of Taiwanese investors and their employees (Taiwanese compatriots) studying in Beijing, they must provide the approval letter issued by the education authorities permitting Taiwanese compatriot children to attend school in Beijing, along with any other required documentation.

(10) Foreign nationals who have obtained the "Foreigner's Permanent Residence Identity Card" in this city and do not have basic medical insurance should submit their passport, the "Foreigner's Permanent Residence Identity Card," and a commitment letter confirming their lack of basic medical coverage.

(11) Spouses and minor children of experts selected for the city’s and the country’s major talent programs who do not have basic medical insurance should submit the expert’s employment contract, proof of selection for the talent program, the expert’s identification documents, marriage certificate, children’s birth certificates, and a commitment letter confirming their lack of basic medical coverage.

(12) Spouses and minor children of talents who have obtained the "Foreigner Work Permit" (Type A) in Beijing but do not have basic medical insurance should submit the "Foreigner Work Permit," their own identification documents, marriage certificate, children's birth certificates, and a commitment letter confirming their lack of basic medical coverage.

Article 5: Retired and pensioned individuals who receive medical benefits under the city's medical assistance policy for urban and rural social assistance recipients must submit their household registration book as well as the "Medical Handbook for Retired and Pensioned Personnel."

Article 6: Insured individuals must complete the enrollment procedures between September 1 and November 30 each year and pay the basic medical insurance premium for urban and rural residents for the following year (hereinafter referred to as the "medical insurance premium") according to the applicable payment standards.

Eligible on-campus students should have their insurance enrollment and payment procedures handled by the school, while other eligible individuals should complete the enrollment and payment process at the social security office in their place of household registration or residence.

Article 7: Insured individuals shall pay the full amount of their medical insurance premiums in one lump sum, typically through bank deduction or similar methods.

Article 8: Individuals receiving the city's minimum living guarantee and hardship allowances for urban and rural residents, low-income assistance recipients in urban and rural areas, particularly vulnerable individuals under care, eligible beneficiaries of regular pensions and subsidies, as well as citizens recognized by the civil affairs department as having made courageous acts while protecting public interests (including surviving family members of those who died heroically and received regular pension benefits), de facto unattended children receiving living support as part of the city's initiatives for children in distress, and retired community-level active participants who qualify for medical assistance under the city's social aid policies for urban and rural residents—these individuals will have their eligibility verified through lists provided by the civil affairs departments of their respective district offices, which will also assist them in completing enrollment and payment procedures.

Persons with disabilities are identified through a list provided by the Municipal Federation of Disabled Persons, which is then cross-referenced against social security records by the relevant service agency. Following this verification process, the district-level federation of disabled persons in the individual’s registered household area assists them in completing the enrollment and payment procedures.

The spouses of deceased retired cadres from municipal (district) government-affiliated units, who are currently unemployed, will have their names provided by the municipal department for senior officials to assist with enrollment and premium payment procedures.

Members of special family planning families are provided with a list by the health and family planning department of the district where their household registration is located, assisting them in completing insurance enrollment and payment procedures.

Low-income farming households will have their names provided by the agricultural committee of their registered household district, which will assist them in completing the enrollment and payment procedures.

Orphans and abandoned infants in the city's social welfare institutions who are supported by the government under the living assistance program for children in difficult circumstances will have their information collected centrally by the social welfare institutions. They will then proceed to the local social insurance administration agency or social security office at the institution's location to complete enrollment and payment procedures.

Article 9: Individuals who meet the eligibility criteria for insurance in the current year must, within 90 days from either obtaining household registration in this city or meeting the enrollment requirements, submit their household registration book, resident identity card, electronic photo, and other relevant documents to the social security office located at their registered domicile or place of residence. They are required to pay the annual medical insurance fee in a lump sum according to the applicable payment standard. Coverage under the Urban and Rural Basic Medical Insurance scheme will commence from the month in which the payment is made, with benefits available until December 31 of the same year.

Among them, newborns under one year old must, within 90 days from the date of household registration, have their relatives submit the applicant’s household registration book, birth certificate, and an electronic photo of the newborn to the local social security office at either the newborn’s registered residence or place of residence. There, they can complete the enrollment and payment procedures by paying a lump sum covering the medical insurance fee for the corresponding year according to the applicable payment standards. Once enrolled, the newborn will be eligible for basic medical insurance benefits for urban and rural residents starting from the day of birth, with coverage extending until December 31 of that same year.

Article 10: Individuals who meet the eligibility criteria for urban and rural resident insurance but failed to complete the enrollment and payment procedures within the prescribed period should submit their household registration book, resident ID card, electronic photos, and other relevant documents to the social security office in either their registered household location or place of residence. They will be required to pay the annual medical insurance fee in a lump sum according to the applicable payment standard. Once the mandatory three-month waiting period expires, they can begin enjoying basic medical insurance benefits for urban and rural residents, with coverage extending until December 31 of the same year.

Article 11: Participants who have already paid the following year's medical insurance premium may, before December 31 of the payment year and provided they meet one of the following conditions, submit the relevant documentation to the social security office in their place of enrollment to process a refund:

(1) In the event of an insured person's death, their family members must provide a death certificate or relevant documentation issued by a medical institution, the public security department, or the civil affairs department.

(II) Residents of working age who are employed and enrolled in the basic urban employee medical insurance must provide a copy of their employment contract issued by their employer.

(III) If other refund conditions are met, submit the corresponding materials.

Article 12: Insured individuals may select up to three designated medical institutions and one community health service station (or village clinic) within the scope of basic medical insurance providers in this city as their personal designated healthcare facilities. Designated traditional Chinese medicine institutions, specialized medical institutions, and Class A designated medical facilities serve as common healthcare providers for all insured individuals. When seeking medical care at their personal designated facilities or the shared common providers, insured individuals will receive basic urban and rural resident medical insurance benefits as outlined in these detailed rules.

Article 13: When insured individuals fall ill, they must present their own social security cards at their designated medical institutions for treatment. The designated medical institutions are required to verify the identity of insured individuals by matching their social security cards against the holders' real names.

Article 14: Outpatient medical care for urban and rural elderly individuals and residents of working age will follow a primary-care first-visit system. If patients seek treatment at other designated medical institutions without first obtaining a referral from their designated primary-care provider, the outpatient medical expenses incurred (excluding emergency cases) will not be covered by the Urban and Rural Resident Medical Insurance Fund. Primary-care designated medical institutions refer to healthcare facilities at or below the primary level among those accredited as basic medical insurance providers.

Article 15: Insured individuals may transfer to their chosen designated medical institution or a shared designated medical institution for treatment, provided they present the initial consultation referral certificate issued by a primary-level designated medical facility. The validity period for this primary-level referral is 180 days.

Article 16: If an insured person is unable to seek medical care at their designated medical institution due to an emergency, they may receive emergency treatment at the nearest designated medical facility. Once their condition stabilizes, they should promptly return to their original designated medical institution for continued care.

Article 17: If insured individuals require a referral or transfer to a non-designated medical institution within the city due to their medical condition, they must first obtain approval from a attending physician or higher-level medical professional at their current designated healthcare provider. Once approved by the institution's medical insurance office, the referral or transfer procedures can then be processed.

Article 18: Medical expenses incurred by insured individuals that fall within the scope of the city's Basic Medical Insurance Drug List, Clinical Treatment Item List, Medical Service Facility Coverage, and Student/Child Supplementary Reimbursement Program shall be paid according to regulations by the Urban and Rural Resident Basic Medical Insurance Fund (hereinafter referred to as the Urban and Rural Resident Medical Insurance Fund).

Article 19: Participants who were continuously insured and paid premiums in the previous year are eligible for outpatient (and emergency) medical insurance benefits this year. Those who fail to maintain continuous coverage and premium payments will not receive such benefits. Individuals who meet the eligibility criteria and enroll in insurance with timely premium payments during the current year will be considered as having maintained continuous coverage.

Article 20: Within a single medical insurance year, the outpatient (emergency) deductible for urban and rural residents' medical insurance is set as follows: 100 yuan for designated medical institutions at Level 1 and below, and 550 yuan for those at Level 2 and above. These deductibles are calculated separately. For expenses exceeding the deductible, the Urban and Rural Residents' Medical Insurance Fund will cover a percentage of the costs, with payment rates of 55% for designated medical institutions at Level 1 and below, and 50% for those at Level 2 and above. The total maximum amount payable under this scheme is capped at 4,500 yuan.

Article 21: Within a single medical insurance year, the deductible for the first inpatient stay of urban and rural elderly individuals and residents of working age is as follows: 300 yuan for designated medical institutions at Level 1 and below, 800 yuan for Level 2 institutions, and 1,300 yuan for Level 3 institutions. For subsequent inpatient stays and beyond, the deductible will be set at 50% of the initial inpatient deductible. For student children, the deductible for their first inpatient stay is 150 yuan for Level 1 and below institutions, 400 yuan for Level 2 institutions, and 650 yuan for Level 3 institutions.

The portion exceeding the deductible is covered by the Urban and Rural Resident Medical Insurance Fund according to the following reimbursement ratios: 80% for designated medical institutions at Level 1 and below, 78% for Level 2 institutions, and 75% for Level 3 institutions. The maximum cumulative reimbursement amount is capped at 250,000 yuan.

Article 22: Designated community health service centers (stations) may establish therapeutic home care beds for insured individuals who require inpatient treatment or, after stable inpatient care, need continued, ongoing treatment. Medical expenses incurred by insured individuals receiving treatment at these therapeutic home care beds will be covered under the urban and rural resident medical insurance fund as per regulations, with the threshold for coverage reduced by half. Additionally, the relevant rules governing hospital transfers will apply.

Article 23: The following medical expenses are not covered by the urban and rural resident medical insurance fund:

(1) Should be covered by public health funding;

(II) Receiving treatment at medical institutions not designated for basic medical insurance;

(III) Receiving treatment at a medical facility not designated for the individual (excluding emergency cases);

(IV) Injuries caused by traffic accidents, medical incidents, or other liability-related accidents;

(5) Injuries caused by the individual's drug use, fighting, or other illegal activities;

(6) Those who seek medical attention due to suicide, self-harm, alcohol abuse, or similar reasons;

(7) Receiving medical treatment abroad or in the Hong Kong, Macao Special Administrative Regions, and Taiwan region;

(8) Other cases that, according to national and municipal regulations, should not be covered by the urban and rural residents' medical insurance fund.

Medical expenses that, according to law, should be covered by a third party will first be paid by the Urban and Rural Resident Medical Insurance Fund if the third party fails to pay or cannot be identified. After making the initial payment, the Urban and Rural Resident Medical Insurance Fund has the right to seek reimbursement from the third party.

Article 24: For insured individuals receiving inpatient treatment, the settlement period is set at 90 days. If the stay does not exceed 90 days, payment will be based on the actual number of hospitalization days. However, if the stay exceeds 90 days, settlement will be calculated in 90-day increments.

Article 25: If insured individuals need to transfer to another hospital within the city due to medical reasons, transfers occurring within 24 hours will be treated as continuous hospitalization. Medical expenses incurred after the transfer, along with those before the transfer, will be settled separately according to the respective levels of the designated medical institutions and then calculated cumulatively. If no expenses have yet been paid by the Urban and Rural Resident Medical Insurance Fund at the original designated medical institution, the inpatient deductible will be calculated based on the deductible standard of the receiving hospital. However, if the Urban and Rural Resident Medical Insurance Fund has already covered expenses at the original designated medical institution, the inpatient deductible will be determined according to the deductible standard of the hospital where the patient was transferred from.

Article 26: The special disease categories covered by the Urban and Rural Residents' Basic Medical Insurance include: outpatient treatment for malignant tumors, renal dialysis, hemophilia, aplastic anemia, intravitreal injection therapy for retinal diseases, targeted therapy for pulmonary arterial hypertension, multidrug-resistant tuberculosis, Niemann-Pick disease type C, biologic therapy for moderate-to-severe allergic asthma, antifibrotic treatment for interstitial lung diseases, anti-rejection therapy following kidney transplantation, anti-rejection therapy after liver transplantation, combined liver-kidney transplant anti-rejection treatment, multiple sclerosis, and other conditions listed below (hereinafter referred to as "special disease categories").

Participants with designated special illnesses receiving outpatient treatment should bring their social security cards to the medical institution of their choice—specifically accredited for treating these conditions—and complete the "Medical Insurance Special Illness Registration Form" (hereafter referred to as the "Form") as required. After obtaining the physician's signature, they must submit the completed form to the medical insurance office at that facility to finalize the registration process. For those seeking care outside their home area, they should present their social security cards, along with a diagnosis certificate confirming the special illness issued by the designated medical provider, and the "Form" itself, to the local medical insurance administration office in their enrollment district to complete the registration procedure. Outpatient medical expenses incurred at the participant’s chosen specialized medical institution will be reimbursed by the Urban and Rural Resident Medical Insurance Fund according to the same criteria applied to inpatient treatments.

Article 27: For insured individuals with specific medical conditions undergoing outpatient or inpatient treatment for these conditions, as well as standard inpatient care, each medical insurance year will serve as a settlement period. If special disease registration is completed within the same year, the settlement period will span from the date of the first medical visit following registration until the end of that medical insurance year.

The reimbursement scope, fixed payment standards, and management measures for anti-rejection treatments following kidney transplantation among urban and rural elderly individuals and residents of working age, as well as for anti-rejection therapies after liver transplantation (including combined liver-kidney transplants), heart transplantation, and lung transplantation, shall be implemented in accordance with the regulations governing basic medical insurance for urban employees.

Article 28: For insured individuals hospitalized for treatment of mental illnesses, the per-bed-day reimbursement rate applicable to psychiatric inpatient medical expenses under basic medical insurance will apply. Each medical insurance year serves as a settlement period.

Article 29: Medical expenses incurred during emergency observation for insured individuals, provided they fall within the scope of basic medical insurance coverage, will be reimbursed according to the regulations governing inpatient medical expenses.

Article 30: Medical expenses incurred by insured individuals for childbirth covered under the city's family planning regulations, as well as medical costs associated with family planning surgeries, will be reimbursed according to the payment standards applicable to employee maternity insurance—specifically, the limits, fixed amounts, and itemized payments—as outlined in these detailed rules for outpatient (emergency) and inpatient claims.

Article 31: Insured individuals who continuously pay their medical insurance premiums for the following year and are hospitalized across two consecutive medical insurance years will have their medical expenses calculated separately for each insurance year during the current settlement period. Medical expenses incurred before December 31 will be combined with those paid in the same year, while expenses occurring on or after January 1 of the following year will be combined with payments made in the subsequent year. The maximum amount reimbursable by the urban and rural resident medical insurance fund will be calculated separately for each of the current and next years.

Article 32: Participants who fail to make consecutive payments for the following year's medical insurance will have their inpatient expenses incurred across different insurance years covered by the Urban and Rural Resident Medical Insurance Fund only up to December 31 of the current year. Medical costs incurred on or after January 1 of the subsequent year will no longer be reimbursed.

Article 33: When insured individuals seek medical care across different insurance systems, the resulting medical expenses will be calculated separately according to the regulations of both the original and the new insurance systems.

Article 34: In the event that insured individuals encounter any of the following situations, they must cover the full cost themselves and then submit a manual reimbursement claim to the social security office in their place of residence.

(1) Medical expenses incurred at the emergency department without a card;

(II) Medical expenses for outpatient surgical procedures related to family planning;

(III) Medical expenses incurred during the manual reimbursement period, the social security card replacement or reissue period, and the period after enrollment but before the card is issued;

(4) Medical expenses incurred during out-of-town medical treatment that meet reimbursement criteria;

(5) Expenses for purchased medications that meet the requirements for external procurement.

Article 35: Urban and rural elderly individuals, as well as residents of working age who have lived outside their home province/city for more than one year, and students or children residing or studying in other provinces/cities, must apply for out-of-town medical treatment registration at the social security administration agency in their place of insurance. They may choose to receive care at two designated medical institutions at or above the county level—or a pediatric specialist institution—in their place of residence, plus one community health service station (or village clinic) within their home city. If insured individuals need to be referred to another location for medical treatment due to their condition, they must submit the "Basic Medical Insurance Out-of-Town Treatment Application Form" to the local medical insurance administration agency where they are insured to complete the registration process.

For medical expenses incurred by the above-mentioned individuals at their designated out-of-town medical institutions, which are eligible under the city's urban and rural residents' basic medical insurance regulations, reimbursement can be processed at the social security office in their Beijing residence. Meanwhile, insured individuals who have already completed the registration for direct settlement of inpatient medical expenses incurred during cross-provincial out-of-town medical treatment can directly settle their hospitalization costs at the specifically designated medical facilities approved for such cross-provincial direct settlement services in their registered out-of-town locations.

Article 36: Emergency medical expenses incurred by insured individuals at designated medical institutions in a different location, provided they meet the eligibility criteria of the city's Urban and Rural Basic Medical Insurance, can be reimbursed at the social security office in their Beijing residence. Meanwhile, insured individuals who have already completed the registration for direct settlement of inpatient medical expenses incurred during cross-provincial out-of-town medical treatment (excluding cases involving referral to another region) can directly settle emergency inpatient expenses at designated medical facilities that participate in this cross-provincial direct settlement program.

Article 37: If insured individuals have already been hospitalized or received outpatient treatment for specific medical conditions before starting to enjoy basic medical insurance benefits for urban and rural residents, they must settle all medical expenses incurred prior to receiving these benefits. After the benefits are activated, eligible medical expenses will be covered by the Urban and Rural Resident Medical Insurance Fund according to regulations.

Article 38: When insured individuals experience a change in their status—such as transitioning between urban and rural elderly, residents of working age, students, or children—they will continue to receive benefits based on the identity under which they were making contributions at the time.

Article 39: Individuals enrolled in the city's urban employee basic medical insurance who, within 90 days from the date their urban employee basic medical insurance coverage is interrupted, subsequently enroll in the city's urban and rural resident basic medical insurance will begin receiving benefits under the latter scheme from the month of their enrollment and payment. These benefits will remain effective until December 31 of the same year.

Article 40: When residents enrolled in the Urban and Rural Basic Medical Insurance become employed and subsequently enroll in the Urban Employee Basic Medical Insurance, they will be entitled to Urban Employee Basic Medical Insurance benefits starting from the month their contributions begin—thereafter, they will no longer be eligible for Urban and Rural Basic Medical Insurance benefits.

Article 41: Flexible employment personnel who have entrusted their personal files to the Municipal Career Counseling Service Center or the Talent Exchange Service Center are already enrolled in the Urban Employee Basic Medical Insurance program according to the "Measures for Flexible Employment Personnel Participating in Employee Basic Medical Insurance" (Beijing Government Office Document [2008] No. 56). Therefore, they are not included within the coverage of the Urban and Rural Resident Basic Medical Insurance scheme.

Article 42: Participants who have entrusted their personal files to the City’s Employment Service Center or Talent Exchange Service Center and are enrolled in the Urban Employee Basic Medical Insurance scheme will continue to receive Urban and Rural Resident Basic Medical Insurance benefits during the current insurance year, provided they have not yet begun receiving benefits under the Urban Employee Basic Medical Insurance. During this period, all medical expenses incurred must be paid in full by the participant in cash; upon settlement, participants should submit the relevant documentation to the social security office in their place of residence to claim reimbursement.

Article 43: Basic medical insurance for urban and rural residents does not establish individual accounts. The contribution period under the urban and rural resident medical insurance is not counted toward the contribution period for basic medical insurance coverage of urban employees.

Article 44: After beneficiaries receive basic medical insurance benefits for urban and rural residents, they may also enjoy critical illness medical insurance benefits for urban and rural residents as stipulated by regulations.

Article 45: Designated medical institutions for urban and rural residents' basic medical insurance shall follow the Management Measures for Designated Medical Institutions under the Basic Medical Insurance Scheme.

Article 46: In accordance with national and municipal regulations, and in conjunction with healthcare insurance fund budget management, we will advance reforms aimed at integrating multiple payment methods—such as per capita payments, diagnosis-related group (DRG) payments, and per diem bed payments—into a comprehensive, hybrid payment system. We will also establish and refine negotiation mechanisms to encourage designated medical institutions to standardize their service practices and effectively curb the unreasonable growth of healthcare costs.

Article 47: Individuals receiving the city's minimum living guarantee and hardship allowances for urban and rural residents, those eligible for low-income assistance in urban and rural areas, and particularly vulnerable individuals under dependent care support—after already benefiting from basic medical insurance coverage for urban and rural residents—may, if they meet the eligibility criteria for medical assistance, continue to apply for such assistance through the civil affairs department.

Urban and rural beneficiaries, as well as retired and retrained personnel who receive medical assistance under the city's urban and rural social assistance policies—along with retired and demobilized active members of neighborhood committees and children facing hardship—can continue to enjoy relevant medical benefits as stipulated, after already benefiting from the basic medical insurance coverage available to urban and rural residents.

Article 48: These Implementing Rules shall come into effect immediately. From the date of issuance of these rules, any existing documents that conflict with these Implementing Rules shall be superseded and governed by these rules instead.

The above information is excerpted from the "Implementation Rules for the Basic Medical Insurance Scheme for Urban and Rural Residents," document No. Jingrenshe Nonghefa [2017] 250, which came into effect on January 1, 2018, with some data updated according to the latest policies.