Commercial insurance agencies participate in new rural cooperative laws

On April 19, the Ministry of Health, the China Insurance Regulatory Commission, the Ministry of Finance, and the State Council's Office of the Leading Group for the Deepening of the Medical and Health System Reform jointly issued the Guiding Opinions on the Participation of Commercial Insurance Institutions in the Management of New Rural Cooperative Medical Services, and standardized the participation of commercial insurance institutions in new farmers. Joint management services.

■ Adhering to the government-led and strict management requirements for access to the “Guidance Opinions” and adhering to the government-led principle, the health and finance departments should work together with the insurance regulatory authorities in the selection of commercial insurance agencies, and reasonably determine the entrusted fees. The coordinating regional health departments shall randomly check the medical insurance institutions' auditing medical expenses. The proportion of inpatients shall not be less than 10%, and the number of outpatients shall not be less than 3%. It is necessary to actively explore the establishment of commercial insurance institutions to strengthen the mechanism for reviewing the responsibility for medical expenses, improve the entrusted payment mechanism and service quality assessment methods, and actively explore and improve the exit mechanism for commercial insurance agencies to handle new rural cooperative services.

The "Guidance Opinions" propose that commercial insurance agencies participating in the service of the new rural cooperative medical service should obtain qualifications for health insurance business, set up branches in co-ordination areas, have a complete service network, and be able to establish a team of professional supervisors with a medical professional background. In addition, an immediate checkout point is set up at a designated medical institution, and a medical institution that has the conditions for a long-term immediate report may not set a checkout point. The commercial insurance institution mainly undertakes the work of participating in information entry, consulting personnel's visit information and medical expenses review, reimbursement, settlement, payment, etc., and assists the health department in the supervision of designated medical institutions.

■Strengthen supervision and management to improve the quality of the “Guiding Opinions” stipulates that commercial insurance agencies should set up new rural cooperative fund expenditure households to settle pharmaceutical costs to designated medical institutions, pay compensation fees to participating staff, and allocate funds to new rural cooperative financial special accounts. The account funds interest. If a commercial insurance institution causes losses to the new rural cooperative fund due to illegal operation or lax review, it shall bear the corresponding economic responsibility.

The "Guidance Opinions" require that, in the process of finding out that a designated medical institution has improper medical behavior, the commercial insurance institution shall report to the health department in time and handle it in accordance with relevant regulations. It is necessary to explore the use of a unified information system and vertical management system of commercial insurance agencies to facilitate the participation of medical personnel in settlement and expense audits in different places, and to conduct centralized audits and payments for the designated medical institutions outside the region.

Commercial insurance companies can provide commercial supplementary medical insurance on a voluntary basis. However, the new rural cooperative medical officer shall not engage in the marketing of commercial supplementary medical insurance products, and may not use the new rural cooperative insurance to reimburse and sell indiscriminately or disguise the commercial supplementary medical insurance products in disguised form.