Application materials usually include the clinic's business license, medical institution license, physician's qualification certificate, and list of medical equipment to prove the clinic's legitimacy and ability to operate. In addition, the clinic is required to provide information about its medical service programs, fees and service quality so that the health insurance administration can assess whether it meets the criteria of a designated health insurance organization.
After submitting an application, the health insurance administration will conduct a rigorous review and assessment of the clinic. This includes an on-site inspection and evaluation of the clinic's facilities and equipment, medical technology, and management level. If the clinic meets the relevant requirements, the medical insurance management department will sign a medical insurance service agreement with it and formally include it in the scope of the medical insurance designated institutions.
After being included in the medical insurance designated institutions, the clinic will enjoy the convenience of medical insurance settlement, and need to provide medical services for the insured patients in accordance with the provisions of the medical insurance policy. The clinic should strictly abide by the medical insurance policy to ensure the quality of medical services and should not violate the law.
In summary:
Clinics applying for health insurance need to ensure that they are operating legally and meet the basic conditions of a designated health insurance organization, and prepare and submit relevant application materials in accordance with the requirements of the health insurance administration. After review and evaluation, clinics that meet the requirements will be included in the scope of medical insurance designated organizations to enjoy the convenience of medical insurance settlement. The clinics should strictly abide by the medical insurance policy and provide quality medical services to the insured patients.
Legal basis:
The People's Republic of China Social Insurance Law
Article 28 stipulates that:
Medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Regulations on the Administration of Medical Institutions
Article 24 stipulates:
No unit or individual may carry out diagnostic or therapeutic activities without obtaining a License to Practice as a Medical Institution.
The Interim Measures for the Administration of Urban Workers' Basic Medical Insurance Designated Medical Institutions
Article 5 stipulates:
The principles for the review and determination of designated medical institutions are: to facilitate access to and management of medical care for the insured; to take into account both specialized and comprehensive care, and traditional Chinese medicine and western medicine, and to focus on giving full play to the roles of community health services; to promote the optimal allocation of medical and health care resources; to increase the efficiency of medical and health care resource utilization; and to rationalize the use of medical and health care resources. optimize the allocation of medical and health resources, improve the efficiency of the use of medical and health resources, rationally control the cost of medical services and improve the quality of medical services.