Published by ChinaMNC · Kaijiang

Dazhou's New Urban-Rural Resident Medical Insurance Rules: A Practical Guide for Foreign Founders

Dazhou City has issued new measures for its urban-rural resident basic medical insurance. For foreign founders operating in China, understanding local insurance rules is part of compliance. This article summarizes the key points from the official notice and explains how they affect your business.

Dazhou's New Medical Insurance Rules for Residents

Dazhou City has published a notice on its Urban-Rural Resident Basic Medical Insurance Management Measures. The rules aim to improve the insurance system, standardize services, protect enrollees' rights, and raise service levels. For foreign founders running a business in China, local social insurance policies can affect your obligations and your employees' benefits. This summary covers only the facts from the official source and frames them as practical guidance for foreign entrepreneurs.

Who Is Covered and Who Pays

The resident medical insurance covers individuals who are not enrolled in the employee basic medical insurance and do not have other state medical coverage. People already enrolled in basic medical insurance cannot enroll again.

Enrollees pay a personal premium, and the government provides subsidies. The subsidy is shared among different levels of government. According to the national subsidy standard for the year, after deducting central and provincial subsidies, the remaining local share is borne entirely by county-level finance in expanded-power counties. In non-expanded-power counties (districts), the city-level finance bears 20% and the county-level finance bears 80%.

County-level governments must include their share of subsidies in the annual fiscal budget and transfer 50% by the end of June and the full amount by the end of December to the city-level social insurance fund fiscal account.

Premium Standards and Subsidies for Vulnerable Groups

The city-level medical insurance, finance, and tax departments set the personal premium standard for the next year and announce it publicly each year, based on national and provincial rules and local economic and fund conditions.

For residents with Dazhou household registration who are in extreme poverty, orphans, minimum living guarantee recipients, or eligible groups at risk of returning to poverty, classified subsidies are provided according to relevant regulations. For severely disabled persons and eligible preferential treatment recipients who have difficulty paying the personal premium, the government of their registered residence provides subsidies.

Benefits and Coverage

Resident medical insurance benefits include ordinary outpatient care, outpatient chronic and special diseases, outpatient medication for hypertension and diabetes (the "two diseases"), inpatient care, and maternity care. Enrollees also receive critical illness insurance benefits as required.

For the "two diseases," patients who receive medication but do not meet the criteria for outpatient chronic and special disease coverage are included in the outpatient medication guarantee. For patients diagnosed with the two diseases, medication costs for lowering blood pressure and blood sugar within the medical insurance policy scope are covered at 90% by the pooled fund, with no deductible. The annual maximum payment limit is 200 yuan for hypertension and 300 yuan for diabetes; for those with both diseases, the limit is 500 yuan.

Inpatient costs at designated medical institutions are settled per admission. The total medical cost minus self-pay items and first self-pay portions, after deducting the deductible, is paid proportionally. The deductible is 100 yuan at township health centers and community health service centers (stations) within Dazhou, 400 yuan at other secondary and lower-level institutions, and 600 yuan at tertiary institutions. For institutions outside the city but within the province (including Chongqing), the deductible is 1,200 yuan; outside the province, 1,800 yuan. For self-arranged out-of-town medical treatment, the deductible increases to 1,500 yuan within the province (including Chongqing) and 2,000 yuan outside the province. For two or more hospitalizations in one insurance year, the deductible decreases by 50 yuan each time, but not below 50 yuan.

The pooled fund payment ratio is 90% at township health centers and community health service centers (stations) within Dazhou, 75% at other secondary and lower-level institutions, and 70% at tertiary institutions.

For two-way referral within the city, the medical costs are treated as one hospitalization. Costs covered by the fund are calculated using the deductible of the higher-level institution and paid in segments according to the payment ratio of the actual institution.

Bed fees are 15 yuan per bed per day at tertiary institutions, 12 yuan at secondary institutions, and 10 yuan at primary and lower institutions. Laminar flow clean wards, intensive care units, and special protection wards follow relevant rules.

For single-use Class B consumables and Class B diagnostic and treatment items costing less than 2,000 yuan, the first self-pay is 20%; for those over 2,000 yuan, it is 30%. Within one hospitalization period, the amount included in fund payment is capped at 10,000 yuan.

For maternity-related inpatient costs within the policy scope, there is no deductible, and payment is made within limits. Prenatal checkup costs receive a fixed subsidy. The city-level medical insurance and finance departments set the standards according to higher-level policies.

With approval from the medical insurance department, township health centers and community health service centers (stations) can establish family beds for certain enrollees. Medical costs covered by the fund are paid at the corresponding inpatient ratio.

Waiting Periods and Continuous Enrollment

Starting in 2025, except for special groups such as newborns, individuals who do not enroll during the centralized enrollment period or do not enroll continuously will have a fixed waiting period of 3 months after enrollment. For those with discontinuous enrollment, each additional year of lapse adds 1 month to the variable waiting period. Enrollees can repair the variable waiting period by paying: each additional year of payment reduces the variable waiting period by 1 month. For those who have lapsed for 4 years or more, after repair, the total of fixed and variable waiting periods is at least 6 months.

Enrollees who have participated in basic medical insurance continuously for 2 years or more and paid as required, and who switch from employee medical insurance to resident medical insurance due to employment or other personal status changes, with an interruption of no more than 3 months, can enjoy benefits normally after payment, and benefits during the interruption are retroactively enjoyed. If the interruption exceeds 3 months, a waiting period is set according to regulations.

Newborns enrolled in the resident medical insurance for the birth year within 90 days of birth enjoy benefits from the date of birth. If enrolled after 90 days, benefits start from the date of payment.

Designated Institutions and Management

Resident medical insurance requires the use of designated medical institutions for medical treatment and medicine purchases. The medical insurance经办机构 (administrative office) determines designated institutions, signs service agreements, provides services, conducts agreement management and assessments, and implements dynamic management.

Designated institutions assign dedicated staff to cooperate with the insurance office in medical service management. Medical costs of enrollees are accounted for separately by financial personnel and provided truthfully, timely, and accurately to the insurance office as required.

What This Means for Foreign Founders

If you operate a company in Dazhou, you may need to enroll in employee medical insurance for yourself and your staff. The resident medical insurance rules described here apply to those not covered by employee insurance, such as family members or certain local hires. Understanding these local rules helps you plan HR compliance and employee benefits. The rules also clarify government subsidies and payment responsibilities, which can affect local hiring costs.

This summary is based on information published by the relevant Chinese government website and is general information, not legal or tax advice.

For assistance with company registration and operations in China, foreign founders can contact ChinaMNC on WhatsApp / WeChat at +86 153 1898 8535.