1. License to practice as a medical institution: TCM clinics need to have a legal license to practice as a medical institution or a relevant medical institution license to prove their qualifications to operate legally and provide medical services;
2. Medical facilities and equipment: TCM clinics need to meet certain medical facilities and equipment standards to ensure that they can provide services that meet the requirements of medical quality. equipment standards to ensure that they can provide services that meet medical quality requirements. For example, it needs to have suitable consultation rooms, medical equipment, drug storage conditions, etc.
3. Qualification of medical personnel: TCM clinics need to have qualified TCM doctors or other medical personnel, who should have relevant practicing qualifications and professional backgrounds;
4. Requirements for clinic management: TCM clinics need to have certain management systems and norms, including management of medical records, management of medical quality, management of drugs, etc., to ensure that services meet the requirements of medical quality.
5.
5. Approval process: Chinese medicine clinics applying for medical insurance designation need to submit an application to the local medical insurance management department and go through the approval process in accordance with the regulations of Guangzhou City.
The scope of medical insurance coverage is as follows:
1. Personally-burdened medical expenses under medical insurance: personally-burdened compliant medical expenses within the scope of the medical insurance directory incurred during the insured year for hospitalization, including home beds, and outpatient specific diseases. Coverage of 1 million yuan, a deductible of 20,000, the reimbursement rate is 80%, and the reimbursement rate for medical treatment outside of the city is 30%;
2. Compensation for personal out-of-pocket expenses outside of the health insurance: the personal expenses incurred outside of the health insurance directory scope of compliance with the medical expenses. The insured amount is 1,000,000 RMB with a deductible of 20,000 RMB, and the reimbursement rate is 60%, and the reimbursement rate for medical treatment outside the city is 30%;
3. Reimbursement of out-of-pocket expenses for malignant tumors: for the treatment of oncological diseases, the insured person will be reimbursed for 90% of the expenses incurred for the use of designated out-of-pocket expenses for malignant tumors within the year of the insured person's use of the specified out-of-pocket expenses for malignant tumors and for those that are consistent with the corresponding indications and total over RMB 10,000 RMB, within RMB 300,000 RMB; the reimbursement rate for malignant tumors that have been incurred prior to the first time of insurance is 60%. Reimbursement for malignant tumors: 90% of medical expenses incurred within the scope of the medical insurance directory after reimbursement by basic medical insurance, major disease insurance and commercial medical insurance within the insured year will be reimbursed for an aggregate amount of 80,000 RMB or more, but not exceeding 250,000 RMB, and 100% of medical expenses incurred for an aggregate amount of 250,000 RMB or more, but not exceeding 1,000,000 RMB will be reimbursed for 100% of medical expenses incurred within the insured year.
5. p>5, general outpatient personal high medical expenses compensation: the insurance year in Foshan City, the designated medical institutions or referral filing, long stay in a different place for the record participants in the insurance year within the validity period of the record of the record of the place of the general outpatient medical institutions incurred in the record of the high cost of medical expenses borne by the individual. Coverage of 100,000 yuan, a deductible of 20,000 yuan, the reimbursement rate of 60%;
6, no-claims preferential treatment for continuous enrollees, 28 kinds of heavy major diseases insurance premium 10,000 coverage, 121 kinds of rare diseases insurance premium 10,000 coverage.
In summary, medical protection departments at all levels should orderly promote the work of urban and rural residents before and after the transfer of responsibilities for the collection and management of medical insurance premiums, to ensure that the quantitative targets for annual financing are put in place.
Legal basis:
Article 27 of the Social Insurance Law of the People's Republic of China
Individuals who have participated in the basic medical insurance for employees, and whose accumulated contributions have reached the number of years stipulated by the state by the time they reach the legal retirement age, will no longer have to pay the basic medical insurance premiums after retirement, and will enjoy the basic medical insurance benefits in accordance with the state regulations; those who have not yet reached the state's stipulated number of years, can Contribute to the state prescribed years.