The following information is for reference only:
●The application form for designated medical institutions in the city shall be uniformly printed by the municipal social insurance agency.
●Application to become a designated medical institution for social insurance in the city shall meet the following conditions:
I. Non-profit medical institutions in the city holding a valid license to practice as a medical institution may apply to become a designated medical institution if they have the following conditions:
(1) Have medical technology equipment and medical and nursing staff corresponding to the level of the medical institution;
(ii) comply with national, provincial and municipal laws, regulations, standards and provisions relating to the management of medical services;
(iii) strictly implement the national, provincial and municipal regulations on non-profit medical charges and retail prices of medicines, and implement a system of public announcements of charges;
(iv) undertake to strictly abide by the implementation of the relevant policies and regulations on the social medical insurance system for urban workers and establish internal medical insurance management that is appropriate to the institution;
(v) strictly abide by the relevant policies and regulations on the implementation of the social medical insurance system for urban workers and establish internal medical insurance management that is appropriate to the institution. (d) undertakes to strictly abide by the relevant policies and regulations of the urban workers' social medical insurance system, to establish an internal management system compatible with the management of medical insurance, to have a sound organization for the management of medical insurance, to have a leader in charge of the work of medical insurance, to be equipped with necessary part-time or full-time management personnel, and to be equipped with computers and other equipment meeting the needs of social medical insurance.
Enterprises and institutions that meet the conditions listed in the preceding paragraph and are located in units with more than 1,000 employees may also apply to become designated medical institutions.
II. In areas where non-profit medical institutions are insufficient to undertake social medical insurance services, for-profit medical institutions that have obtained a license to practice as a medical institution and that meet the conditions listed in the first paragraph of Article 5 of these Measures may apply to become a designated medical institution for municipal social insurance.
Third, the application to become a designated medical institution shall submit the following written application materials and electronic files to the municipal social insurance institution:
(1) application for designated medical institution;
(2) copy of the license to practice as a medical institution (verification of the original);
(3) proof of the grade of the medical institution or the relevant certificates from the administrative department of health;
(4) the certificate of the medical institution or the relevant certificates from the administrative department of health;
(5) the certificate of the medical institution or the relevant certificates from the administrative department of health;< /p>
(iv) Proof of passing the annual inspection by the Drug Administration and Supervision Department;
(v) The General Catalog of Drugs by Pharmacology and the Social Insurance Drug List.
The application form for designated medical institutions is uniformly printed by the municipal social insurance agencies.
Fourth, the municipal social insurance agency will not accept the application of a medical institution to become a designated medical institution if the medical institution has any of the following circumstances:
(a) the application information is incomplete or untrue;
(b) the qualification of the designated medical institution has been canceled for less than 2 years;
(c) there is a major violation of laws and regulations, which is being investigated and dealt with.
V. After accepting the application materials of the medical institutions, the municipal social insurance agency shall organize relevant experts to conduct on-site inspections of the medical institutions that have submitted applications and conduct comprehensive evaluation.
The municipal social insurance institutions based on the overall planning of the city's designated medical institutions and expert evaluation to decide whether to apply for medical institutions as designated medical institutions.
The decision in the preceding paragraph shall be made within 30 working days from the date of acceptance of the application, and the medical institution making the application shall be notified in writing.
Sixth, the application of the medical institutions identified as designated medical institutions, the municipal social insurance agency and its social insurance designated medical institutions signed an agreement, and the municipal social insurance agency issued "urban workers in the city of social health insurance designated medical institutions" sign, and announced to the community.
The agreement signed between the municipal social insurance agency and the designated medical institution shall include the following main provisions:
(1) service items, departments and other services;
(2) quality of service requirements and supervision methods;
(3) settlement of medical expenses and reimbursement standards;
(4) liability for breach of contract;
(v) conditions and procedures for changing or terminating the agreement;
(vi) other contents that both parties consider necessary to be agreed upon.
The agreement on social insurance designated medical institutions is valid for two years.
VII. Before the municipal social insurance agency issues the label of "designated medical institution for social medical insurance for urban workers in the city", the designated medical institution shall, according to the requirements of the agreement, do the following:
(1) formulate the internal management system related to social medical insurance services;
(2) conduct the computerized management system with the municipal social insurance agency;
(3) conduct the computerized management system with the municipal social insurance agency; and ) computer networking with the municipal social insurance agency;
(iii) organizing training in medical insurance business for relevant medical staff and registration clerks, bookkeepers and computer operators.
VIII, designated medical institutions shall, in accordance with the "Measures" and the agreement, do the following:
(a) strictly implement the relevant provisions of the social health insurance management methods, in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, the scope of medical service facilities and the local supplemental medical insurance drug list, diagnostic and therapeutic items, to provide medical care;
(b) there are (b) medical facilities that meet more than 80% of the standard requirements for basic medical insurance service facilities and more than 80% of the medicines in the basic medical insurance drug list;
(c) separate accounts for medical expenses for social medical insurance, and are required to accurately and timely provide the relevant documents and information to the municipal social insurance agency;
(d) new diagnostic and therapeutic items are provided in accordance with the "Basic Medical Insurance Diagnostic and Therapeutic Items and Service Facilities for Municipal Employees in the Municipality". (d) New diagnostic and therapeutic items are implemented in accordance with the "Measures for the Administration of the Scope of Diagnostic and Therapeutic Items and Service Facilities of the City's Urban Employees' Basic Medical Insurance", and the costs of new diagnostic and therapeutic items shall not be counted as part of the account of the social medical insurance if they have not been applied for;
(e) when providing medical services to the insured, the outpatient charts, prescriptions, inpatient expense bills, and application forms for examination and treatment of large-scale medical equipments are used in accordance with the unified requirements of the municipal social insurance institutions;
(g) Implement the system of checklist of the outpatient medical expenses and the system of daily checklist of the inpatient hospitalization expenses, and provide a detailed list of the expenses of all the items to be charged before the discharge of the insured person from the hospital, and the signatures of the insured person or the family members of the insured person before settling the accounts.
(viii) If it provides diagnostic and treatment items, drug catalogs and service facilities outside the scope of social medical insurance, it shall obtain the consent and signature of the participant or his/her family members;
(ix) The costs of medical services provided to the participants shall be settled in accordance with the "Settlement Methods of Social Medical Insurance Costs for Urban Workers in the City".
(j) Regularly checking the implementation of the Measures, agreements and the relevant rules and regulations of the organization by the relevant departments, and copying the checking information to the municipal social insurance agency on a quarterly basis.
The following information is for reference only:
●Application forms for designated medical institutions in the city are printed by the municipal social insurance agency.
●Applications for becoming a designated medical institution for social insurance in the city shall meet the following conditions:
I. Non-profit medical institutions in the city holding a valid license to practice as a medical institution may apply to become a designated medical institution if they have the following conditions:
(1) They have medical and technical equipment and medical and nursing staff corresponding to the level of the medical institution;
(ii) comply with national, provincial and municipal laws, regulations, standards and provisions relating to the management of medical services;
(iii) strictly implement the national, provincial and municipal regulations on non-profit medical charges and retail prices of medicines, and implement a system of public announcements of charges;
(iv) undertake to strictly abide by the implementation of the relevant policies and regulations on the social medical insurance system for urban workers and establish internal medical insurance management that is appropriate to the institution;
(v) strictly abide by the relevant policies and regulations on the implementation of the social medical insurance system for urban workers and establish internal medical insurance management that is appropriate to the institution. (d) undertakes to strictly abide by the relevant policies and regulations of the urban workers' social medical insurance system, to establish an internal management system compatible with the management of medical insurance, to have a sound organization for the management of medical insurance, to have a leader in charge of the work of medical insurance, to be equipped with necessary part-time or full-time management personnel, and to be equipped with computers and other equipment meeting the needs of social medical insurance.
Enterprises and institutions that meet the conditions listed in the preceding paragraph and are located in units with more than 1,000 employees may also apply to become designated medical institutions.
II. In areas where non-profit medical institutions are insufficient to undertake social medical insurance services, for-profit medical institutions that have obtained a license to practice as a medical institution and that meet the conditions listed in the first paragraph of Article 5 of these Measures may apply to become a designated medical institution for municipal social insurance.
Third, the application to become a designated medical institution shall submit the following written application materials and electronic files to the municipal social insurance institution:
(1) application for designated medical institution;
(2) copy of the license to practice as a medical institution (verification of the original);
(3) proof of the grade of the medical institution or the relevant certificates from the administrative department of health;
(4) the certificate of the medical institution or the relevant certificates from the administrative department of health;
(5) the certificate of the medical institution or the relevant certificates from the administrative department of health;< /p>
(iv) Proof of passing the annual inspection by the Drug Administration and Supervision Department;
(v) The General Catalog of Drugs by Pharmacology and the Social Insurance Drug List.
The application form for designated medical institutions is uniformly printed by the municipal social insurance agencies.
Fourth, the municipal social insurance agency will not accept the application of a medical institution to become a designated medical institution if the medical institution has any of the following circumstances:
(a) the application information is incomplete or untrue;
(b) the qualification of the designated medical institution has been canceled for less than 2 years;
(c) there is a major violation of laws and regulations, which is being investigated and dealt with.
V. After accepting the application materials of the medical institutions, the municipal social insurance agency shall organize relevant experts to conduct on-site inspections of the medical institutions that have submitted applications and conduct comprehensive evaluation.
The municipal social insurance institutions based on the overall planning of the city's designated medical institutions and expert evaluation to decide whether to apply for medical institutions as designated medical institutions.
The decision in the preceding paragraph shall be made within 30 working days from the date of acceptance of the application, and the medical institution making the application shall be notified in writing.
Sixth, the application of the medical institutions identified as designated medical institutions, the municipal social insurance agency and its social insurance designated medical institutions signed an agreement, and the municipal social insurance agency issued "urban workers in the city of social health insurance designated medical institutions" sign, and announced to the community.
The agreement signed between the municipal social insurance agency and the designated medical institution shall include the following main provisions:
(1) service items, departments and other services;
(2) quality of service requirements and supervision methods;
(3) settlement of medical expenses and reimbursement standards;
(4) liability for breach of contract;
(v) conditions and procedures for changing or terminating the agreement;
(vi) other contents that both parties consider necessary to be agreed upon.
The agreement on social insurance designated medical institutions is valid for two years.
VII. Before the municipal social insurance agency issues the label of "designated medical institution for social medical insurance for urban workers in the city", the designated medical institution shall, according to the requirements of the agreement, do the following:
(1) formulate the internal management system related to social medical insurance services;
(2) conduct the computerized management system with the municipal social insurance agency;
(3) conduct the computerized management system with the municipal social insurance agency; and ) computer networking with the municipal social insurance agency;
(iii) organizing training in medical insurance business for relevant medical staff and registration clerks, bookkeepers and computer operators.
VIII, designated medical institutions shall, in accordance with the "Measures" and the agreement, do the following:
(a) strictly implement the relevant provisions of the social health insurance management methods, in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, the scope of medical service facilities and the local supplemental medical insurance drug list, diagnostic and therapeutic items, to provide medical care;
(b) there are (b) medical facilities that meet more than 80% of the standard requirements for basic medical insurance service facilities and more than 80% of the medicines in the basic medical insurance drug list;
(c) separate accounts for medical expenses for social medical insurance, and are required to accurately and timely provide the relevant documents and information to the municipal social insurance agency;
(d) new diagnostic and therapeutic items are provided in accordance with the "Basic Medical Insurance Diagnostic and Therapeutic Items and Service Facilities for Municipal Employees in the Municipality". (d) New diagnostic and therapeutic items are implemented in accordance with the "Measures for the Administration of the Scope of Diagnostic and Therapeutic Items and Service Facilities of the City's Urban Employees' Basic Medical Insurance", and the costs of new diagnostic and therapeutic items shall not be counted as part of the account of the social medical insurance if they have not been applied for;
(e) when providing medical services to the insured, the outpatient charts, prescriptions, inpatient expense bills, and application forms for examination and treatment of large-scale medical equipments are used in accordance with the unified requirements of the municipal social insurance institutions;
(g) Implement the system of checklist of the outpatient medical expenses and the system of daily checklist of the inpatient hospitalization expenses, and provide a detailed list of the expenses of all the items to be charged before the discharge of the insured person from the hospital, and the signatures of the insured person or the family members of the insured person before settling the accounts.
(viii) If it provides diagnostic and treatment items, drug catalogs and service facilities outside the scope of social medical insurance, it shall obtain the consent and signature of the participant or his/her family members;
(ix) The costs of medical services provided to the participants shall be settled in accordance with the "Settlement Methods of Social Medical Insurance Costs for Urban Workers in the Municipality".
(j) Regularly checking the implementation of the Measures, agreements and the relevant rules and regulations of the organization by the relevant departments, and copying the checking information to the municipal social insurance agency on a quarterly basis.
Extended reading: insurance how to buy, which is good, hand to teach you to avoid these insurance "pit"