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In official website, the National Medical Insurance Bureau issued an announcement to formally solicit opinions from the public on the medical insurance law (draft for comments). The exposure draft emphasizes that six medical expenses are not included in the payment scope of the basic medical insurance fund, including health care consumption and health check-up expenses.
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The insured shall not participate in medical insurance again.
The exposure draft stipulates the financing and treatment of medical insurance, fund management, medical services, public management services, supervision and management, and legal responsibilities. ?
According to the exposure draft, state organs, enterprises and institutions, social organizations, individual industrial and commercial households with employees and other employers and their employees should participate in the basic medical insurance for employees; Those who did not participate in the basic medical insurance for employees or did not enjoy other medical insurance in accordance with the regulations shall participate in the basic medical insurance for urban and rural residents according to law; Encourage individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer and other flexible employees to participate in the basic medical insurance for employees. At the same time, it is emphasized that the insured shall not participate in the basic medical insurance repeatedly.
Six medical expenses are not included in medical insurance.
The exposure draft emphasizes that six medical expenses are not included in the basic medical insurance fund. Including the expenses that should be paid by the industrial injury insurance fund; Should be borne by a third party; Should be borne by public health; Go abroad for medical treatment; Physical quality, health care consumption and health examination; Other expenses not paid by the basic medical insurance fund stipulated by the state. At the same time, when it has a significant impact on economic and social development, the non-payment scope of the basic medical insurance fund can be temporarily adjusted through legal procedures.
In terms of fund-raising, it is pointed out in the exposure draft that the basic medical insurance premiums for employees are paid by both employers and employees, and a unified withholding and remittance system is implemented by employers. ?
For flexible employees who participate in the basic medical insurance for employees in their personal capacity, the basic medical insurance premium shall be paid by individuals. The basic medical insurance premium for urban and rural residents shall be shared by the finance and individuals. Those who enjoy the minimum living guarantee, those who are included in the scope of assistance and support for poor people, the disabled who have lost their ability to work, the elderly and minors over 60 years old in low-income families, etc. Will be subsidized by the government to participate in the basic medical insurance for urban and rural residents. ?
In addition, people with multiple identities are given subsidies according to the highest treatment they can enjoy, and subsidies cannot be repeated.
Individuals who cheat medical insurance will be fined.
The exposure draft also clarifies that if designated medical institutions violate the rules in the use of medical security funds, the medical security administrative department shall order them to make corrections and may interview the relevant responsible persons; If losses are caused to the medical insurance fund, it shall be ordered to return it, and a fine of 1 times and 2 times shall be imposed; Refusing to correct or causing serious consequences, the designated medical institutions shall be ordered to suspend the use of medical services involved in the medical security fund for more than 6 months and less than 6+0 years.
The designated medical institutions and their staff to defraud the medical security fund expenditure, shall be ordered by the administrative department of medical security to return, and impose a fine of more than 2 times and less than 5 times the amount of fraud; Ordering designated medical institutions to suspend the use of medical services involved in the medical insurance fund for more than 6 months 1 year, until the medical insurance agency terminates the service agreement; Those with professional qualifications shall be revoked by the relevant competent departments according to law. Designated medical institutions in violation of the provisions of this law, resulting in heavy losses of medical security funds or other serious adverse social impacts, the administrative department of medical security shall impose a fine of more than 50% 1 times of the previous year's income on their legal representative or principal responsible person, and prohibit them from engaging in the management activities of designated medical institutions for five years, and the relevant departments shall impose sanctions according to law.
Individuals who pass medical insurance certificates to others for fraudulent use and repeatedly enjoy medical insurance benefits shall be ordered by the administrative department of medical security to make corrections; Causing losses to the medical security fund, shall be ordered to return; For those who are insured, the online settlement of medical expenses will be suspended for 3 months to 12 months. At the same time, if an individual defrauds the medical insurance fund, in addition to handling it in accordance with the provisions of the preceding paragraph, the administrative department of medical security shall impose a fine of more than 2 times and less than 5 times the amount defrauded.