Legal basis: Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers.
Forty-first provincial labor and social security administrative departments in accordance with the relevant provisions of the state, in conjunction with the planning, trade, finance, health administration, drug supervision and management departments to determine the basic medical insurance drug list.
The provincial labor and social security administrative department shall, in accordance with the relevant provisions of the state, jointly with the planning, finance, health administration and drug supervision and management departments, determine the basic medical insurance diagnosis and treatment project directory, the scope of medical service facilities and payment standards.
The use of drugs, medical treatment projects and medical service facilities that are not included in the basic medical insurance coverage will not be paid by the overall fund.
Forty-second provincial labor and social security administrative departments in accordance with the relevant provisions of the state, in conjunction with the health administration, drug supervision and management departments to develop basic medical insurance designated medical institutions management approach.
The provincial administrative department of labor and social security shall, in accordance with the relevant provisions of the state, formulate measures for the administration of designated pharmacies for basic medical insurance in conjunction with the pharmaceutical supervisory and administrative departments.
Labor and social security, health administration and drug supervision and management departments shall implement dynamic management of the qualifications of designated medical institutions and designated pharmacies.
Article 43 Labor and social security, health administration, drug supervision and administration departments and social insurance agencies shall determine the designated medical institutions and pharmacies according to the Measures for the Administration of Designated Medical Institutions and Designated Drugstores, and in accordance with the principle of paying equal attention to Chinese and Western medicine, giving consideration to community, specialist and comprehensive medical institutions, and facilitating the insured to seek medical treatment, and announce them to the insured.
Article 44 With a personal account, patients can seek medical treatment and purchase medicines at any designated medical institution or pharmacy.
According to the provisions of the medical expenses paid by the overall fund, patients should go to designated medical institutions for medical treatment.
Forty-fifth medical expenses paid by the overall fund can be implemented in advance according to the principle of total control.
Social insurance agencies can regulate the number of prepaid pooling funds according to the quantity and quality of medical services provided by designated medical institutions and the protection of the legitimate medical rights and interests of the insured.
Forty-sixth designated medical institutions and pharmacies shall abide by the provisions of the state and province on medical and health care and basic medical insurance, and shall not damage the legitimate medical rights and interests of the insured in any way.
Designated medical institutions must inform patients of the details of medical services and charges.
Article 47 The charging standard for basic medical services shall be formulated and revised by the provincial labor and social security and price management departments in conjunction with the health administration and finance departments, and submitted to the provincial government for approval.
The price of basic medical insurance drugs shall conform to the relevant state provisions on drug pricing.
In violation of the basic medical service charges and drug price regulations, the basic medical insurance fund account does not pay the medical expenses that exceed the standard.