I. Insurance registration management
The registration of basic medical insurance is the primary link of insurance management. The insured shall submit relevant materials to the local social insurance agency in accordance with the prescribed procedures and requirements, and complete the insurance registration procedures. The social insurance agency shall carefully examine the submitted materials to ensure the authenticity and integrity of the information. At the same time, the insured units should also go through the insurance procedures for employees in a timely manner in accordance with the regulations to ensure the rights and interests of employees' basic medical insurance.
Second, payment management
The payment of basic medical insurance is an important part of insurance management. The insured shall pay the basic medical insurance premium in full according to the prescribed payment standard and time. The social insurance agency shall establish and improve the payment record and management system to ensure the accuracy and completeness of the payment information. For the insured who fails to pay in full and on time, the social insurance agency has the right to suspend their basic medical insurance benefits until they pay the arrears.
Third, the management of treatment enjoyment
The basic medical insurance treatment is the most concerned issue for the insured. Social insurance agencies shall, in accordance with the prescribed standards and procedures, timely approve and issue basic medical insurance benefits for the insured. At the same time, it is necessary to strengthen the management of designated medical institutions and pharmacies to ensure that the medical services and drug quality they provide meet the requirements and protect the medical rights and interests of the insured.
To sum up:
The basic medical insurance management regulations are a series of operating regulations to standardize the management links of the insured personnel of basic medical insurance, such as registration, payment and treatment enjoyment. The implementation of these regulations will help to ensure the smooth implementation of the basic medical insurance system, safeguard the legitimate rights and interests of the insured and promote the healthy development of social insurance. In practice, social insurance agencies should strictly follow the prescribed requirements to ensure the standardization and effectiveness of all work.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23 provides that:
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for 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 state regulations.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.