Shijiazhuang Municipal People's Government on the issuance of Shijiazhuang city urban residents of basic medical insurance implementation rules (for trial implementation) and the large amount of supplemental medical insurance interim measures notice
Shijiazhuang Municipal People's Government Office documents
Shijiazhuang City Government Office [2007] No. 83
Shijiazhuang City People's Government on the issuance of urban residents of basic medical insurance implementation rules (for trial implementation) and large amount of supplemental medical insurance interim measures notice
Shi Shijiazhuang city urban residents basic medical insurance implementation rules (for trial implementation) and large supplementary medical insurance interim measures notice
Shijiazhuang city people's governments of the five districts, high-tech zone management committee, the municipal government departments, municipal units:
"Shijiazhuang city urban urban residents basic medical insurance implementation rules (for trial implementation)", "Shijiazhuang city urban residents large supplemental medical insurance interim measures" has been Municipal government agreed, is issued to you, please conscientiously implement.
October 29, 2007
Shijiazhuang City, urban residents of basic medical insurance implementation rules (for trial implementation)
Chapter I General
Article 1 of the "Shijiazhuang City, urban residents of the basic medical insurance implementation program" to formulate the implementation of the rules.
The second urban area (Xinhua District, Qiaoxi District, Chang'an District, East Qiaodong District, Yuhua District, High-tech Development Zone) in the city are not part of the basic medical insurance for urban workers (hereinafter referred to as the employee's health insurance) system coverage, with the city's urban household registration of the non-employed residents can participate in the Shijiazhuang urban urban residents of the basic medical insurance (hereinafter referred to as the residents of the basic medical insurance). Hukou in the rural areas all year round with their parents in the city's urban school students, nursery school children can voluntarily participate in the Shijiazhuang City, urban residents of medical insurance.
Article 3 of the residents of the medical insurance follow the "low level, wide coverage, the masses voluntary, local management, co-ordination and coordination" principle, focusing on protecting the urban residents of hospitalization and outpatient medical needs of major diseases.
Article 4 of the residents of the basic medical insurance premiums (hereinafter referred to as the residents of the basic medical insurance premiums) of the implementation of the residents of the individual or family contributions, government subsidies, social contributions to the combination of methods. The basic medical insurance fund (hereinafter referred to as the residents of the basic medical insurance fund) adhere to the principle of "to determine expenditure on the basis of income, a balance of income and expenditure, with a slight surplus".
Article 5 of the residents of medical insurance by the Municipal Bureau of Labor and Social Security in charge of the Municipal Bureau of Finance, Municipal Health Bureau, Municipal Public Security Bureau, Municipal Bureau of Civil Affairs, Municipal Disabled Persons' Federation, Municipal Education Bureau, and the district government co-management by the Municipal Medical Insurance Management Center (hereinafter referred to as the Medical Insurance Center), the District Personnel and Social Security Bureau of Labor and Social Security Bureau of the organization of the jurisdiction of the labor security workstations to carry out the work of the residents of medical insurance.
Chapter II of the management body responsibilities
Article VI of the Municipal Bureau of Labor and Social Security for the city's residents of the administrative management of health insurance, its main responsibilities are: (a) the development of residents of the pilot health insurance master plan. (B) the formulation of residents' health insurance policy, regulations. (C) is responsible for the implementation of residents' health insurance policy. (D) Supervision and guidance on the implementation of the residents' health insurance process. (E) Responsible for the qualification of designated medical institutions in urban areas. (F) Coordinating the handling of disputes related to residents' medical insurance. (VII) Implementing rewards and punishments for units and individuals implementing the residents' medical insurance policy.
Article VII of the Municipal Health Insurance Management Center (hereinafter referred to as the Medical Insurance Center) for the urban residents of the medical insurance agency, its main responsibilities are: (a) conscientiously implement the residents of the medical insurance policy, regulations, and put forward proposals to improve and perfect the residents of the medical insurance system. (b) Preparing the budget and final accounts of the income and expenditure of the basic residents' medical insurance fund. (c) To be responsible for the collection, payment and management of the basic residents' medical insurance fund. (D) Selecting and determining designated medical institutions for residents' medical insurance. (e) Supervising and inspecting the fees and drug prices of designated medical institutions in conjunction with the price department. (vi) To be responsible for auditing the medical fees and related information of designated medical institutions. (vii) Entrusted by the Municipal Bureau of Labor and Social Security to conduct inspections, assessments, rewards and punishments on the implementation of the residents' medical insurance policy by designated medical institutions, community labor security workstations and individuals. (viii) Responsible for summarizing and filling in the various financial and accounting reports and statistical reports of the residents' medical insurance. (IX) contractors community labor security workstations and residents of the residents of medical insurance consultation, inquiries. (J) is responsible for the city's residents of medical insurance business guidance.
Article VIII of the Personnel Labor and Social Security Department of each district is responsible for organizing the jurisdiction of the labor security workstations to carry out residents' health insurance. The main responsibilities of the labor security workstations are: (a) conscientiously implement the policies and regulations of the residents' health insurance, and do a good job of publicity and education. (b) To be responsible for household surveys, enrollment registration and the establishment and uploading of computerized information on residents' medical insurance. (iii) Responsible for assisting in the collection of medical insurance premiums paid by residents individually or as a family and declaring the government subsidy funds for residents' medical insurance. (D) Responsible for the preparation and submission of reports on residents' medical insurance. (e) Being responsible for the issuance of residents' medical insurance cards, medical record books and medical insurance manuals. (f) Being responsible for the reimbursement of residents' medical fees. (vii) Inquiring about residents' medical insurance. (viii) Undertaking other matters related to residents' medical insurance.
Article IX designated medical institutions shall set up a medical insurance section or determine a person responsible for residents' medical insurance work. Its main responsibilities are: (a) to undertake the medical service business of residents' medical insurance, and develop relevant management system. (b) To conscientiously implement the policies and regulations of the residents' medical insurance, and to do a good job of publicizing and educating the residents. (iii) To be responsible for the establishment of residents' health records, registration and summarization of medical consultations and medical consumption, and to implement computerized information management in accordance with the regulations, and to transmit information and submit relevant reports to the medical insurance center in a timely manner. (d) It is responsible for organizing the first diagnosis and referral of the insured residents according to regulations; (e) It is responsible for supervising and inspecting the implementation of the policies and regulations on residents' medical insurance by the staff of this unit. (F) To undertake other matters related to residents' medical insurance.
Chapter III of the scope of coverage and object
Article 10 of the residents of the scope of implementation of health insurance and specific objects include: (a) primary and secondary school students (including vocational high schools, junior colleges, technical schools students). (B) account in rural areas with their parents year-round in the city's urban areas, primary and secondary school students, nursery school children. (iii) Non-school residents aged 18 and below. (iv) Residents within the age group of working employment (women over 18 to 50 years old, men over 18 to 60 years old) who are not enrolled in the Employee's Medical Insurance Scheme and hold the Certificate for Persons with Disabilities of the People's Republic of China (PRC) with disabilities of the first or second degree of disability; and residents who have no employing organization and hold the Minimum Livelihood Guarantee Benefit for Urban Residents of Shijiazhuang City (Shijiazhuang Municipality Minimum Living Guarantee Benefit Certificate) who are in receipt of the Minimum Living Guarantee Benefit. (E) in the age of labor and employment have the ability to work, by the government employment support can not be employed residents, can voluntarily participate in the residents of medical insurance, employment must participate in the employee medical insurance. (F) Female residents over 50 years of age and male residents over 60 years of age.
Article 11 of the residents of the medical insurance does not include the following people: (a) active military personnel. (B) Retirement in a different place to enjoy the pension or retirement benefits. (C) has participated in the new rural cooperative medical care.
Chapter IV Registration
Article 12 of the residents eligible for insurance, should be with their family household book and a copy of their own identity card and a copy of the student handbook (student card), disability card and a copy of the low income guarantee and a copy of the household in the rural areas all year round with their parents in the urban areas of the city, primary and secondary school students, nursery school children should be with the parents of one of the "Temporary Residence Permit", the education department of the relevant certificates to their household registration. Relevant certificates, to my domicile or temporary residence certificate of the local labor security workstations to apply for residents' health insurance, and according to their own situation to fill out the "Shijiazhuang City Urban Residents Health Insurance Registration Form", for the basic health insurance registration (hereinafter referred to as the insurance registration).
Article 13 of the labor security workstations, health insurance centers accept residents to participate in the registration, approved contribution standards and basic health insurance information changes for the record, should be in accordance with the provisions of Article 10 of the Implementing Rules, Article 12, strict examination of the applicant provided by the relevant departments recognized by the relevant documents, and to meet the conditions of the registration and filing.
Article 14: The age of residents shall be calculated until December 31 of the year of registration.
Article 15: Based on the information obtained from the registration, the labor security workstations shall establish computerized information for each resident applying for insurance according to the content and format required by the medical insurance center, and transmit or report the relevant information to the medical insurance center in a timely manner.
Article 16 of the medical insurance center according to the labor security workstation transmission or report of information in a timely manner for review and confirmation, and based on the confirmed information were compiled "Shijiazhuang city urban residents medical insurance premium collection plan" and "Shijiazhuang city urban residents basic medical insurance card, medical records and medical insurance handbook issuance details", feedback to the corresponding labor security workstations as the collection of basic medical insurance premiums and the issuance of residents The collection of basic medical insurance premiums and the issuance of medical insurance cards, medical record books and medical insurance manuals are based on this program.
Article 17: The termination of the medical insurance relationship and the cancellation of the medical insurance card shall be handled separately for residents who are employed, whose household registration has been moved out of the urban area of the city, or who have died. The medical insurance premiums paid by the person shall not be returned. Labor security workstations shall strictly examine the relevant documents submitted by the applicant, and those who meet the conditions shall go to the medical insurance center before the 10th day of each month. (a) If a resident is unemployed and needs to terminate his/her health insurance relationship, he/she should submit the following documents and materials: 1. labor contract of employment, 2. health insurance card, and 3. resident's identity card. (2) If a resident moves his/her household registration out of the urban area of the city and needs to terminate his/her medical insurance relationship, he/she should submit the following documents and materials: 1) medical insurance card. 2) certificate of transfer of household registration and a copy of it. 3) medical insurance card and a copy of it. (C) the death of residents, the termination of the health insurance relationship, immediate family members within 30 days for the cancellation of the health insurance card, the following documents and materials should be submitted: 1, health insurance card. 2, death certificate.
Chapter V of the basic medical insurance premiums
Article 18 of the residents of the basic medical insurance premiums by the residents of individual or family contributions, government subsidies and social contributions. Residents of individual or family contributions, the medical insurance center is responsible for collection, labor security workstations to assist in the collection; government subsidies, by the Municipal Finance Bureau is responsible for the collection of funds.
Article 19 of the residents of the contribution and government subsidies are as follows: a. School students and primary and secondary school students and non-school residents aged 18 years and under, the funding standard is 100 yuan per person per year (of which 6 yuan for accidental injury costs). Among them, persons with disabilities of the first and second grades, and residents receiving the urban minimum subsistence allowance do not pay individually, but are fully subsidized by the government at all levels; other persons pay 50 yuan individually, and are subsidized 50 yuan by the government at all levels. Second, the financing standard for residents over 18 years of age is 300 yuan per person per year (of which 6 yuan is for accidental injury expenses). Among them: first- and second-degree disabled persons and residents receiving the urban minimum subsistence allowance do not pay individually, and are fully subsidized by all levels of government; residents of low-income families aged 60 or older pay 100 yuan individually, with subsidies of 200 yuan from all levels of government; residents of females aged 50 or older and males aged 60 or older pay 200 yuan individually, with subsidies of 100 yuan from all levels of government; and other persons pay 250 yuan individually, with subsidies of 50 yuan from all levels of government. 50 yuan.
Article 20 of the residents of individual or family contributions, government subsidies standards need to be adjusted, in the health insurance center based on the income and expenditure of the proposal, by the labor security department and the financial sector to put forward the adjustment program, reported to the people's government of Shijiazhuang City approved.
Article 21 of the residents of the basic health insurance premiums for the implementation of the advance payment system, paid on an annual basis. September 1 to November 25 each year for the centralized registration, payment and resident health insurance information change time. Residents shall enroll in the insurance in accordance with the prescribed time limit and pay the residents' medical insurance premiums in full and on time according to the prescribed standard. The start-up phase is a two-month period from the date of publication of these implementation rules for centralized enrollment registration and fee payment. Newborns and newly moved primary and secondary school students, 18 years of age and under the age of non-school residents, from the date of domicile settlement within three months of the date of enrollment and payment of fees, but not in the centralized processing period, the current year's residents of the basic health insurance premiums paid in full by the individual or the family.
Article 22 of the health insurance center in Shijiazhuang City Commercial Bank set up residents of the health insurance fund income transition account. Residents of individual or family contributions collected by the Shijiazhuang City Commercial Bank, residents should be registered in the required registration payment period with the health insurance card or resident identification card to the Shijiazhuang City Commercial Bank outlets to the income transition account, the health insurance center at the end of the month will be paid by the residents of the health insurance premiums into the financial account, the end of the month, the income account has no balance. Commercial banks should meet the demand for residents to pay fees, and timely transmission of residents' personal payment information to the medical insurance center.
Article 23 of the medical insurance center according to the residents of the actual payment of sub-district preparation of residents' contributions summary table, the district personnel labor and social security bureau accordingly in a timely manner to the financial declaration of the residents of the government subsidies for medical insurance funds, district finance bureau received the funds within 20 days after the request for government subsidies for funds to the municipal finance bureau of the medical insurance fund financial account; the municipal finance bureau shall be the central, provincial and municipal government subsidies for funds transferred to the financial account in a timely manner to ensure that the central, provincial and municipal government subsidies for funds. The municipal finance bureau shall transfer the subsidized funds from the central, provincial and municipal governments to the special financial account in time to ensure the normal use of the residents' basic medical insurance fund. Municipal and district financial burden of the residents of the government subsidies should be fully included in the same level of the financial budget.
Chapter VI of the basic medical insurance fund management and use
Article 24 of the city's urban residents of medical insurance, do not establish a personal account, with the residents of the basic medical insurance premiums for the residents of the residents of the basic medical insurance fund.
Article 25 of the residents of the basic medical insurance fund set up a special account, the implementation of two lines of management, separate accounts, independent accounting, earmarked for any unit or individual shall not be squeezed and misappropriation.
Article 26 of the medical insurance center to set up the residents of the basic medical insurance fund expenditure account, monthly based on the previous month's expenditure on the preparation of the residents of the basic medical insurance fund allocation application, the Municipal Bureau of Finance in a timely manner will be the residents of the basic medical insurance fund into the medical insurance center of the residents of the basic medical insurance fund expenditure account to ensure that the settlement of the bill in a timely manner.
Article 27 of the residents of the basic medical insurance fund does not count all kinds of taxes and fees.
Article 28 of the residents of the basic medical insurance fund of interest, with reference to the employees of the medical insurance fund interest-bearing methods of implementation.
Article 29 of the residents of the basic medical insurance fund for residents of hospitalization, outpatient emergency rescue belonging to the "Shijiazhuang City urban residents of the basic medical insurance emergency rescue of the diseases listed in the catalog", malignant tumors (including leukemia) outpatient radiotherapy, outpatient dialysis, chronic renal insufficiency outpatient ultrasonic emulsification of cataracts, cataracts, the use of outpatient organ transplantation, antirejection drugs. Expenses other than those borne by the individual.
Article 30: The starting standard for payment of inpatient medical fees by the residents' basic medical insurance fund shall be determined according to the level of the medical institution, with the following specific amounts: RMB 400 yuan for medical treatment in a first-level medical institution (including community health service centers); RMB 600 yuan for medical treatment in a second-level medical institution; RMB 900 yuan for medical treatment in a third-level medical institution; and if the medical institution has not been assessed as a level, it shall be subject to the same basic standard for reference. (c) Medical institutions that are not graded shall refer to the same basic standards as the level of the medical institution. A case of cataract outpatient ultrasonic emulsification IOL placement is considered as one hospitalization, and the starting payment standard is the amount of the medical institution where the treatment is provided.
Article 31: A single hospitalization of a resident refers to a single admission and discharge procedure. Emergency rescue and hospitalization without interruption is considered a hospitalization. A hospitalization process across the year, according to the discharge settlement time to determine the health insurance year.
Article 32 of the residents hospitalized in excess of the starting standard part of the medical fees are mainly paid by the residents of the basic health insurance fund, but the individual also has to bear a certain proportion of the residents of the basic health insurance fund to pay the proportion of the level of medical institutions are determined. The specific standards are as follows: 70% for medical treatment in first-level medical institutions (including community health centers); 60% for medical treatment in second-level medical institutions; and 50% for medical treatment in third-level medical institutions. The number of years residents have been paying basic medical insurance premiums is linked to the proportion of payment from the Resident Basic Medical Insurance Fund. For those who have been continuously insured for more than five years, the proportion of payment from the Resident Basic Medical Insurance Fund may be increased by 05 percentage points for each additional year of payment of basic medical insurance premiums, but the proportion of the increase shall not exceed 10 percentage points at the most. The number of years of payment of medical insurance premiums for residents and employees shall not be regarded as the same as each other. The proportion of individual burden of medical fees for outpatient radiotherapy (chemotherapy) for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency, outpatient use of anti-rejection drugs after organ transplantation, and outpatient ultrasonic emulsification for cataract implantation of artificial lenses shall be implemented in accordance with the standards of the fixed-point medical institutions where the residents receive medical treatment. When residents are hospitalized and use diagnostic and therapeutic items that are partially paid for by the basic medical insurance fund, the individual pays 15% out-of-pocket, and the remaining 85% is paid for by the individual and the basic medical insurance fund in accordance with the regulations. For the use of drugs belonging to the "Class B Catalog" of the Basic Medical Insurance Drug List, the individual pays 10% out-of-pocket, and the remaining 90% is paid by the individual and the Basic Medical Insurance Fund in accordance with the regulations. For the use of disposable medical materials with a unit price of 1,000 yuan or more, the individual pays 50% of the cost, and the remaining 50% is paid by the individual and the basic medical insurance fund according to the regulations.
Article 33: For medical expenses incurred in overseas medical institutions upon approval of transfer, the proportion paid by the basic medical insurance fund for residents shall be reduced by 5 percentage points compared with that for medical treatment in designated medical institutions of the corresponding level in the city.
Article 34: The maximum amount of medical fees to be paid by the residents' basic medical insurance fund shall be 25,000 yuan on an annual basis. After exceeding the maximum limit, according to the "Shijiazhuang city residents large supplementary medical insurance interim measures".
Article 35 of the residents of accidental injury hospitalization costs separately formulated payment management methods.
Chapter VII medical services management
Article 36 residents to implement the first medical treatment system.
Article 37 residents should be based on their actual situation, the proximity of a first-class designated medical institutions, as their first designated medical institutions, must be unchanged for one year. When a resident is sick and needs to be hospitalized, he or she must first seek medical treatment at the first designated medical institution of his or her choice. If a resident's condition requires transfer to another hospital for treatment, the first designated medical institution shall give its opinion before the resident is allowed to seek medical treatment at a secondary or higher designated medical institution. The first designated medical institutions have the conditions of treatment, shall not be arbitrarily transferred out.
Article 38: Residents who are sick shall seek medical treatment with their medical insurance cards and medical records.
Article 39 of the residents to seek medical treatment, the designated medical institutions shall verify the patient's medical records and medical insurance card, found fraudulent use, should be detained medical records and medical insurance card, and promptly report to the medical insurance center.
Article 40 of the residents due to emergency rescue belongs to the "Shijiazhuang City urban residents of basic medical insurance emergency rescue disease catalog" of the diseases listed in the disease, can be close to the convenience of medical treatment, but should be within five days to the medical insurance center for emergency rescue disease identification procedures, identification, hospitalization fees can be used to use the card in the medical institutions to account for the settlement of the medical institutions; does not meet the requirements of the emergency rescue or did not handle the identification procedures If you do not meet the requirements for emergency medical treatment or do not complete the identification procedures, the medical expenses incurred will not be paid by the residents' basic medical insurance fund.
Article 41: The basic medical insurance fund shall not pay the medical expenses incurred by residents who go to other medical institutions without the approval of the first designated medical institution.
Article 42 of the medical insurance center shall sign an agreement with the designated medical institutions on the scope of medical insurance services, service quality standards, supervision and inspection, and settlement of fees, etc., to clarify the responsibilities and obligations of both parties.
Article 43 of the residents use the basic medical insurance fund for medical treatment, the drugs used, the diagnostic and treatment items used, the medical service facilities used and the charges refer to the provisions of the Shijiazhuang City urban workers basic medical insurance.
Article 44 of the first diagnosis of the designated medical institutions shall be required by the medical insurance center for residents to establish health records, medical services management information and medical records.
Article 45 In order to facilitate the settlement of medical bills and medical service management, the designated medical institutions shall establish a computer system for residents' medical insurance according to the requirements of the medical insurance center and network with the medical insurance center.
Article 46 of the designated medical institutions shall strictly implement the relevant provisions of the medical insurance, standardize medical behavior, according to the actual condition of the residents seeking medical treatment, in accordance with the principle of reasonable examination, reasonable treatment, reasonable use of medication, provide appropriate medical services, and strictly implement the standards of hospitalization, discharge and referral, transfer system, and shall not unreasonably refuse, shirking, detaining and transferring the residents seeking medical treatment.
Article 47: When a resident is hospitalized, the designated medical institution shall register the resident in accordance with the requirements, and promptly and accurately enter the details of the resident's hospitalized medical expenses into the computer and upload them to the medical insurance center through the computer network system. When a resident is discharged from the hospital, the designated medical institution shall allow the patient or his/her relatives to verify the details of the hospitalized medical expenses and sign, and the residents' basic medical insurance fund shall not pay for the medical expenses that are not signed by the patient or his/her relatives. If there is any dispute, it will be reported to the medical insurance center. Residents discharged from the hospital or emergency resuscitation end with the amount of medicine, acute diseases shall not exceed 7 days amount, chronic diseases shall not exceed 15 days amount, herbal medicine shall not exceed 7 days dose.
Article 48: Residents who need to go to other medical institutions for examination, treatment and purchase of medicines without being transferred to other medical institutions due to the limitations of the conditions of the designated medical institution where they reside shall be subject to the approval of the medical insurance section of the designated medical institution where they reside.
Article 49: Outpatient radiotherapy (chemotherapy) for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency, and outpatient use of anti-rejection drugs after organ transplantation shall be subject to fixed-point management, and the types of diseases shall be treated in designated designated fixed-point comprehensive medical institutions or specialized medical institutions after being recognized by the medical insurance center. The settlement method of fixed-point management is formulated separately.
Article 50: If a resident needs to be transferred to a designated medical institution in the urban area of the city due to the limitation of the condition of the institution, the physician who is the deputy director of the tertiary medical institution or above shall put forward his opinion, and the medical insurance section shall review the case, and the leader in charge of the case shall sign his opinion and report it to the medical insurance center for approval, and the resident shall be transferred to another medical institution only.
Article 51 of the residents of the medical insurance does not deal with the resident out of town and relocation of people to seek medical treatment.
Article 52: The residents' basic medical insurance fund will not pay for medical expenses incurred during residents' trips abroad and to Hong Kong, Macao and Taiwan.
Article 53: The Basic Medical Insurance Fund shall not pay for medical expenses incurred by residents who are responsible for crimes, traffic accidents, fights and assaults, alcoholism, suicides, intentional self-injury and self-mutilation, or medical malpractice.
Chapter 8: Settlement and Reimbursement of Medical Expenses
Article 54: For medical expenses incurred by residents hospitalized in a designated medical institution, the residents' basic medical insurance fund shall pay for the expenses by the residents themselves by presenting their medical insurance cards to the designated medical institution for billing and settlement; and the expenses borne by the individuals shall be settled between the residents and the designated medical institution by the residents themselves.
Article 55 refers to the "Shijiazhuang Urban Urban Workers' Medical Insurance Medical Fee Settlement Methods" for the settlement of medical fees between the medical insurance center and the designated medical institutions.
Article 56: If a resident's medical fee for one hospitalization is below the starting standard (including the starting standard), it is not regarded as one hospitalization.
Article 57: Medical expenses incurred by residents during their stay away from home due to the treatment of diseases listed in the Emergency Rescue Diseases Catalogue shall be reimbursed to the medical insurance centers in accordance with the regulations through the workstations of their communities' labor security, with all the information of medical records of the local hospitals, details of the hospitalization medical expenses, receipts of the medical expenses, and the medical insurance cards.
Article 58: If a resident is hospitalized in a designated medical institution and is approved to go to another medical institution for examination, treatment, or purchase of medicines, the expenses will first be advanced by the individual, and will be reimbursed by the approved medical institution in accordance with the regulations and included in the expenses of the current hospitalization.
Article 59: The medical expenses for the transfer to an overseas medical institution shall be paid in advance by the individual, and upon completion of the treatment, the individual shall be reimbursed through the labor security workstation in his/her community through the medical insurance center in accordance with the provisions of the regulations by presenting the approval form for the transfer to an overseas medical institution, all the medical records, the breakdown of the hospitalization expenses, the receipts of the medical expenses, and the medical insurance card.
Chapter IX Supervision and Evaluation
Article 60 of the labor security workstations should be announced annually to the residents of the jurisdiction of the low-income families of 60 years of age or older to participate in the insurance list, to accept public supervision.
Article 61 of the residents have the right to the health insurance centers, labor security workstations, designated medical institutions to implement the implementation of the residents of the health insurance policy to implement supervision, the masses of the relevant units and personnel of the complaints and reports are protected by law.
Article 62 establishes the Residents' Medical Insurance Fund Supervisory Committee, which is composed of representatives of the competent labor security departments, financial departments, audit departments, management agencies, medical institutions and residents, to supervise the operation of the Residents' Medical Insurance Fund.
Article 63 of the medical insurance center is responsible for monitoring, inspecting and evaluating the implementation of residents' basic medical insurance policies and regulations by insured residents, designated medical institutions and labor security workstations. The insured residents, designated medical institutions and labor security workstations shall actively cooperate.
Chapter X Rewards and Punishments
Article 64 shall be commended or rewarded if the following conditions are met and the achievements are outstanding. (1) The designated medical institutions conscientiously implement the policies and regulations of the residents' medical insurance, provide timely and accurate information on the residents' medical treatment as required, actively cooperate with the relevant inspections and examinations, and contribute to the protection of the residents' basic medical treatment. (b) Labor security workstations conscientiously implement the policies and regulations of the residents' medical insurance, conduct household surveys, register for the insurance on time, collect residents' medical insurance premiums in full and in a timely manner, submit all kinds of reports in a timely manner, provide truthful information on residents' medical treatment in non-scheduled medical institutions, and strictly check their medical fee reimbursements. (C) The staff of the medical insurance center actively publicize and conscientiously implement the policies and regulations of the residents' medical insurance, adhere to the principles, dare to resist unethical practices, correct or deal with violations of the policies and regulations in a timely manner, and make outstanding achievements for the cause of residents' medical insurance. (d) Residents take the initiative to report and expose violations of residents' medical insurance policies and regulations by designated medical institutions, labor security workstations, and medical insurance centers, so as to save the residents' medical insurance fund from losses.
Article 65 of the designated medical institutions and their staff have one of the following behaviors, the medical insurance center shall, according to the contract, pursue the responsibility of breach of contract, and give a notice of criticism; notice of criticism more than three times, the suspension of a deadline for rectification; rectification of the ineffective, the suspension of the agreement; the circumstances of the seriousness of the situation, the cancellation of its designated; if necessary, to the relevant departments in accordance with the law, the person responsible for the administrative sanctions; constitutes a crime, the Prosecute criminal responsibility according to law. (I) Failure to verify whether the patient belongs to the insured residents, resulting in medical treatment under an impostor's name. (ii) Adopting a registered name for hospitalization, fabricating medical records, or discrepancies between hospitalized medical records and details of hospitalized medical fees. (iii) Shirking, detaining or transferring patients. (D) Failure to ensure the necessary examination, treatment and medication of residents, resulting in adverse consequences. (E) Switching diagnostic and treatment items and medicines, and including non-compliant diagnostic and treatment items and medicines in the scope of medical fees paid by the residents' medical insurance fund. (F) Violating the fee standards for diagnostic and treatment items and the regulations on drug prices and charging indiscriminately. (G) Examination, treatment and medication are not in line with the condition of the patient. (H) Taking advantage of work to prescribe medicines. (Ix) Other violations of residents' health insurance policy.
Article 66 of the residents of one of the following acts, resulting in losses to the residents' medical insurance fund, the medical insurance center, in addition to recovering the losses, may be given a notice of criticism, and may be suspended from enjoying medical insurance treatment. If necessary, to the relevant departments of the responsible person shall be punished according to law; constitutes a crime, shall be investigated for criminal responsibility. (i) Providing one's medical insurance card and medical record book to others, resulting in impersonation for medical treatment. (ii) Falsely claiming medical fees. (C) Other violations of residents' medical insurance policies and regulations.
Article 67 of the medical insurance center staff of one of the following acts, the unit or labor security department to recover illegal gains, and depending on the severity of the case, be given administrative sanctions; constitutes a crime, shall be investigated for criminal responsibility. (A) In the management of medical insurance work, favoritism and fraud, public enrichment. (B) Using his or her authority and work to solicit and accept bribes for personal gain. (C) violation of the provisions of the residents of the medical insurance fund for other purposes. (D) malpractice resulting in losses to the residents' medical insurance fund.
Chapter XI Supplementary Provisions
Article 68 of the residents due to sudden, epidemic diseases and natural disasters and other force majeure factors caused by a wide range of acute, critical and serious patients of the rescue medical expenses, the government to comprehensively coordinate the solution.
Article 69 of these rules by the Shijiazhuang Municipal Bureau of Labor and Social Security is responsible for the interpretation.
Article 70 of these rules shall come into force on December 26, 2007.
Extended reading: insurance how to buy, which is good, hand to teach you to avoid the insurance of these "pits"