Provinces, autonomous regions and municipalities of labor and social security department (bureau):
To conscientiously implement "the State Council on urban residents carry out the basic medical insurance pilot guidance" (State of the [2007]
20), we formulated the "urban residents on the basic medical insurance services for the views of governance", is issued to you,
Please combination of actual implementation.
September 4, 2007
On the urban residents in the basic medical insurance management services for the views
To conscientiously implement "the State Council on urban residents carry out the basic medical insurance pilot guidance" (State of the [2007]
20) the spirit of urban residents to do a good job in the basic medical insurance management services and ensure smooth implementation of pilot work,
Now make the following observations:
First, management services - the basic requirements
(A) attach great importance to carefully organize
Urban residents in the basic medical insurance management services for social insurance agencies (hereinafter referred to as "Action")
Of a new function. Labor and social security departments at all levels should attach great importance, as the scientific development concept, building a socialist and
Harmonious society important task, carefully organize the implementation, and ensure the smooth operation of the system.
(B) integration of resources, exploration and innovation
To take full advantage of the basic medical insurance for urban workers, the basis of governance, relying on the streets and community labor and social security work platform for test
At work. In the pilot, we should pay attention to explore the establishment of a reasonable funding mechanism, a sound governance system and standardize the operation mechanism, Canada
Strong guide and standardize management. Explore and establish a medical security system for urban and rural co-ordinate the region, it is necessary to integrate the management of existing resources, speed up
Establish a unified and efficient governance platform.
(C) grasp the characteristics of service-oriented
Urban residents in the basic medical insurance management services to fully embody the concept of people-oriented,寓governance in the service,
To promote governance services, and constantly enhance service awareness, improve service, improve service quality and level of reimbursement payment in hand to simplify
Continued, focus on implementation of various convenient ride out the services to provide the residents with convenient and faster services.
(D) wide publicity to strengthen consultation
We should give full play to the newspaper, television, radio, Internet and other media, printed summary of publicity materials to promote urban residents -
The medical insurance policies, open enrollment fee, medical treatment and medical expenses, and other procedures. 12,333 to rely on labor security consultation
Hotline for urban residents in the provision of policy advice. The city should be conditional on the creation of Labor and Social Security website column.
Second, management services - the main content
(A) participants to register and pay
Manpower regional agencies responsible for the unified organization of governance of urban residents to register and pay the participants work. Participants with the conditions of city
Town residents持有效证件and information services to the agencies window, community labor and social security work platform or agencies commissioned by the
The unit for enrollment procedures. On the mobility of the elderly, the disabled should be carried out door registration enrollment services. Community work
Security work platform or agencies commissioned officers of the units on enrollment as a standard fee of First Instance, rehabilitation agencies
Nuclear.
Manpower regional agencies to actively explore the characteristics of urban residents for payment, can be entered into an agreement with commercial banks,
Bank staff to facilitate enrollment fee or commission Daikou direct payment. Medical insurance premiums, in principle, at the collection, charging units should be
Certificate issued by a unified fee.
(B) information collection and documentation of
In follow Jinbaogongcheng information structure and General Clauses which data are available on the basis of criteria, agencies to guide community labor and social security work
In accordance with the requirements of unified platform for the collection, recording basic data to help guide the procedures for participants and submit relevant units of the relevant information.
To do a good job in checking the basis of the information, and timely maintenance update. Enrollment information personnel changes may be community-labor and social security work
Taiwan or accepted by the relevant units, agencies responsible for the reunification of dealing with change.
Provincial agencies to guide co-ordinate regional agencies, according to the participants of urban residents and payment information, create a unified
Zhengka medical insurance, special medical manuals, and other relevant documents, relevant documents available through community labor and social security work platform or the commission
Units issued to participants in time staff to ensure that medical treatment and medical insurance billing costs.
Manpower in the use of the IC card as Zhengka, to follow uniform standards of the National People's Republic of China Social Security card.
(C) designated for medical treatment and management agreement
Manpower regional agencies in accordance with relevant regulations, and designated medical institutions and retail pharmacies designated to enter into service agreements and
Timely announced to the public and address list for the selection of participants to facilitate the designated agencies. To guide the Senate in accordance with the relevant provisions
Bao staff make full use of community health services and Chinese medicine services.
Enrollment staff in accordance with the regulations designated medical institutions for medical treatment choices, and provisions for change. Participants in the designated medical institutions
When medical treatment should be provided to produce my medical insurance Zhengka, special medical manuals valid documents.
Agencies and designated medical institutions and retail pharmacies signed sentinel sentinel medical service agreement, should the scope of medical services,
Service quality, billing methods, assessment methods, indicators and assessment of incentive measures, such as content, clearly the respective responsibilities,
Rights and obligations.
Agencies at all levels, according to the agreement, the designated medical institutions, retail pharmacies designated for supervision and inspection, the designated agency
Carry out the agreement to assess the situation. To continuously improve the management of fixed-point agreement institutions and gradually establish credibility rating standards,
Trial classification governance, the public should be informed of the implementation of information disclosure system, designated institutions to promote reasonable clinics, rational drug use, drop
Low-cost, to provide quality medical services.
(D) payment of medical expenses and billing management
The participants ill patient and out-patient medical expenses, as required by the personal burden of medical costs paid by individuals,
Funds to pay the medical expenses incurred by the sentinel medical institutions, retail pharmacies designated agencies reporting to the settlement. Emergency, referral,
Remote medical treatment, such as in non-designated medical institutions in medical costs, participants can be first to advance from the staff, to the agencies for trial
Nuclear claims, apply for a work by the community labor and social security work platform or commissioned by the relevant units of admissibility.
Agencies at all levels must explore effective ways of settlement of medical expenses. Actively explore the implementation of the disease payment, according to the total
Such as prepaid billing; exploration agreement determining the cost of medical services standards approach. Explore the establishment of funding levels, pay and years
The level of treatment linked to the mechanism to ensure basic medical care under the premise of reasonable control medical costs, and curb waste.
(5) Fund Management
Urban residents in the basic medical insurance fund implementation of separation between revenue and expenditure management, into the special account, separate accounts and separate accounts.
Agencies at all levels should strictly implement the Social Insurance Fund's financial accounting system, establish a complete basic medical insurance for urban residents -
The income and expenditure accounts, do a really good job of urban residents basic medical insurance fund governance.
Agencies at all levels to strengthen urban residents in the basic medical insurance fund collection of governance, accurate and complete to the same labor -
Impaired the administration and the business departments in charge of providing a higher level of urban residents enrollment fee, and to facilitate the full and timely financial assistance funds to
- No fraud, obtaining financial assistance of funds. Fund expenditures in accordance with provisions of items of expenditure strict governance. Reasonable
Control of urban residents in the basic medical insurance fund balance of the scale, and explore the establishment of a fund transfers and risk prevention mechanism.
Agencies at all levels should establish and improve the urban residents in the basic medical insurance fund governance and internal control regulations, and strict
Grid implementation, the establishment of mechanisms to prevent irregularities and ensure security fund. To regularly to the same level labor and social security administrative departments and higher-level business owners
Report of the sector fund balance of payments situation, the risks involved in such important matters should be promptly reported.
The establishment of urban residents in the basic medical insurance fund internal audit system, and consciously accept the legal departments of the external audit. In accordance with the regulations
Regularly to by government agencies, insurance, social groups, service agencies, and other aspects of traditional Chinese medicine composed of representatives of social medical insurance supervisor
Governor's urban residents reported the basic medical insurance fund balance of payments and staff participants to enjoy medical insurance treatment of the basic information,
Social and announced to accept social supervision.
Third, control service system in Action
(A) strengthen the institutional capacity-building Action
Agencies at all levels in government departments, with the support of efforts to meet the basic medical insurance for urban residents of the need for the development of the cause,
Strengthening institution-building, enrichment would force the implementation of governance, the configuration of facilities, carry out personnel training. Actively explore building
Li and services and people linked to the business of staffing and funding mechanism of protection mechanisms, the establishment of medical insurance management services
Reward and punishment mechanism. Study and formulate medical insurance management services technical standards, would achieve the standardization of governance, information technology, the
Of the industry.
(B) to enhance community building platform for labor and social security work
To expand community of urban residents in the basic medical insurance management services, for support of the relevant units in a timely manner for the community
Labor and social security work platform equipped with appropriate staff to ensure that the work for. Agencies should strengthen community management staff of medical insurance
Training. Community platform for labor and social security of staff working in agencies under the guidance, seriously carry out urban residents are insured
In the first instance and pay the standard registration and enrollment, based on information collected entry and policy advocacy work.
(C) specification - a point of order management services
Provincial agencies to the urban residents in accordance with the national basic medical insurance management services requirements, guidance and Manpower region
Formulate a unified business point of order and governance, including registration of participants, premium collection, treatment management, billing and reimbursement of expenses, such as
Various services - the handling process, participants affairs officer for the need to provide certificate information and agencies
The audit governance responsibilities. Manpower regional agencies through effective channels to open procedures, supervision of telephone opened, the establishment of
Improve the admissibility of complaints mechanism.
(D) To strengthen the building of information systems
Information systems throughout the building to follow Jinbaogongcheng unified plan, and effectively play its information network and database based on the role.
According to the basic medical insurance for urban residents running governance needs of existing urban workers in the basic medical insurance system based on the increase
Established the basic medical insurance for urban residents governance functions. Establish and improve connectivity community work platform of labor and social security information network and develop
Community work platform for labor and social security system. Exploration and public security, civil affairs, health, medicine, people with disabilities, and other information management systems
Networking, the establishment of urban residents in the community of public service information sharing platform.
(5) to strengthen the building of basic data and statistical analysis
Agencies at all levels in accordance with the characteristics of urban residents and establish the basis of accounting, strengthen basic data collection and maintenance, security
Impaired participants Personal information security. Establish and improve the basic medical insurance for urban residents of the professional file management system, properly preserved
All types of files.
The establishment of urban residents in the basic medical insurance system statistics. Labour and Social Security, together with other relevant departments to develop uniform
Table, agencies at all levels should be in accordance with the requirements of timely, complete, and accurate reporting.
According to agencies at all levels of urban residents enrollment, payment, financial assistance, the flow of medical treatment, medical expenses, and the sentinel
Corporate governance and other information, comprehensive analysis, the establishment of operational analysis and risk early warning system, regularly to the same level of Labor and Social Security
Administrative departments and higher-level departments in charge of business analysis and submit the report.
To conscientiously implement "the State Council on urban residents carry out the basic medical insurance pilot guidance" (State of the [2007]
20), we formulated the "urban residents on the basic medical insurance services for the views of governance", is issued to you,
Please combination of actual implementation.
September 4, 2007
On the urban residents in the basic medical insurance management services for the views
To conscientiously implement "the State Council on urban residents carry out the basic medical insurance pilot guidance" (State of the [2007]
20) the spirit of urban residents to do a good job in the basic medical insurance management services and ensure smooth implementation of pilot work,
Now make the following observations:
First, management services - the basic requirements
(A) attach great importance to carefully organize
Urban residents in the basic medical insurance management services for social insurance agencies (hereinafter referred to as "Action")
Of a new function. Labor and social security departments at all levels should attach great importance, as the scientific development concept, building a socialist and
Harmonious society important task, carefully organize the implementation, and ensure the smooth operation of the system.
(B) integration of resources, exploration and innovation
To take full advantage of the basic medical insurance for urban workers, the basis of governance, relying on the streets and community labor and social security work platform for test
At work. In the pilot, we should pay attention to explore the establishment of a reasonable funding mechanism, a sound governance system and standardize the operation mechanism, Canada
Strong guide and standardize management. Explore and establish a medical security system for urban and rural co-ordinate the region, it is necessary to integrate the management of existing resources, speed up
Establish a unified and efficient governance platform.
(C) grasp the characteristics of service-oriented
Urban residents in the basic medical insurance management services to fully embody the concept of people-oriented,寓governance in the service,
To promote governance services, and constantly enhance service awareness, improve service, improve service quality and level of reimbursement payment in hand to simplify
Continued, focus on implementation of various convenient ride out the services to provide the residents with convenient and faster services.
(D) wide publicity to strengthen consultation
We should give full play to the newspaper, television, radio, Internet and other media, printed summary of publicity materials to promote urban residents -
The medical insurance policies, open enrollment fee, medical treatment and medical expenses, and other procedures. 12,333 to rely on labor security consultation
Hotline for urban residents in the provision of policy advice. The city should be conditional on the creation of Labor and Social Security website column.
Second, management services - the main content
(A) participants to register and pay
Manpower regional agencies responsible for the unified organization of governance of urban residents to register and pay the participants work. Participants with the conditions of city
Town residents持有效证件and information services to the agencies window, community labor and social security work platform or agencies commissioned by the
The unit for enrollment procedures. On the mobility of the elderly, the disabled should be carried out door registration enrollment services. Community work
Security work platform or agencies commissioned officers of the units on enrollment as a standard fee of First Instance, rehabilitation agencies
Nuclear.
Manpower regional agencies to actively explore the characteristics of urban residents for payment, can be entered into an agreement with commercial banks,
Bank staff to facilitate enrollment fee or commission Daikou direct payment. Medical insurance premiums, in principle, at the collection, charging units should be
Certificate issued by a unified fee.
(B) information collection and documentation of
In follow Jinbaogongcheng information structure and General Clauses which data are available on the basis of criteria, agencies to guide community labor and social security work
In accordance with the requirements of unified platform for the collection, recording basic data to help guide the procedures for participants and submit relevant units of the relevant information.
To do a good job in checking the basis of the information, and timely maintenance update. Enrollment information personnel changes may be community-labor and social security work
Taiwan or accepted by the relevant units, agencies responsible for the reunification of dealing with change.
Provincial agencies to guide co-ordinate regional agencies, according to the participants of urban residents and payment information, create a unified
Zhengka medical insurance, special medical manuals, and other relevant documents, relevant documents available through community labor and social security work platform or the commission
Units issued to participants in time staff to ensure that medical treatment and medical insurance billing costs.
Manpower in the use of the IC card as Zhengka, to follow uniform standards of the National People's Republic of China Social Security card.
(C) designated for medical treatment and management agreement
Manpower regional agencies in accordance with relevant regulations, and designated medical institutions and retail pharmacies designated to enter into service agreements and
Timely announced to the public and address list for the selection of participants to facilitate the designated agencies. To guide the Senate in accordance with the relevant provisions
Bao staff make full use of community health services and Chinese medicine services.
Enrollment staff in accordance with the regulations designated medical institutions for medical treatment choices, and provisions for change. Participants in the designated medical institutions
When medical treatment should be provided to produce my medical insurance Zhengka, special medical manuals valid documents.
Agencies and designated medical institutions and retail pharmacies signed sentinel sentinel medical service agreement, should the scope of medical services,
Service quality, billing methods, assessment methods, indicators and assessment of incentive measures, such as content, clearly the respective responsibilities,
Rights and obligations.
Agencies at all levels, according to the agreement, the designated medical institutions, retail pharmacies designated for supervision and inspection, the designated agency
Carry out the agreement to assess the situation. To continuously improve the management of fixed-point agreement institutions and gradually establish credibility rating standards,
Trial classification governance, the public should be informed of the implementation of information disclosure system, designated institutions to promote reasonable clinics, rational drug use, drop
Low-cost, to provide quality medical services.
(D) payment of medical expenses and billing management
The participants ill patient and out-patient medical expenses, as required by the personal burden of medical costs paid by individuals,
Funds to pay the medical expenses incurred by the sentinel medical institutions, retail pharmacies designated agencies reporting to the settlement. Emergency, referral,
Remote medical treatment, such as in non-designated medical institutions in medical costs, participants can be first to advance from the staff, to the agencies for trial
Nuclear claims, apply for a work by the community labor and social security work platform or commissioned by the relevant units of admissibility.
Agencies at all levels must explore effective ways of settlement of medical expenses. Actively explore the implementation of the disease payment, according to the total
Such as prepaid billing; exploration agreement determining the cost of medical services standards approach. Explore the establishment of funding levels, pay and years
The level of treatment linked to the mechanism to ensure basic medical care under the premise of reasonable control medical costs, and curb waste.
(5) Fund Management
Urban residents in the basic medical insurance fund implementation of separation between revenue and expenditure management, into the special account, separate accounts and separate accounts.
Agencies at all levels should strictly implement the Social Insurance Fund's financial accounting system, establish a complete basic medical insurance for urban residents -
The income and expenditure accounts, do a really good job of urban residents basic medical insurance fund governance.
Agencies at all levels to strengthen urban residents in the basic medical insurance fund collection of governance, accurate and complete to the same labor -
Impaired the administration and the business departments in charge of providing a higher level of urban residents enrollment fee, and to facilitate the full and timely financial assistance funds to
- No fraud, obtaining financial assistance of funds. Fund expenditures in accordance with provisions of items of expenditure strict governance. Reasonable
Control of urban residents in the basic medical insurance fund balance of the scale, and explore the establishment of a fund transfers and risk prevention mechanism.
Agencies at all levels should establish and improve the urban residents in the basic medical insurance fund governance and internal control regulations, and strict
Grid implementation, the establishment of mechanisms to prevent irregularities and ensure security fund. To regularly to the same level labor and social security administrative departments and higher-level business owners
Report of the sector fund balance of payments situation, the risks involved in such important matters should be promptly reported.
The establishment of urban residents in the basic medical insurance fund internal audit system, and consciously accept the legal departments of the external audit. In accordance with the regulations
Regularly to by government agencies, insurance, social groups, service agencies, and other aspects of traditional Chinese medicine composed of representatives of social medical insurance supervisor
Governor's urban residents reported the basic medical insurance fund balance of payments and staff participants to enjoy medical insurance treatment of the basic information,
Social and announced to accept social supervision.
Third, control service system in Action
(A) strengthen the institutional capacity-building Action
Agencies at all levels in government departments, with the support of efforts to meet the basic medical insurance for urban residents of the need for the development of the cause,
Strengthening institution-building, enrichment would force the implementation of governance, the configuration of facilities, carry out personnel training. Actively explore building
Li and services and people linked to the business of staffing and funding mechanism of protection mechanisms, the establishment of medical insurance management services
Reward and punishment mechanism. Study and formulate medical insurance management services technical standards, would achieve the standardization of governance, information technology, the
Of the industry.
(B) to enhance community building platform for labor and social security work
To expand community of urban residents in the basic medical insurance management services, for support of the relevant units in a timely manner for the community
Labor and social security work platform equipped with appropriate staff to ensure that the work for. Agencies should strengthen community management staff of medical insurance
Training. Community platform for labor and social security of staff working in agencies under the guidance, seriously carry out urban residents are insured
In the first instance and pay the standard registration and enrollment, based on information collected entry and policy advocacy work.
(C) specification - a point of order management services
Provincial agencies to the urban residents in accordance with the national basic medical insurance management services requirements, guidance and Manpower region
Formulate a unified business point of order and governance, including registration of participants, premium collection, treatment management, billing and reimbursement of expenses, such as
Various services - the handling process, participants affairs officer for the need to provide certificate information and agencies
The audit governance responsibilities. Manpower regional agencies through effective channels to open procedures, supervision of telephone opened, the establishment of
Improve the admissibility of complaints mechanism.
(D) To strengthen the building of information systems
Information systems throughout the building to follow Jinbaogongcheng unified plan, and effectively play its information network and database based on the role.
According to the basic medical insurance for urban residents running governance needs of existing urban workers in the basic medical insurance system based on the increase
Established the basic medical insurance for urban residents governance functions. Establish and improve connectivity community work platform of labor and social security information network and develop
Community work platform for labor and social security system. Exploration and public security, civil affairs, health, medicine, people with disabilities, and other information management systems
Networking, the establishment of urban residents in the community of public service information sharing platform.
(5) to strengthen the building of basic data and statistical analysis
Agencies at all levels in accordance with the characteristics of urban residents and establish the basis of accounting, strengthen basic data collection and maintenance, security
Impaired participants Personal information security. Establish and improve the basic medical insurance for urban residents of the professional file management system, properly preserved
All types of files.
The establishment of urban residents in the basic medical insurance system statistics. Labour and Social Security, together with other relevant departments to develop uniform
Table, agencies at all levels should be in accordance with the requirements of timely, complete, and accurate reporting.
According to agencies at all levels of urban residents enrollment, payment, financial assistance, the flow of medical treatment, medical expenses, and the sentinel
Corporate governance and other information, comprehensive analysis, the establishment of operational analysis and risk early warning system, regularly to the same level of Labor and Social Security
Administrative departments and higher-level departments in charge of business analysis and submit the report.
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