1, is responsible for accepting the basic medical insurance, industrial injury insurance, maternity insurance and retired cadres and medical expenses of the integrated fund of the approval, payment, management and other day-to-day affairs.
2. It provides corresponding management services for employers, employees and retired cadres participating in basic medical insurance, work injury insurance and maternity insurance.
:
1. Article 28 of the Social Insurance Law stipulates that medical expenses in line with the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations. According to the basic requirements for the payment of basic medical insurance benefits in China, participants who go to the medical insurance organization to reimburse the medical expenses incurred by themselves for visiting the doctor generally have to meet the following conditions: participants must go to the designated medical institutions of the basic medical insurance to visit and purchase medicines, or go to the designated retail pharmacies determined by the social insurance organization to purchase medicines out of the hospital with a prescription issued by the doctor of the designated hospital. Medical expenses incurred by insured persons in the course of seeking medical treatment must be in accordance with the scope and payment standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, in order to be paid by the basic medical insurance fund in accordance with the regulations. The portion of the medical expenses incurred by a participant that meet the scope of payment of the basic medical insurance, above the starting standard and below the maximum payment limit of the social medical insurance fund, shall be paid by the social medical insurance fund in a uniform proportion.
2. Main responsibilities:
(1) implement the national, provincial and municipal medical and maternity insurance policies and regulations, is responsible for the development of the city's health insurance specific business processes and operational norms and organization and implementation.
(2) Responsible for the management and payment of medical and maternity insurance funds, strictly implement the financial management system of medical, work-related injuries and maternity insurance, and ensure the safety and integrity of the funds.
(3) It is responsible for preparing the draft budgets of the medical and maternity insurance funds, and submitting various financial and statistical reports on time.
(4) Establishing and improving the early warning system of the medical and maternity insurance fund, and regularly analyzing and forecasting the income and expenditure of the fund.
(5) It is responsible for identifying designated medical institutions and designated retail pharmacies, signing service agreements with them, and giving guidance and management to their business work.
(6) It is responsible for auditing, settlement and disbursement of medical expenses of designated medical institutions and designated retail pharmacies.
(7) Supervising and inspecting the implementation of basic medical insurance regulations and medical services by designated medical institutions and designated retail stores, coordinating conflicts between doctors and patients, and protecting the interests of insured workers.
(8) Receiving inquiries from insured units and insured workers about medical and maternity insurance, publicizing medical and insurance policies, and providing consulting services to insured workers.
(9) Handling the examination and payment of medical and maternity insurance benefits.
(10) Responsible for the city's enterprises, administrative institutions, retired cadres, medical co-ordination fee collection, medical expenses audit, reimbursement and management work.
(11) It is responsible for providing operational guidance to county and district medical insurance organizations.
3. Supervising and inspecting the implementation of basic medical insurance provisions and medical services of designated medical institutions and designated retail stores, coordinating conflicts between doctors and patients, and protecting the interests of insured workers. It accepts inquiries from insured units and insured employees on medical and maternity insurance business, publicizes various medical insurance policies, and provides consulting services for insured employees. Handling the examination and payment of medical and maternity insurance benefits. It is responsible for coordinating the collection and payment of medical expenses, inspection, reimbursement and management of retired cadres of enterprises and public institutions in the city. It is responsible for providing business guidance to county and district medical insurance organizations.