The "Medical Security Law" began to solicit public opinion and stipulated many contents such as financing and treatment, fund management, medical services, etc.
6 items including health check-ups are not included in medical insurance
Yesterday, the National Medical Insurance Bureau issued an announcement on its official website to formally solicit opinions from the public on the "Medical Security Law (Draft for Comment)."
A reporter from Beijing Youth Daily noted that the draft for comments emphasized that six medical expenses are not included in the scope of payment by the basic medical insurance fund, including health care consumption and health check-up expenses.
The deadline for comments is July 16, 2021.
Participants are not allowed to participate in medical insurance repeatedly
The consultation draft stipulates a number of contents such as the financing and benefits of medical insurance, fund management, medical services, public management services, supervision and management, and legal responsibilities.
According to the draft, state agencies, enterprises, public institutions, social organizations, individual industrial and commercial households with hired workers and other employers and their employees shall participate in the basic medical insurance for employees; those who have not participated in basic medical insurance for employees or have not enjoyed other medical insurance in accordance with regulations Personnel participate in basic medical insurance for urban and rural residents in accordance with the law; individual industrial and commercial households without employees, part-time employees who are not in the employer’s basic medical insurance for employees, and other flexible employees are encouraged to participate in basic medical insurance for employees.
At the same time, it is emphasized that insured persons shall not participate in the basic medical insurance repeatedly.
6 items of medical expenses are not included in medical insurance
A reporter from the Beijing Youth Daily noted that the draft for comments emphasized that 6 medical expenses were not included in the payment scope of the basic medical insurance fund.
These include those that should be paid from the work-related injury insurance fund; those that should be borne by a third party; those that should be borne by public health; those who seek medical treatment abroad; sports fitness, health care consumption, and health check-ups; the basic medical insurance fund stipulated by the state is not allowed Other expenses paid.
At the same time, when encountering a major impact on economic and social development, the scope of non-payment of the basic medical insurance fund can be adjusted temporarily after legal procedures.
In terms of financing, the draft for comments pointed out that the basic medical insurance premiums for employees should be paid jointly by the employer and the employees, and the employer's unified withholding and payment system shall be implemented.
For flexible employees who participate in the basic medical insurance for employees as an individual, the basic medical insurance premiums shall be paid by the individual.
The basic medical insurance premiums for urban and rural residents shall be borne jointly by finance and individuals.
Those who enjoy the minimum living security, those who are included in the scope of assistance and support for the extremely poor, the disabled who are incapacitated, the elderly and minors from low-income families over 60 years of age, and other individuals who participate in the basic medical insurance for urban and rural residents, shall be paid by the individual The government gives subsidies.
In addition, people with multiple identities will be subsidized in accordance with the highest remuneration that can be enjoyed, and the subsidy may not be repeated.
Individuals defrauding medical insurance to be fined
The draft for comments also clarifies that if a designated medical institution has irregular use of the medical security fund, the medical security administrative department shall order it to make corrections, and may interview the relevant person in charge; if the medical security fund is damaged, it shall be ordered to be returned and the amount of the loss caused shall be imposed1 If it refuses to make corrections or causes serious consequences, the designated medical institution shall be ordered to suspend the medical services used by the medical security fund for 6 months to 1 year by the relevant responsible department.
For designated medical institutions and their staff to defraud the medical security fund expenditures, the medical security administrative department shall order the refund and impose a fine of 2 times to 5 times the amount defrauded; order the designated medical institutions to suspend the relevant responsible departments for 6 months to 1 year Medical services involving the use of the medical security fund until the service agreement is terminated by the medical security agency; if there is a qualification, the relevant competent authority shall revoke the qualification in accordance with the law.
If a designated medical institution violates the provisions of this law and causes major losses to the medical security fund or other serious adverse social impacts, the medical security administrative department shall impose on its legal representative or main person in charge the previous year’s 50% or more of the income from the unit 1 times The following fines shall be prohibited from engaging in management activities of designated medical institutions within 5 years, and shall be punished by relevant departments in accordance with the law.
If an individual commits acts such as handing over his medical security certificate to others for false use, re-enjoying medical insurance benefits, etc., the medical security administrative department shall order correction; if it causes loss of medical security fund, it shall be ordered to return; if it belongs to the insured person, its medical expenses shall be suspended Online settlement is 3 to 12 months.
At the same time, if an individual defrauds the expenditure of the medical security fund, in addition to dealing with the provisions of the preceding paragraph, the medical security administrative department shall also impose a fine of 2 times to 5 times the amount of fraud.
Text/Reporter Xie Li