The basic medical insurance mentioned in these Measures includes basic medical insurance for employees and basic medical insurance for urban and rural residents. Article 3 The people's governments at or above the county level shall organize, lead and coordinate the supervision and management of basic medical insurance within their respective administrative areas, establish and improve the linkage mechanism, and bring basic medical insurance into the social insurance supervision and management system for key supervision.
The social insurance administrative department of the provincial people's government is responsible for the supervision and management of the province's basic medical insurance. The social insurance administrative department of the people's government of the city, state and county shall be responsible for the supervision and management of the basic medical insurance in this area.
The departments of development and reform, finance, health and family planning, food and drug supervision, public security, supervision and auditing of the people's governments at or above the county level shall, according to their respective functions and duties, do a good job in the supervision and management of basic medical insurance. Article 4 Medical insurance agencies shall be responsible for the daily management and service of basic medical insurance in accordance with the laws, regulations, rules and duties stipulated by the people's government at the corresponding level, and may be entrusted by the administrative department of social insurance to carry out relevant supervision and inspection according to law.
The medical insurance agency shall publicly handle the basis, process, processing time limit, application materials, payment standard, handling personnel and consultation telephone number of the basic medical insurance on the website of the social insurance administrative department at the same level or the website of the people's government at the same level, simplify the service procedures, and timely review and pay the basic medical insurance expenses.
Medical insurance agencies shall establish and improve the basic medical insurance business, finance, fund security and risk management, internal audit and other systems, and regularly announce the income, expenditure, balance and investment operation income of the basic medical insurance fund to the public every year. Fifth the implementation of medical insurance agencies and medical institutions, retail pharmacies agreement management system.
In accordance with the principle of "fairness, justice and openness", medical institutions and retail pharmacies of various ownership types are encouraged and guided to apply to the medical insurance agencies in the overall planning area to become the basic medical insurance agreement agencies according to their own service capabilities and business needs, and the medical insurance agencies shall not charge or charge any fees in disguise. Article 6 When receiving medical services of basic medical insurance, the insured shall take the initiative to show the basic medical insurance certificate, accept the certificate inspection, consciously fulfill the obligation of good faith, and shall not defraud the basic medical insurance fund.
The employer shall not forge, alter or tamper with medical records and medical bills to defraud the basic medical insurance fund, nor shall it collude with the insured or fraudulently use the name of the insured to defraud the basic medical insurance fund. Seventh relevant departments of the people's governments at or above the county level shall unblock the channels of social supervision of basic medical insurance, establish and improve the social supervision mechanism of basic medical insurance, and take various measures to encourage and support all sectors of society to participate in the supervision of basic medical insurance. Chapter II Insurance and Payment Article 8 Enterprises, organs, institutions, social organizations, private non-enterprise units, individual industrial and commercial households and other organizations (hereinafter referred to as employers) and their employees shall participate in the basic medical insurance for employees.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for urban employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with the relevant provisions of the state and the province. Article 9 The employing unit shall strengthen the management and service of the insured personnel of the basic medical insurance of the unit, and provide the relevant certification materials of the insured personnel to the medical insurance agency in a timely and accurate manner.
The employing unit shall pay the basic medical insurance premium paid by the unit on time and in full according to law, withhold and remit the basic medical insurance premium paid by the individual employees of the unit, and inform the employees of the details of payment in writing on a monthly basis.
After the employer terminates or terminates the labor and personnel relationship with the insured, it shall go through the relevant formalities with the medical insurance agency in a timely manner in accordance with the relevant provisions. Article 10 When paying insurance premiums, an employer shall not commit any of the following acts:
(a) providing false financial statements, deliberately concealing or underreporting the total wages of employees and the number of insured persons;
(two) the basic medical insurance premiums that should be paid in arrears;
(3) Issuing false labor and personnel relationship certificates for employees other than employees of the unit to participate in the basic medical insurance for employees;
(four) other acts in violation of the provisions of the basic medical insurance management. Eleventh to encourage other urban and rural residents who have not participated in the medical insurance for employees to participate in the basic medical insurance for urban and rural residents.
The personnel mentioned in the preceding paragraph who participate in the basic medical insurance for urban and rural residents shall pay the basic medical insurance premiums that individuals should pay in accordance with the relevant provisions of the state and the province, and the people's government in the overall planning area shall arrange financial subsidy funds and give subsidies in accordance with the relevant provisions of the state and the province. Twelfth medical insurance agencies shall, in accordance with the relevant provisions of the state and the province, verify the payment base of the insured units and insured persons. The collection and payment institution of the basic medical insurance premium shall collect the basic medical insurance premium in full and on time, and shall not reduce or agree with the insured units and insured persons to postpone the payment of the basic medical insurance premium except for force majeure and other legal reasons.
The basic medical insurance fee collection agency shall inform the insured units and insured personnel in writing about the payment. Insured units and insured persons can query relevant payment information in real time through the basic medical insurance handling information network.
The basic medical insurance fund shall be managed by special financial accounts, which shall be used for special purposes, and no unit or individual may occupy or misappropriate it.