Documents of General Office of Shijiazhuang Municipal People's Government
Shi Zheng Ban Fa [2007] No.83
Notice of the General Office of Shijiazhuang Municipal People's Government on Printing and Distributing the Detailed Rules for the Implementation of the Basic Medical Insurance for Urban Residents in Shijiazhuang (for Trial Implementation) and the Interim Measures for Large Supplementary Medical Insurance
The people's governments of the five districts in the city, the Administrative Committee of the High-tech Zone, the departments of the municipal government and the units directly under the municipal government:
The detailed rules for the implementation of the basic medical insurance for urban residents in Shijiazhuang (for Trial Implementation) and the Interim Measures for the Large Supplementary Medical Insurance for Urban Residents in Shijiazhuang have been approved by the municipal government and are hereby printed and distributed to you, please follow them. Please implement it carefully.
Press release issued on 29 October 2007/KLOC-0.
Detailed Rules for the Implementation of Basic Medical Insurance for Urban Residents in Shijiazhuang (for Trial Implementation)
Chapter I General Provisions
Article 1 These Detailed Rules are formulated in accordance with the Implementation Plan of Basic Medical Insurance for Urban Residents in Shijiazhuang City.
Article 2 All non-employed residents with urban household registration who are not covered by the basic medical insurance system for urban workers (hereinafter referred to as employee medical insurance) in the urban areas of this Municipality (Xinhua District, qiaoxi district, Chang 'an District, Qiaodong District, Yuhua District and High-tech Development Zone) can participate in the basic medical insurance for urban residents in Shijiazhuang (hereinafter referred to as resident medical insurance). Primary and secondary school students and kindergarten children who have rural hukou and go to school with their parents in the urban areas of this city may voluntarily participate in medical insurance for urban residents in Shijiazhuang.
Article 3 The residents' medical insurance shall follow the principle of "low level, wide coverage, voluntary participation of the masses, territorial management and overall coordination", and focus on ensuring the medical needs of urban residents for hospitalization and outpatient serious illness.
Article 4 The residents' basic medical insurance premium (hereinafter referred to as the residents' basic medical insurance premium) shall be raised by combining individual or family contributions, government subsidies and social donations. The residents' basic medical insurance fund (hereinafter referred to as the residents' basic medical insurance fund) adheres to the principle of "fixed expenditure based on income, balance of payments and slight savings".
Article 5 The Municipal Labor and Social Security Bureau is responsible for residents' medical insurance, assisted by the Municipal Finance Bureau, the Municipal Health Bureau, the Municipal Public Security Bureau, the Civil Affairs Bureau, the Municipal Disabled Persons' Federation, the Municipal Education Bureau and the district governments, and handled by the Municipal Medical Insurance Management Center (hereinafter referred to as the Medical Insurance Center). The personnel, labor and social security bureaus of all districts organize labor and social security workstations in their respective jurisdictions to carry out medical insurance for residents.
Chapter II Responsibilities of Management Institutions
Article 6 The Municipal Labor and Social Security Bureau is the administrative department in charge of residents' medical insurance in this Municipality, and its main responsibilities are: (1) to formulate the overall plan for the pilot project of residents' medical insurance. (2) Formulating policies and regulations on residents' medical insurance. (three) responsible for the implementation of the residents' medical insurance policy. (four) to supervise and guide the implementation process of medical insurance for residents. (five) responsible for the qualification examination and approval of designated medical institutions in urban areas. (six) to coordinate and handle disputes related to residents' medical insurance. (seven) the implementation of medical insurance policies for residents of the units and individuals to implement rewards and punishments.
Article 7 The Municipal Medical Insurance Management Center (hereinafter referred to as the Medical Insurance Center) is the handling institution of medical insurance for urban residents, and its main responsibilities are: (1) To conscientiously implement policies and regulations on medical insurance for residents and put forward suggestions for improving and perfecting the medical insurance system for residents. (two) the preparation of the basic medical insurance fund for residents. (three) responsible for the collection, payment and management of the basic medical insurance fund for residents. (four) to select and determine the designated medical institutions for residents' medical insurance. (five) in conjunction with the price department to supervise and inspect the charging standards and drug prices of designated medical institutions. (six) responsible for reviewing the medical expenses and related materials of designated medical institutions. (seven) entrusted by the Municipal Labor and Social Security Bureau to inspect, assess, reward and punish the implementation of residents' medical insurance policies by designated medical institutions, community labor and social security workstations and individuals. (eight) to be responsible for the summary and reporting of various financial, accounting and statistical statements of residents' medical insurance. (nine) to undertake the consultation and inquiry of community labor security workstations and residents on residents' medical insurance. (ten) responsible for guiding the city's residents' medical insurance business.
Eighth district personnel, labor and social security departments responsible for organizing the area of labor and social security workstation to carry out medical insurance for residents. The main duties of the labor security workstation are: (1) conscientiously implement the policies and regulations on residents' medical insurance and do a good job in publicity and education. (two) responsible for household survey of residents' medical insurance, insurance registration and the establishment and uploading of computer information. (three) to assist in the collection of medical insurance premiums paid by individuals or families and to declare government subsidies for medical insurance for residents. (four) responsible for the preparation and reporting of the relevant statements of residents' medical insurance. (five) responsible for issuing medical insurance cards, medical records and medical insurance manuals. (six) responsible for the reimbursement of residents' medical expenses. (seven) responsible for the residents' medical insurance query. (eight) to undertake other matters related to residents' medical insurance.
Ninth designated medical institutions should set up a medical insurance department or determine the person in charge of medical insurance for residents. Its main responsibilities are as follows: (1) To undertake the medical service business of residents' medical insurance and formulate relevant management systems. (two) seriously implement the policies and regulations of residents' medical insurance, and do a good job in publicity and education. (three) responsible for the establishment of residents' health records, the registration and summary of medical treatment and medical consumption, and the implementation of computer information management in accordance with the provisions, timely transmission of information to the medical insurance center and submit relevant statements. (four) responsible for the first diagnosis and referral of insured residents in accordance with the regulations; (five) responsible for the supervision and inspection of the staff of the unit to implement the policies and regulations of residents' medical insurance. (six) to undertake other matters related to residents' medical insurance.
Chapter III Scope and Object of Protection
Article 10 The implementation scope and specific targets of residents' medical insurance include: (1) Primary and secondary school students (including students from vocational high schools, technical secondary schools and technical schools). (two) rural household registration, primary and secondary school students and kindergarten children who study in the urban area of this city all the year round with their parents. (3) 18 years old and below non-school residents. (4) Residents of working age (female 18 to 50 years old, male 18 to 60 years old), who have not participated in employee medical insurance and hold the People's Republic of China (PRC) Disabled Persons' Card, are first-and second-class disabled residents; Useless units, and hold the "Shijiazhuang minimum living guarantee certificate", to receive the minimum living guarantee for residents. (five) residents who have the ability to work within the working age and are unable to find employment under the support of government employment may voluntarily participate in residents' medical insurance, and must participate in employees' medical insurance after employment. (6) Residents with women over 50 years of age and men over 60 years of age.
Article 11 Medical insurance for residents does not include the following personnel: (1) Servicemen. (2) people who retire in different places and enjoy pensions or pension benefits. (3) Persons who have participated in the new rural cooperative medical system.
Chapter IV Insurance Registration
Twelfth residents who meet the conditions of insurance shall apply for medical insurance for residents with the residence booklet and its photocopy, resident ID card and its photocopy, student handbook (student ID card), disability certificate and its photocopy, and subsistence allowance and its photocopy. Primary and middle school students and kindergarten children with permanent household registration in Shijiazhuang city should apply for medical insurance at the labor security workstation where the household registration or temporary residence permit is located with their parents' temporary residence permit and relevant certificates from the education department, and fill in "Shijiazhuang city" according to their own situation.
Article 13 When accepting residents' insurance registration, verifying payment standards and changing basic medical insurance information for the record, labor security workstations and medical insurance centers shall, in accordance with the provisions of Articles 10 and 12 of these Detailed Rules, strictly examine the relevant documents approved by the relevant departments provided by the applicants, and register and record those that meet the requirements.
Fourteenth residents' age is calculated to 65438+February 3 1 in the year of insurance registration.
Fifteenth labor and social security workstation according to the information obtained from the insurance registration, according to the content and format required by the medical insurance center, establish relevant computer information for each insured resident, and timely transmit or submit relevant information to the medical insurance center.
Article 16 The medical insurance center shall timely review and confirm according to the information transmitted or submitted by the labor security workstation, and prepare the Collection and Payment Scheme of Medical Insurance for Urban Residents in Shijiazhuang and the Detailed List of Making and Distributing Basic Medical Insurance Cards, Medical Records and Medical Insurance Manuals for Urban Residents in Shijiazhuang respectively according to the confirmation information. And feedback to the corresponding labor security workstation, as a basis for collecting basic medical insurance premiums from residents and issuing medical insurance cards, medical records and medical insurance manuals.
Seventeenth residents employment, household registration migration out of the city, death, etc. , should be handled separately to terminate the medical insurance relationship and medical insurance card cancellation procedures. The medical insurance premium paid by me will not be refunded. The labor and social security workstation shall strictly review the relevant documents submitted by the applicant, and go to the medical insurance center before 10 every month if they meet the requirements. (1) If a resident changes from unemployment to employment and needs to terminate the medical insurance relationship, submit the following documents and materials: 1 Employment labor contract. 2 medical insurance card. 3 Resident ID card. (2) If the household registration moves out of the urban area of this city and the medical insurance relationship needs to be terminated, the following documents and materials shall be submitted: 1, medical insurance card. 2, household registration migration certificate and a copy. (3) If a resident dies, the medical insurance relationship will automatically terminate, and the immediate family members shall cancel the medical insurance card within 30 days, and submit the following documents and materials when handling it: 1, medical insurance card. 2. Death certificate.
Chapter V Improvement of Basic Medical Insurance Expenses
Eighteenth residents' basic medical insurance premiums are composed of individual or family contributions, government subsidies and social donations. Individual or family residents pay fees, which are collected by the medical insurance center and assisted by the labor security workstation; Government subsidy funds are collected by the Municipal Finance Bureau.
Article 19 The standards of residents' contributions and government subsidies are as follows:1.1primary and secondary school students under the age of 8 and non-school residents. The subsidy standard is 100 yuan per person per year (of which 6 yuan is used for accidental injury expenses). Among them, the first and second categories of disabled people and individual residents who receive urban subsistence allowances do not pay fees, and are fully subsidized by governments at all levels; Other individuals pay 50 yuan, and governments at all levels subsidize 50 yuan. Two, 18-year-old residents' financing standard is 300 yuan per person per year (including 6 yuan for accidental injury expenses). Among them: Class I and II disabled people, individual residents who receive urban subsistence allowances do not pay fees, and are fully subsidized by governments at all levels; Individuals over 60 years old from low-income families pay 100 yuan, and governments at all levels subsidize 200 yuan; Individual residents who are over 50 years old for women and over 60 years old for men pay 200 yuan, with government subsidies at all levels 100 yuan; Other individuals pay 250 yuan, and governments at all levels subsidize 50 yuan.
Twentieth individual or family residents to pay fees, government subsidies need to be adjusted, by the medical center according to the income and expenditure of the proposal, by the labor and social security departments and the financial sector to put forward the adjustment plan, reported to the Shijiazhuang Municipal People's government for approval.
Twenty-first residents' basic medical insurance premiums shall be paid in advance and annually. Every year from September 1 day to June165438+1October 25th, residents' medical insurance information is registered, paid and changed in a centralized way. Residents should be insured within the prescribed time limit, and pay residents' medical insurance premiums in full and on time according to the prescribed standards. The start-up stage is the centralized registration payment period within two months from the date of promulgation of these rules. Newborns and newly moved primary and secondary school students,/kloc-non-school residents aged 0/8 and below, can pay insurance premiums within 3 months from the date of household registration, but they are not handled within the centralized processing period. The basic medical insurance premiums for residents in that year are all paid by individuals or families.
Twenty-second medical insurance center in Shijiazhuang City Commercial Bank to set up residents' medical insurance fund income transition households. Individual or family contributions are collected by Shijiazhuang City Commercial Bank. Residents shall, within the prescribed period of insurance registration and payment, pay to the income transition households at the business outlets of Shijiazhuang City Commercial Bank with the medical insurance card or resident ID card. At the end of the month, the medical insurance center will include the medical insurance expenses paid by residents in the financial accounts, and the income households at the end of the month have no balance. Commercial banks should meet the payment needs of residents and transmit the individual payment information of residents to the medical insurance center in time.
Article 23 The medical insurance center shall compile a summary table of residents' payment by region according to the actual payment of residents, and the District Personnel, Labor and Social Security Bureau shall timely report the government subsidy funds for residents' medical insurance to the finance at the corresponding level, and the District Finance Bureau shall turn over the government subsidy funds at the corresponding level to the financial account of the medical insurance fund of the Municipal Finance Bureau within 20 days after receiving the application for funds; The Municipal Finance Bureau shall timely transfer the subsidy funds of the central, provincial and municipal governments to the financial accounts to ensure the normal use of the residents' basic medical insurance fund. The government subsidy funds for residents' medical insurance with financial burden at the city and district levels should be fully included in the fiscal budget at the same level.
Chapter VI Management and Use of the Basic Medical Insurance Fund
Twenty-fourth urban residents' medical insurance, do not establish personal accounts, and use the basic medical insurance premium to establish a basic medical insurance fund for insured residents.
Twenty-fifth residents' basic medical insurance fund to set up financial accounts, the implementation of two lines of revenue and expenditure management, separate accounts, independent accounting, earmarking, no unit or individual may misappropriate.
Article 26 The medical insurance center shall set up households with expenditure of residents' basic medical insurance fund, and prepare the application for disbursement of residents' basic medical insurance fund every month according to the expenditure of last month. The Municipal Finance Bureau shall transfer the residents' basic medical insurance fund to the households with expenditure of residents' basic medical insurance fund in the medical insurance center in time to ensure timely settlement.
Twenty-seventh residents' basic medical insurance fund is not restricted by various taxes and fees.
Twenty-eighth residents' basic medical insurance fund interest, with reference to the employee medical insurance fund interest.
Article 29 The residents' basic medical insurance fund is used to pay the expenses other than the diseases listed in the Catalogue of Emergency Rescue Diseases of Shijiazhuang Urban Residents' Basic Medical Insurance, outpatient radiotherapy for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency, phacoemulsification and intraocular lens implantation in cataract outpatient clinic, and the use of anti-rejection drugs in outpatient clinic after organ transplantation.
Article 30 The threshold for residents' basic medical insurance fund to pay hospitalization medical expenses is determined according to the level of medical institutions, and the specific amount is as follows: those who seek medical treatment in first-class medical institutions (including community health service centers) are within 400 yuan; 600 yuan when seeking medical treatment in a secondary medical institution; 900 yuan when seeking medical treatment in tertiary medical institutions; If the level of medical institutions is not assessed, it shall be implemented with reference to the level of medical institutions with the same basic standards. Cataract clinic 1 case of phacoemulsification and intraocular lens implantation is regarded as a hospitalization, and the deductible standard is the amount of medical treatment in designated medical institutions.
Thirty-first residents' first hospitalization refers to the process of admission and discharge procedures. Emergency rescue and hospitalization are uninterrupted, which is regarded as a hospitalization. If the hospitalization process spans multiple years, the medical insurance year shall be determined according to the discharge settlement time.
Article 32 The residents' medical expenses exceeding Qifubiaozhun are mainly paid by the residents' basic medical insurance fund, but individuals also have to bear a certain proportion, and the proportion paid by the residents' basic medical insurance fund is determined according to the level of medical institutions. The specific criteria are: 70% of first-class medical institutions (including community health service centers) seek medical treatment; 60% of medical treatment in secondary medical institutions; Medical treatment in tertiary medical institutions is 50%. The number of years that residents pay the basic medical insurance premium is linked to the payment ratio of the residents' basic medical insurance fund. For those who have been insured for more than 5 years in a row, the proportion of residents' basic medical insurance fund payment can be increased by 0.5 percentage points for every increase of 1 year, but the maximum increase is not more than 1 percentage point. Residents' medical insurance and employees' medical insurance payment period are not regarded as each other. The proportion of personal burden of medical expenses for outpatient radiotherapy (chemotherapy) for malignant tumor (including leukemia), outpatient dialysis for chronic renal insufficiency, outpatient use of anti-rejection drugs after organ transplantation, and outpatient phacoemulsification and intraocular lens implantation for cataract shall be implemented according to the standards of designated medical institutions. Residents are hospitalized with medical treatment items that belong to the basic medical insurance fund to pay part of the expenses. Individuals pay 15% first, and the remaining 85% is paid by individuals and basic medical insurance funds according to regulations. For drugs in the "Class B Catalogue" in the basic medical insurance drug list, the individual pays 10% first, and the remaining 90% is paid by the individual and the basic medical insurance fund according to the regulations. Residents use disposable medical materials with a unit price of 1 1,000 yuan or more. Individuals pay 50% first, and the remaining 50% is paid by individuals and basic medical insurance funds according to regulations.
Thirty-third approved medical expenses incurred in foreign medical institutions, the proportion of residents' basic medical insurance fund payment is 5 percentage points lower than that of designated medical institutions at the same level in this Municipality.
Thirty-fourth calculated on an annual basis, the maximum amount of medical expenses paid by the residents' basic medical insurance fund is 25,000 yuan. After exceeding the maximum limit, it shall be implemented according to the Interim Measures for Large Supplementary Medical Insurance for Urban Residents in Shijiazhuang.
Thirty-fifth residents accident hospitalization expenses shall be formulated separately.
Chapter VII Management of Medical Services
Thirty-sixth residents to implement the fixed-point system of first diagnosis.
Thirty-seventh residents should, according to their own actual situation, choose a first-class designated medical institution as the first-time designated medical institution, which will remain unchanged for one year. When residents need hospitalization due to illness, they must first seek medical treatment in the designated medical institution for the first visit I selected. If it is really necessary to be transferred for diagnosis and treatment due to illness, the first-time designated medical institution shall put forward its opinions before seeking medical treatment in the designated medical institutions at level two or above. The first designated medical institution with diagnosis and treatment conditions shall not be transferred out at will.
Thirty-eighth residents get sick with medical insurance cards and medical records.
Article 39 When residents seek medical treatment, designated medical institutions shall verify the patient's medical records and medical insurance cards. If fraudulent use is found, medical records and medical insurance cards should be detained and reported to the medical insurance center in time.
Article 40 Residents who are in emergency rescue of diseases listed in the Catalogue of Emergency Rescue Diseases of Basic Medical Insurance for Urban Residents in Shijiazhuang City may go to the nearest hospital for treatment, but they shall go through the procedures for identifying emergency rescue diseases at the medical insurance center within five days. After identification, the hospitalization expenses can be settled in medical institutions with medical insurance cards; Do not meet the requirements of emergency rescue or did not go through the identification procedures, the residents' basic medical insurance fund will not pay the medical expenses incurred.
Forty-first without the approval of the designated medical institutions, residents to other medical institutions for medical expenses, residents' basic medical insurance fund will not pay.
Forty-second medical centers should sign agreements with designated medical institutions on the scope of medical insurance services, service quality standards, supervision and inspection, cost settlement and other contents, and clarify the responsibilities and obligations of both parties.
Forty-third residents use the basic medical insurance fund for medical treatment, and the drugs, diagnosis and treatment items, medical service facilities and charging standards used shall be implemented with reference to the provisions of the basic medical insurance for employees in Shijiazhuang.
Forty-fourth designated medical institutions should establish health records, medical service management data and medical records for residents according to the requirements of the medical insurance center.
Forty-fifth in order to facilitate the settlement of medical expenses and medical service management, designated medical institutions should establish a computer system for residents' medical insurance according to the requirements of the medical insurance center, and connect with the medical insurance center.
Article 46 Designated medical institutions shall strictly implement the relevant provisions of medical insurance, standardize medical behavior, provide corresponding medical services according to the actual situation of residents and the principles of reasonable examination, reasonable treatment and rational drug use, strictly implement the hospitalization and discharge standards and the referral and referral system, and shall not refuse, shirk, stay or transfer without reason.
Forty-seventh residents in hospital, designated medical institutions should be registered in accordance with the provisions, timely and accurately input the detailed medical expenses of residents into the computer, and upload them to the medical insurance center through the computer network system. When residents leave the hospital, designated medical institutions shall require patients or their relatives to verify the details of hospitalization medical expenses and sign them. Without the signature of the patient or his relatives, the residents' basic medical insurance fund will not pay medical expenses. If there is any dispute, report it to the medical insurance center for handling. At the end of residents' discharge or emergency rescue, the dosage of acute diseases should not exceed 7 days, chronic diseases should not exceed 15 days, and Chinese herbal medicines should not exceed 7 days.
Forty-eighth residents need to go to other medical institutions for examination, treatment and drug purchase because of the conditions of the designated medical institutions in their places of residence, and they need to be examined and approved by the medical insurance department of the designated medical institutions in their places of residence.
Article 49 Anti-rejection drugs used in outpatient radiotherapy for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency and organ transplantation shall be managed at designated points, and their diseases shall be treated at designated general medical institutions or specialized medical institutions after being determined by the medical insurance center. Measures for fixed-point management and settlement shall be formulated separately.
Article 50 If residents need to be transferred to other places for diagnosis and treatment due to the limited conditions of designated medical institutions in the urban areas of this Municipality, the deputy chief physician and above in tertiary medical institutions shall put forward their opinions, which shall be reviewed by the medical insurance department, signed by the competent leaders and reported to the medical insurance center for approval before being transferred.
Fifty-first residents' medical insurance does not handle medical procedures for people who are permanently stationed in other places or resettled in different places.
Fifty-second residents abroad and to Hong Kong, Macao and Taiwan during the medical expenses, residents' basic medical insurance fund will not pay.
Fifty-third residents due to illegal crimes, traffic accidents, fighting, alcoholism, suicide, intentional self-injury, medical accidents and other medical expenses borne by the other party, the residents' basic medical insurance fund will not pay.
Chapter VIII Settlement and Reimbursement of Medical Expenses
Fifty-fourth medical expenses incurred by residents in designated medical institutions, the expenses paid by the residents' basic medical insurance fund shall be settled with the designated medical institutions by myself with the medical insurance card; The expenses that should be borne by the individual shall be settled by himself and the designated medical institution.
Fifty-fifth medical centers and designated medical institutions for medical expenses settlement with reference to the "Shijiazhuang urban workers' medical insurance settlement measures".
Fifty-sixth residents a hospitalization medical expenses below Qifubiaozhun (including Qifubiaozhun), not as a hospitalization.
Article 57 When residents go out, the medical expenses incurred due to the diagnosis and treatment of diseases listed in the emergency rescue catalogue shall be reported to the medical insurance center for review and reimbursement through the local community labor security workstation on the basis of all medical records of local hospitals, details of hospitalization medical expenses, medical expense receipts and medical insurance cards.
Fifty-eighth residents in designated medical institutions during hospitalization, approved to other medical institutions for examination, treatment and drug purchase, the expenses paid by individuals in advance, by the approved medical institutions in accordance with the provisions of reimbursement, included in the hospitalization expenses.
Fifty-ninth medical expenses transferred to other medical institutions shall be paid by individuals in advance. After the diagnosis and treatment, the local community labor and social security workstation will submit the approval form, all medical records, details of hospitalization expenses, medical expense receipts and medical insurance cards to the medical insurance center for reimbursement according to regulations.
Chapter IX Supervision and Evaluation
Sixtieth each labor security workstation shall announce the list of insured persons from low-income families over 60 years old to the residents in this area every year, and accept the supervision of the masses.
Sixty-first residents have the right to supervise the implementation of residents' medical insurance policies in medical insurance centers, labor security workstations and designated medical institutions, and complaints and reports from the masses to relevant units and personnel are protected by law.
Article 62 A residents' medical insurance fund supervision committee shall be established, in which the competent labor and social security department, financial department, auditing department, handling agency, medical institution and residents' representatives participate, to supervise the operation of residents' medical insurance fund.
Sixty-third medical insurance center is responsible for the supervision, inspection and assessment of the implementation of the basic medical insurance policy for residents by insured residents, designated medical institutions and labor security workstations. Insured residents, designated medical institutions and labor security workstations should actively cooperate.
Chapter X Reward and Punishment
Sixty-fourth in line with the following circumstances and outstanding achievements, be commended or rewarded. (1) Designated medical institutions conscientiously implement policies and regulations on residents' medical insurance, provide timely and accurate information on residents' medical treatment as required, actively cooperate with relevant inspections and assessments, and make contributions to ensuring residents' basic medical care. (II) The labor and social security workstation conscientiously implements the policies and regulations on residents' medical insurance, conscientiously conducts household surveys, handles insurance registration on time, collects residents' medical insurance fees in full and on time, submits various reports in time, truthfully provides residents with medical treatment in non-designated medical institutions, and strictly controls their reimbursement of medical expenses. (3) The staff of the medical insurance center actively publicize and conscientiously implement the residents' medical insurance policies and regulations, adhere to principles, dare to resist unhealthy practices, promptly correct or deal with violations of policies and regulations, and make outstanding achievements for the residents' medical insurance cause. (four) residents take the initiative to report and expose the acts of designated medical institutions, labor security workstations and medical insurance centers in violation of residents' medical insurance policies and regulations, and protect residents' medical insurance funds from losses.
Sixty-fifth designated medical institutions and their staff have one of the following acts, the medical insurance center shall, in accordance with the provisions of the contract, investigate the liability for breach of contract and give it to informed criticism; Informed criticism more than 3 times, stop rectification within a time limit; If the rectification is ineffective, the agreement shall be suspended; If the circumstances are serious, its fixed-point qualification shall be cancelled; When necessary, draw the relevant departments to give administrative sanctions to the responsible person according to law; If a crime is constituted, criminal responsibility shall be investigated according to law. (a) do not verify whether the patient belongs to the insured residents, resulting in an impostor for medical treatment. (two) the use of fake hospitalization, medical records, medical records and hospitalization expenses do not match the details. (three) prevarication, detention or transfer of patients. (four) can not guarantee the necessary inspection, treatment and medication for residents, resulting in adverse consequences. (5) Exchanging diagnosis and treatment items and medicines, and including the non-conforming diagnosis and treatment items and medicines into the scope of medical expenses paid by the residents' medical insurance fund. (six) in violation of the charging standards for medical treatment projects and the provisions on drug prices. (seven) examination, treatment and medication are inconsistent with the condition. (eight) taking advantage of work to prescribe drugs by car. (nine) other acts in violation of the residents' medical insurance policy.
Sixty-sixth residents have one of the following acts, resulting in the loss of residents' medical insurance fund, the medical insurance center in addition to recover the losses, can give informed criticism, and can suspend his enjoyment of medical insurance benefits. When necessary, draw the relevant departments to punish the responsible person according to law; If a crime is constituted, criminal responsibility shall be investigated according to law. (a) to provide my medical insurance card and medical records to others, resulting in an impostor for medical treatment. (2) Falsely reporting medical expenses. (three) other violations of the provisions of the residents' medical insurance policy.
Sixty-seventh medical insurance center staff has one of the following acts, by the unit or the labor and social security department to recover illegal income, and depending on the seriousness of the case, given administrative sanctions; If a crime is constituted, criminal responsibility shall be investigated according to law. (a) in the management of medical insurance, favoritism, favoritism. (two) taking advantage of his authority and work to ask for bribes and seek personal gain. (three) in violation of regulations, the residents' medical insurance fund is used for other purposes. (4) Loss of residents' medical insurance fund due to dereliction of duty.
Chapter II XI Supplementary Provisions
Sixty-eighth residents due to sudden, epidemic diseases and natural disasters and other force majeure factors caused by a wide range of acute, dangerous and serious patients, by the government's comprehensive coordination to solve.
Article 69 The Shijiazhuang Municipal Labor and Social Security Bureau shall be responsible for the interpretation of these Rules.
Article 70 These Rules shall come into force on February 26th, 2007.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.