Article 23 The designated medical institutions and designated retail pharmacies shall be determined according to local management based on the principles of integrating Chinese and Western medicines, taking into account primary, specialized and comprehensive medical institutions, and facilitating the workers' access to medical care and purchase of medicines. The medical insurance administration organizations shall sign service agreements with designated medical institutions and designated retail pharmacies. The medical insurance operators at all levels shall strengthen supervision of designated medical institutions and designated retail pharmacies in accordance with their respective responsibilities, and regulate the behavior of medical services. Specific measures will be formulated separately by the state Human Resources and Social Security Bureau.
Article 24: Patients who cannot be treated due to the limited technical and equipment conditions of the hospitals should follow the principle of transferring to other hospitals on a step-by-step basis, and can only be transferred to the next level of hospitals for treatment after the designated hospitals put forward their opinions on transferring to other hospitals for the approval of the medical insurance agencies in the places where the insured are participating in the insurance scheme.
Article 25 In order to facilitate the long-term residence of the insured person in a different place for medical treatment and purchase of medicines, you can choose three local designated hospitals for medical insurance and three designated retail pharmacies in your place of long-term residence, and after incurring the medical expenses, the relevant information will be declared by the insured unit to the health insurance agency (the flexible employed person will be declared by the person), and after the audit of the health insurance agency in accordance with the provisions of the health insurance agency, the medical expenses to be paid will be transferred directly into the participating unit, the flexible employed person will be transferred directly into his own. The flexible employees will be directly transferred to their own bank accounts.
Article 26 The statewide unified use of the "Golden Insurance Project" health insurance network system, in the network coverage of designated medical institutions, designated retail pharmacies to implement the network of health insurance costs instant settlement, the part of the medical costs of the insured person should be paid for by the medical insurance by the medical insurance agency and the designated medical institutions, The part of the medical expenses of the insured that should be paid by the medical insurance shall be settled directly between the medical insurance management organization and the designated medical institutions and designated retail pharmacies, and the part that belongs to the individual shall be settled between the designated medical institutions and designated retail pharmacies and the individual. The immediate settlement of outpatient medical treatment for "severe chronic diseases" is separately stipulated.
Article 27 The medical insurance agencies and designated hospitals implement monthly settlement, and before settlement of the medical expenses incurred by the insured employees are subject to random audits in accordance with the regulations, and 90% of the expenses payable are paid for the medical expenses in line with the scope of the policy, and the remaining 10% as a deposit to be disbursed based on the assessment after the annual assessment; the designated clinics and designated retail pharmacies implement monthly settlement, and carry out regular and irregular inspections, and the medical expenses in line with the scope of the policy are paid for the remaining 10% as a guarantee; the designated medical institutions and retail pharmacies implement monthly settlement, and carry out regular and irregular inspections. For fixed-point clinics and fixed-point retail pharmacies, monthly settlement is made, regular and irregular inspections are carried out, and 95% of the fees payable are paid for medical expenses in line with the scope of the policy, with the remaining 5% as a deposit to be disbursed according to the assessment after the annual assessment.