Chapter V Measures of Wuhan Municipality on Basic Medical Insurance for Urban Workers; Basic Medical Insurance and Medical Service Management

Thirty-sixth basic medical insurance is managed by designated medical institutions and designated retail pharmacies. Medical institutions and retail pharmacies that have been approved by the health and drug supervision and administration department and obtained the practice license may apply to the municipal labor and social security administrative department for the qualification of designated medical services for basic medical insurance; After passing the examination, the municipal labor and social security administrative department will issue the qualification certificate of basic medical insurance medical service. Article 37 The municipal administrative department of labor and social security shall, in accordance with the principle of integrating traditional Chinese and western medicine, giving consideration to primary medical institutions, specialized medical institutions and comprehensive medical institutions, and facilitating employees and retirees to seek medical treatment and purchase medicines, make overall plans to determine designated medical institutions and designated retail pharmacies that provide basic medical services for employees and retirees. Workers and retirees can choose designated medical institutions and designated retail pharmacies for medical treatment and drug purchase. Thirty-eighth medical insurance agencies should sign basic medical insurance medical service agreements with designated medical institutions and retail pharmacies, and clarify the rights and obligations of both parties. Article 39 Designated medical institutions and retail pharmacies shall set up specialized institutions or be equipped with full-time personnel to be responsible for the work related to basic medical insurance, strictly implement the provisions of the basic medical insurance drug list, diagnosis and treatment items, the scope of medical service facilities and payment standards, and shall not expand the scope of services without authorization or defraud the medical insurance fund by forged materials, expense documents and other improper means. Measures for the administration of the basic medical insurance drug list, diagnosis and treatment items, scope of medical service facilities and payment standards shall be formulated by the municipal labor and social security administrative department jointly with relevant departments. Article 40 Designated retail pharmacies must ensure the variety and quality of basic medical drugs, purchase drugs that have passed the inspection by the drug inspection department from units holding the Drug Business License, and implement the drug price standards set by the price department. Forty-first employees and retirees should show their basic medical insurance certificates when seeking medical treatment in designated medical institutions or purchasing medicines in designated retail pharmacies; It's up to you whether to buy medicine in designated medical institutions or in designated retail pharmacies with prescriptions. Designated medical institutions and retail pharmacies shall verify the basic medical insurance certificate. The basic medical insurance certificate shall not be fraudulently used, forged or lent. Forty-second workers and retirees in designated medical institutions outpatient medical treatment and drug purchase in designated retail pharmacies, medical expenses, in line with the provisions of the basic medical insurance, paid by personal accounts, overruns do not make up. Forty-third employees and retirees in designated medical institutions in accordance with the provisions of the basic medical insurance hospitalization, outpatient emergency rescue and outpatient treatment of major diseases of medical expenses, should be borne by the individual, by himself and the designated medical institutions settlement; The part that should be paid by the overall fund shall be settled by the medical insurance agency and the designated medical institution. Specific settlement measures shall be formulated by the municipal labor and social security administrative department in conjunction with the municipal health and finance departments. Article 44 The municipal labor and social security administrative department shall, according to the relevant provisions of the basic medical insurance, organize the health, drug administration, price and other departments to conduct annual assessment of designated medical institutions and annual qualification examination of designated retail pharmacies; Those who fail to pass the examination or fail to pass the examination shall be disqualified. Article 45 The municipal health, drug administration and price departments shall, in accordance with the guiding opinions of national, provincial and municipal urban medical and health system reform and the provisions and requirements of basic medical insurance medical services, strengthen supervision and inspection of designated medical service institutions, establish a new classified management system for medical institutions, implement a system of separate accounting, separate management and centralized bidding and purchasing of drugs, adjust drug prices, and improve the quality of medical services.