Commercial insurance agency handling basic medical insurance pilot expansion

In order to accelerate the diversification of management mode in our province of our province in the basic health insurance, conscientiously sum up the pilot experience, to further expand the commercial insurance agency orgnaization of urban and rural residents basic medical insurance services, the scope of the pilot, Huangnan, Guoluo Prefecture into commercial insurance agency orgnaization of urban and rural residents basic health care services in the scope of the pilot. August 1st to start the pilot work.

pilot area government to open tender to determine the commercial insurance institutions. The service fee shall be arranged by the local government. Government departments are responsible for: the pilot area government to develop specific programs for urban and rural residents medical insurance services, commissioned management agreements and other supporting documents. The Department of human resources and social security is responsible for the collection and payment of medical insurance for urban and rural residents. In accordance with the proportion of 30% of the first instance of the application materials for review, the violation of the double line indicators of hospitals and doctors in accordance with the provisions of the appropriate punishment. The commercial insurance agencies responsible for urban and rural residents medicare hospitalization expenses and medical expenses of insured people special audit services, in accordance with the proportion of 100% medical expenses and review the original list, the result of the examination and the designated hospitals violations submitted to the government health insurance administration review. To provide a risk assessment report, through the establishment of medical expenses warning line, set the doctor warning line, to strengthen the supervision and treatment of medical institutions and medical expenses. Due to the illegal operation of commercial insurance institutions, audit lax caused by the loss of health insurance funds, to bear the corresponding economic responsibility.

 

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