)Students or guardians login:
"Student medical insurance online declaration" of "Shenzhen Children's Medical Insurance Online Declaration" in the "Children's Medical Insurance Individual Online Declaration System", "first enrollment", enter the ID card inquiry information to confirm the application (inaccurate information corrected by the school); print or fill out the "Children's Medical Insurance Individual Online Declaration System". Registration Form" to the school for confirmation of the application for participation
1. Participation object (three kinds):
In the park in the school children in Shenzhen education, health, civil affairs, human resources and social security bureau approved the establishment of all child care institutions, elementary school, junior high schools, high schools, junior colleges, technical schools and vocational schools (excluding tertiary section), special schools in the children, which is not a household registration of the children of their parents should be either one of their parents is in the city to participate in social insurance and has completed one year of social insurance. (hereinafter referred to as students) who have been enrolled in social insurance in the city for more than one year.
Non-school children who are not enrolled in schools or settled outside the city and are under 18 years old (hereinafter referred to as children).
Undergraduates full-time undergraduates (including junior colleges), full-time graduate students (hereinafter referred to as undergraduates).
2. Participation and payment standards:
374 yuan per person per year, of which 174 yuan is paid by the child's family and 200 yuan is paid by the financial subsidy. Contributions are made according to the school year (from September of the current year to August of the following year) and are collected once a year and deducted from the participant's or guardian's passbook.
3. Enrollment Methods
1). Students, college students:
Participants (students) submit declaration information to their schools, which will handle the enrollment procedures. The school uploads the information of all registered students to the social security organization through the online reporting system of the Municipal Social Security Bureau;
2). Children:
A. The participant submits the declaration materials to the community or street where he/she lives, and the community or street accepts the declaration materials and reports them to the social security institution after the preliminary examination;
B. The participant submits the declaration materials to the social security institution in the place where he/she lives, and the social security institution accepts the declaration materials.
Shenzhen Children and Teenagers Hospitalization and Major Disease Outpatient Medical Insurance Trial Measures
Chapter 1 General Provisions
Article 1
In order to improve the medical insurance system of Shenzhen and protect the health of children and teenagers, these Measures have been formulated in accordance with the relevant laws and policies of the State.
Article 2
Children and adolescents with household registration in the city who are enrolled in all nurseries, kindergartens, elementary schools, junior high schools, senior high schools, junior colleges, special schools, technical schools and vocational schools (excluding junior colleges) (hereinafter referred to as primary and middle schools and child care institutions in the city) approved by the departments of education, civil affairs and labor security in the city, and children and adolescents under the age of 18 years old who are not enrolled in school or kindergarten and those who are with household registration in the city, and children and adolescents who are with household registration in the city who are not enrolled in school or kindergarten. Children and adolescents who are registered in the city, and children and adolescents under 18 years of age who are registered in the city but have not enrolled in school or kindergarten, and children and adolescents under 18 years of age who are registered in the city but have settled outside the city, and who are in compliance with the national family planning policy, shall be enrolled in the inpatient and outpatient medical insurance for major illnesses (hereinafter referred to as the medical insurance for children).
Children and adolescents enrolled in primary and secondary schools and child-care institutions in the city who are not of the city's household registration and are in compliance with the national family planning policy, and who reside in Shenzhen with their parents, and one of whose parents has been participating in the city's social insurance scheme for more than one year at the time of applying for the children's medical insurance, shall also participate in the children's medical insurance scheme.
The enrollees referred to in these Measures refer to the children and young people who are enrolled in the juvenile medical insurance.
Article 3
Children's medical insurance follows the principles of combining fairness and efficiency, rights and obligations correspond to each other, and the level of protection corresponds to the level of development of social productivity.
Article 4
The establishment of a children's medical insurance fund, the implementation of the city's co-ordination, into the financial account management, earmarked for children's medical insurance.
Children's medical insurance fund to implement the principle of income and expenditure, pay-as-you-go, balance of payments, a slight surplus, the current year's shortfall in payment, by adjusting the standard of children's medical insurance contributions to be resolved.
Article 5
The municipal administrative department of labor security is responsible for the formulation, organization and implementation of policies on children's medical insurance and supervision and management. The Municipal Social Insurance Fund Management Organization (hereinafter referred to as the Municipal Social Insurance Organization) shall be the organization for children's medical insurance, and shall be specifically responsible for the collection, use and management of the children's medical insurance fund.
The municipal education department shall assist in publicizing the policy of children's medical insurance, and urge the primary and secondary schools and child care institutions to assist in the collection of children's medical insurance, and the primary and secondary schools and child care institutions shall report the basic information of the participants to the municipal social security institution every year.
The municipal health department shall strengthen the management of medical institutions, standardize the behavior of medical services, and reasonably control the level of medical costs.
The municipal finance and audit departments shall do a good job of managing and supervising the special account of the children's medical insurance fund. Financial departments at all levels shall allocate the relevant financial subsidies on time.
Chapter II children's medical insurance fund mobilization
Article 6
The sources of children's medical insurance fund are children's medical insurance premiums and their interest, financial subsidies, social contributions and other income.
Article 7
Children's medical insurance premiums are paid on an annual basis and consist of two parts, namely, contributions from children's families and financial subsidies.
The financial subsidies for juvenile medical insurance shall be shared by the municipal and district finances in the ratio of 1:1, with the subsidies first unified by the municipal finances and then settled by the municipal and district finances.
Article 8
Children from low-income families with Shenzhen household registration shall be exempted from the payment of children's medical insurance premiums, and the exempted expenses shall be borne by the Welfare Lottery Fund. The Municipal Civil Affairs Bureau shall unify the enrollment procedures for children from low-income families, and the enrollment procedures shall be carried out by submitting the participant's household register and the Minimum Subsistence Security Benefit Receipt Certificate and other relevant supporting documents.
Article 9
Participants of primary and secondary schools and childcare institutions in the city are required by the municipal social security institutions to collect children's medical insurance premiums in September every year; children and young people under 18 years of age who are not enrolled in school or kindergarten or who have settled outside of the city and who have the city's household registration are required to go to the municipal social security institutions for enrollment and payment of premiums in September every year, with the residence account book and other relevant documents, by their parents or other legal guardians. Children's medical insurance contribution standard is 150 yuan per person per year, of which the children's families pay 75 yuan per person per year, financial subsidies 75 yuan per person per year.
If a child is not enrolled in September, the child's parents or other legal guardians can apply for enrollment at a municipal social security agency at another time and pay the premiums on the fourth month from the date of application for enrollment. The contribution rate for the child's family in the child health insurance year is:
75 yuan ÷ 12 months × the number of months of contribution (the number of months of contribution is from the month of contribution to the month of the end of the current child health insurance year)
The financial subsidy in the child health insurance year is:
75 yuan ÷ 12 months × the number of months of contribution (the number of months of contribution is from the month of contribution to the month of the end of the current child health insurance year)
The financial subsidy is:
75 yuan ÷ 12 months × the number of months of contribution (the number of months of contribution is from the month of contribution to the month of the end of the current child health insurance year). (The number of months of contribution is the month from the month of contribution to the month of the end of the current child health insurance year).
If a newborn child who is a household registration of the city applies for enrollment and pays the premiums within two months from the date of birth, the number of months of premium payment shall be calculated from the month of the child's birth.
Article 10
The Children's Medical Insurance Fund shall calculate interest at the bank's deposit rate for the same period.
Article 11
Small and medium-sized schools and child-care institutions as well as relevant departments in the city shall assist and cooperate in completing the collection of children's medical insurance premiums, and the municipal social security institutions shall provide appropriate financial subsidies, which shall be incorporated by the municipal finance into the departmental budget of the municipal social security institutions.
Chapter III Children's medical insurance treatment
Article 12
Participants who uniformly apply for enrollment and payment of fees in September each year shall be entitled to the children's medical insurance treatment for the current children's medical insurance year from the month in which they make the required payment.
If you apply for enrollment at any other time, you will be entitled to the children's health insurance benefits for the current children's health insurance year from the month you make the required contributions. Newborns who apply for enrollment and make contributions within 2 months from the date of birth are entitled to the children's medical insurance benefits for the current children's medical insurance year from the date of birth.
If a participant stops paying the child health insurance premiums, he/she will stop enjoying the child health insurance benefits from the child health insurance year in which he/she stops paying.
Article 13
The basic medical expenses incurred by the insured person for hospitalization in the designated medical institutions of the juvenile medical insurance, as well as the basic medical expenses for specialized outpatient treatment of leukemia, hemophilia, aplastic anemia, and pernicious tumors after discharge from the hospital, the expenses for outpatient dialysis treatment before receiving a kidney transplant, and the expenses for post-operative treatment with anti-rejection drugs, as approved by the social security institution of the city, shall be treated by the municipal social security institution. Specialized basic medical expenses (hereinafter collectively referred to as outpatient expenses for major diseases) are included in the scope of payment of the fund, and enjoy the treatment of pediatric medical insurance under the provisions of these measures.
The basic medical expenses referred to in the preceding paragraph mean the medical expenses within the scope of the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as other medical expenses stipulated in the regulations.
Article 14
Approved by the Municipal Social Security Institution, disposable medical materials with a unit price of more than 1,000 yuan used in the children's medical insurance program shall be included in the scope of the fund's payment at 90% of the price of the domestically produced universal type, and if there is no comparable price of the domestically produced universal type, it shall be included in the scope of the fund's payment at 50% of the price of the imported universal type.
Article 15
Basic medical expenses for organ transplantation surgical treatment are approved for reimbursement in accordance with the regulations, and other expenses are not included in the scope of payment by the Fund.
The scope of organ transplantation includes: kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow transplantation.
Article 16
With the information stipulated in Article 33 of these Measures, one can go to the Municipal Social Security Institution for reimbursement of the cost of placing and replacing an artificial organ in accordance with the regulations approved.
Artificial organs include artificial pacemakers, artificial heart valves, artificial crystals and artificial joints. The cost of artificial organs is included in the scope of payment by the fund at 90% of the price of the domestic universal type; if there is no comparable price of the domestic universal type, it is included in the scope of payment by the fund at 50% of the price of the imported universal type. The payment ceiling is 15,000 yuan for artificial pacemakers, 8,000 yuan for artificial heart valves, 5,000 yuan for artificial joints and 1,500 yuan for artificial crystals.
Article 17
Special medical materials include intracardiovascular catheters, intracardiovascular stents and intracardiac vascular balloons. The cost of special medical materials is included in the scope of payment of the fund at 90% of the price of the domestic universal type. If there is no domestic universal comparable price, 50% of the imported universal price is included in the scope of payment of the fund. The maximum limit of payment is 1,200 yuan for intracardiovascular catheter, 11,500 yuan for intracardiovascular stent, and 6,500 yuan for intracardiac vascular balloon.
Article 18
Children's medical insurance implements the system of hospitalization starting payment standard (hereinafter referred to as the starting line), that is to say, the fund will not pay for the hospitalization medical expenses incurred by children that fall within the scope of the fund's account and below the starting line.
The outpatient expenses for major diseases stipulated in this plan are not subject to the starting line system.
The starting line for pediatric medical insurance is 300 yuan for hospitals of the first class and below in the city, 400 yuan for hospitals of the second class in the city, 500 yuan for hospitals of the third class in the city, and 600 yuan for hospitals outside the city.
If a child is hospitalized several times in the same medical insurance year, the starting line for each hospitalization from the second hospitalization will be reduced by RMB 100 on top of the corresponding standard, until the starting line is zero.
Article 19
The Children's Medical Insurance Fund establishes the annual maximum payment limit of the Children's Medical Insurance, which is linked to the time of continuous participation in the Children's Medical Insurance, and the specific standards are as follows:
(1) If the continuous participation in the Children's Medical Insurance is less than one year, the annual maximum payment limit of the Children's Medical Insurance Fund shall be one times of the average annual salary of the on-the-job workers in the previous year in the city;
(e) If you have continuously participated in pediatric medical insurance for more than four years, the annual maximum payment limit of the pediatric medical insurance fund shall be 200,000 yuan.
Article 20
If the basic medical expenses incurred by a participant for each hospitalization above the starting payment line, or for each outpatient treatment of major diseases are within the annual maximum payment limit, the Children's Medical Insurance Fund shall pay for them in accordance with the following standards:
80% of the portion of the amount less than 5000 Yuan shall be paid by the Children's Medical Insurance Fund;
80% of the portion of the amount more than 5000 Yuan and less than 10000 Yuan shall be paid by the Children's Medical Insurance Fund;
5000 For the part above 5000 RMB and below 10000 RMB, the Children's Medical Insurance Fund pays 85%;
For the part above 10000 RMB, the Children's Medical Insurance Fund pays 90%.
Article 21
According to the characteristics of the children's medical insurance participants, the municipal social security institutions may appropriately adjust the individual elements of the management of the drug catalog, diagnostic and therapeutic items and service facilities scope of the children's medical insurance on the basis of the basic medical insurance.
Article 22
Participants in any of the following cases shall not be entitled to the treatment of children's medical insurance as stipulated in these Measures:
(1) those who have been treated in Hong Kong, Macao, Taiwan or abroad;
(2) those who have gone to a non-specified medical institution in the city on their own for medical treatment, except those who have life-threatening signs and need to be resuscitated in their vicinity;
(3) those who have purchased their own medicines;
(4) those who have been treated in a medical institution in Hong Kong, Macao or Taiwan; and medicines;
(d) injuries caused by other people's responsibility, intentional acts or illegal acts;
(e) injuries caused by traffic accidents or medical accidents;
(f) other cases stipulated by the State, Guangdong Province and Shenzhen Municipality.
Article 23
Participants who use the following diagnostic and treatment items and medical materials shall not be entitled to the treatment of children's medical insurance as stipulated in these Measures:
(1) services such as registration, consultation, and special medical service;
(2) non-disease treatment such as cosmetic treatment, non-functional cosmetic surgery, health checkups, medical consultation, and preventive care;
p>(iii) non-basic medical insurance diagnostic and treatment items such as positron emission tomography (PET) scanning and photon knife;
(iv) disposable medical materials that are not reimbursed by basic medical insurance;
(v) rehabilitative devices such as eyeglasses, dentures and hearing aids;
(vi) organ sources or tissue sources for various types of organ or tissue transplants;
(vii) non-disease treatment items other than kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow transplants;
(viii) auxiliary therapeutic items such as qigong therapy and magnetic therapy;
(ix) all kinds of diagnostic and therapeutic items of scientific research and clinical validation;
(x) other diagnostic and therapeutic items not reimbursable under the regulations of the State, Guangdong Province and Shenzhen City.
The specific scope of diagnostic and therapeutic items and medical materials listed in the preceding paragraph shall be implemented with reference to the provisions of social medical insurance.
Article 24
After a participant is employed and joins the social medical insurance within the year of the pediatric medical insurance, his/her years of contribution to the pediatric medical insurance can be calculated consecutively with those of the social medical insurance, and he/she can enjoy the social medical insurance benefits.
Chapter IV: Designated Medical Institutions
Article 25
Children's medical insurance is managed by designated medical institutions. The management of fixed-point medical institutions shall be implemented with reference to the relevant provisions of social medical insurance.
Article 26
The municipal social security institutions shall sign agreements with fixed-point medical institutions.
Article 27
The designated medical institutions shall provide medical services to the insured in accordance with the provisions of these measures and the agreement.
Article 28
Specified medical institutions shall establish an internal management system compatible with the pediatric medical insurance system.
Article 29
Specified medical institutions shall strictly implement and publicize the government's regulations on medical charges and drug prices.
Specified medical institutions shall provide participants with an itemized list of daily charges for hospitalization.
Chapter 5
Settlement of Children's Medical Insurance Expenses, Cash Reimbursement and Out-of-City Referrals
Article 30
Medical expenses incurred by hospitalized participants in compliance with the provisions of the Children's Medical Insurance shall be recorded by the designated medical institution in accordance with the regulations on the basis of the participant's "Shenzhen Children's Medical Insurance Card".
The Municipal Social Security Institution shall not pay for the medical expenses incurred by the insured person for hospitalization which do not belong to the provisions of the Children's Medical Insurance.
Article 31
The settlement of medical expenses for children's medical insurance may be made by way of settlement of service items, settlement of service units, settlement of disease types or settlement of total prepayment.
The municipal social security institutions shall determine the settlement methods according to the different categories of the designated medical institutions and the actual situation, and specify them in the agreement signed between the municipal social security institutions and the designated medical institutions.
The specific settlement method for children's medical insurance costs is based on the settlement method for basic medical insurance.
Article 32
Medical expenses incurred by a participant in hospitalization and outpatient clinic for major illnesses in accordance with the provisions of the basic medical insurance may be reimbursed to the municipal social security institution with the relevant documents and information under one of the following circumstances if cash is paid first:
(1) outpatient medical expenses for major illnesses as stipulated in Article 13;
(2) computer malfunction of the medical institution visited or the outpatient medical expenses for minor illnesses are not covered. medical institutions have computer malfunctions or cannot be recorded due to the damage of the children's medical insurance card;
(3) hospitalization for treatment of emergency or critical illnesses in non-scheduled medical institutions in the city;
(4) transfer to out-of-town medical institutions for hospitalization with the consent of the scheduled medical institutions of children's medical insurance in the city or the municipal social security institutions;
(5) hospitalization for acute illnesses in medical institutions outside of the city during family visits or vacations;
(6) hospitalization of children's medical institutions outside of the city during family visits or vacations; and (e) hospitalization in an out-of-town medical institution for an acute illness during a family visit or vacation outside of the city;
(f) hospitalization or outpatient treatment of a major illness of children and teenagers with household registration outside of the city, and prior registration of the out-of-town registration with the municipal social security institution.
Article 33
If a participant is hospitalized under one of the circumstances stipulated in Article 32 of these Measures and pays the medical expenses in cash, the following information shall be provided to the Municipal Social Security Institution when reimbursement is made:
(1) the original receipt of the charges;
(2) a detailed list of the charges;
(3) a copy of the hospitalization medical record (stamped with the official seal of the medical institution)
(d) Diagnostic certificate of disease;
(e) Certificate of medical insurance for children;
(f) Original and copy of bank folders of parents or other legal guardians.
If a participant is hospitalized in an out-of-town hospital due to an emergency, he or she should also register for out-of-town medical treatment with the municipal social security institution by phone or e-mail within one month of admission.
Article 34
When handling the reimbursement of medical expenses incurred by a participant who has been referred to out-of-town medical treatment by a designated medical institution in the city or by a municipal social security institution, the participant shall, in addition to providing the information stipulated in the first paragraph of Article 33
to the municipal social security institution, submit the "Application Form for Audit of Out-of-Town Referral for Medical Treatment of Children's Medical Insurance in Shenzhen City" with an approved opinion, and shall follow the procedures as follows Approval for reimbursement:
(1) If the referral is approved by the municipal social security institution, the above information shall be sent directly to the municipal social security institution for approval for reimbursement;
(2) If the referral is made by a municipal tertiary hospital or a municipal specialized hospital, the above information shall be sent to the medical institution from which the referral was made, and the approved reimbursement plan shall be submitted to the municipal social security institution for review, and the reimbursement after review shall be subject to the reimbursement expenses.
Article 35
If a participant pays medical expenses in cash and needs to apply for reimbursement, he/she shall apply for reimbursement to the municipal social security institution with the relevant information within six months from the date of incurring the expenses (or the date of discharge if he/she has been hospitalized), and the reimbursement will not be made after that date.
Article 36
An insured person may be transferred to an out-of-town medical institution if he/she is treated at a designated medical institution in the city under one of the following circumstances:
(1) difficult diseases that cannot be diagnosed by the tertiary hospitals in the city or by municipal specialized hospitals through examinations and consultations;
(2) critically ill patients for whom the tertiary hospitals in the city or the municipal specialized hospitals do not have the equipment or technology to treat at present. Critically ill patients.
Article 37
If a participant meets the conditions for out-of-town referral, the attending physician of the tertiary hospital or municipal specialized hospital in the city shall first provide a summary of the medical records, give the reasons for referral, fill in the "Shenzhen Children's Medical Insurance Out-of-Town Referral Review Application Form" in duplicate, and then send it to the Medical Affairs Office and the person in charge of the hospital to be reviewed and stamped with the official seal after the department head of the transferring hospital has signed the opinion.
Article 38
According to the agreement signed between the municipal social security institutions and the municipal tertiary hospitals and municipal specialized hospitals, if the illnesses belonging to the diseases need to be referred by the designated medical institutions, the patients can be referred to out-of-town medical institutions after going through the examination and approval formalities in accordance with the provisions of Article 37 of the present Measures.
Article 39
According to the agreements signed between the municipal social security institutions and the municipal tertiary hospitals and municipal specialized hospitals, the diseases that are referred by the municipal social security institutions can be referred to medical institutions outside of the city for consultation and treatment after going through the examination and approval procedures in the fixed-point medical institutions, which are required to go through the approval procedures in the municipal social security institutions.
Article 40
The medical institutions that accept referrals outside of the city shall be non-profit medical institutions of the same level or above as the medical institutions to which the referrals are made.
Article 41
If a participant needs to be re-referred after being transferred to a medical institution outside of the city, the medical institution that accepts re-referrals shall be a non-profit medical institution at the same level or above of the medical institution that is transferred out of the city.
Article 42
The maximum duration of an out-of-town referral is three months. If it is necessary to exceed 3 months, a certificate from the receiving medical institution shall be presented to the municipal social security institution for filing.
Article 43
Specified medical institutions shall strictly follow the referral conditions and referral procedures to review and approve the referral of patients. If the fixed-point medical institutions are responsible for reviewing the referrals, the basic medical expenses incurred shall be settled in accordance with the methods stipulated in the agreement signed between the municipal social security institutions and the fixed-point medical institutions. If the municipal social security institution is responsible for reviewing the referral, the basic medical expenses incurred shall be reviewed and reimbursed by the municipal social security institution.
Chapter 6
Supervision and Management of Children's Medical Insurance
Article 44
Parents or other legal guardians of children shall truthfully declare the information that children are enrolled in the Children's Medical Insurance and are exempted from the payment of the Children's Medical Insurance premiums and shall not make any false declaration.
Article 45
The Municipal Social Security Organization shall produce the "Shenzhen Children's Medical Insurance Certificate" as a voucher for the participants to enjoy the children's medical insurance benefits. When providing medical services to insured persons, the designated medical institutions shall carefully check the Shenzhen Children's Medical Insurance Card in the consultation and treatment and bookkeeping processes.
Article 46
The municipal social security organizations may record, audio-record, video-record, take photographs and duplicate the relevant information when carrying out inspections, and shall keep the confidentiality of the insured units. The inspected unit shall truthfully reflect the situation and provide relevant information as required, and the inspected unit shall not refuse the inspection, or misrepresent or conceal the information.
Article 47
Any unit or individual shall have the right to report to the insured person, the designated medical institution, the unit assisting in the collection, the health department and the municipal social insurance agency and its staff on the violation of laws and regulations concerning children's medical insurance.
Reporting verified, the city social security institutions to sign the informant will be rewarded, the amount of reward for the investigation of illegal, illegal amount of 20%, paid by the municipal social security institutions from the children's health insurance fund. Specific reporting and reward provisions refer to the relevant provisions of social health insurance.
Article 48
The municipal social security institutions shall, in conjunction with the relevant departments of health, price, and pharmaceuticals, conduct joint supervision and inspection of designated medical institutions on a regular or irregular basis.
Article 49
If a person other than those enrolled under these Measures applies for pediatric medical insurance, the relationship of pediatric medical insurance of such enrollee shall be invalid, and the municipal social security institution shall recover the medical expenses already paid by the pediatric medical insurance fund.
Article 50
The municipal social security institution shall recover the medical expenses paid by the juvenile medical insurance fund if a participant commits any of the following acts:
(1) lends his juvenile medical insurance document to another person for medical treatment;
(2) overstates or fraudulently collects the medical expenses by falsifying the medical records, prescriptions, and expense documents;
(3) Any other fraudulent behavior.
Article 51
If a designated medical institution violates the agreement on designated medical institutions for pediatric medical insurance, the municipal social security institution shall pursue the responsibility for breach of contract based on the agreement.
Article 52
Specified medical institutions that commit any of the following acts, resulting in losses to the children's medical insurance fund, shall compensate for the losses; if the circumstances are serious, the municipal social security institution may suspend or cancel its qualification as a designated medical institution in accordance with the agreement:
(1) the medical expenses of a non-participant will be paid for by the children's medical insurance fund;
(2) medical expenses should be paid by the individual out-of-pocket;
(2) the medical expenses should be paid by the individual out-of-pocket. medical expenses that should be paid by individuals out of their own pockets into the scope of payment by the Children's Medical Insurance Fund;
(iii) hospitalizing participants who do not meet the criteria for hospitalization, or arbitrarily prolonging the hospitalization time of the participants, adopting the practice of hospitalization in the name of the participant, making false medical records, accounting for the medical expenses in sections, or admitting participants into the super-standard wards without their consent;
(iv) adopting other means to increase the amount of payment by the Children's Medical Insurance Fund payments.
Article 53
Specified medical institutions violating the provisions of price management shall be punished by the municipal price administration department in accordance with the relevant provisions. The designated medical institutions violating the regulations on drug management shall be punished by the municipal drug administration department in accordance with the relevant regulations.
Article 54
Any staff member of the municipal social security institution who abuses his or her power, neglects his or her duties, or engages in malpractice for personal gain shall be given administrative sanctions by his or her employer or by the relevant department; if he or she causes any loss to the Children's Medical Insurance Fund, he or she shall be liable to pay compensation; and if he or she is suspected of committing a crime, he or she shall be transferred to the judicial organs for handling in accordance with the law.
Chapter VII Supplementary Provisions
Article 55
The "children's medical insurance year" referred to in these measures means the period from September 1 to August 31 of the following year.
Article 56
The "following" referred to in these Measures includes this number, and the "above" does not include this number.
Article 57
These Measures shall come into force on September 1, 2007 onwards.
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