Notice On Strengthening The Agreement Management Work Of Medical Insurance For Work-Related Injury Insurance

Notice on strengthening the agreement management work of medical insurance for work-related injury insurance

The departments of labor and social security (bureaus), health departments (bureaus) and Chinese medicine administrations of all provinces, autonomous regions and municipalities directly under the Central Government:

When workers suffer from accidents or occupational diseases, they are provided with medical insurance through work-related injury insurance.

An important part of the insurance system.

To do well in the agreement management of medical insurance for work-related injury insurance is conducive to ensuring the enjoyment of workers' injuries according to law.

The rights and interests of medical services are conducive to strengthening the management of industrial injury insurance funds, regulating medical behavior and promoting health in China.

Industry development.

All localities should fully understand the importance of strengthening the medical service for industrial injury insurance from the perspective of putting people first and building a harmonious socialist society.

The importance of the management of the agreement.

According to the regulations on industrial injury insurance and the relevant laws and regulations of the state, we will strengthen industrial injury insurance.

The notification for the management of the insurance medical service agreement is as follows:

I. to clarify the way of management of medical insurance service agreements for industrial injury insurance, and strictly grasp the conditions of medical insurance institutions for work-related injury insurance agreements.

Work-related injury insurance implements an agreement medical service mode.

On the basis of open, fair and equal consultation, social insurance agencies

The agency signed a medical service agreement with a qualified medical institution.

Name of work-related injury insurance medical institution

It should be announced to the public in an appropriate way.

The medical insurance institutions must have the following basic conditions:

(1) medical institutions approved by the health and Chinese medicine administrative departments and obtained the practice license of medical institutions, and

Military medical institutions that provide services to the community through local health administration departments;

(two) having the conditions for providing good medical services to the injured workers, in respect of industrial injury treatment, rehabilitation and occupational disease prevention and control.

It has professional and technical advantages.

(three) comply with the state regulations and standards concerning the management and prevention of medical services and occupational diseases, and have sound and sound medical services.

Management system;

(four) comply with the price policy of medical services and pharmaceuticals stipulated by the price control departments of the state and provinces, autonomous regions and municipalities directly under the central government;

(five) abide by the laws and regulations of industrial injury insurance.

Two, conscientiously strengthen the medical management of work-related injury workers.

After work-related injuries, workers should be treated at the agreed medical institutions in the areas where they are co-ordinate.

Rescue workers should be treated by medical institutions, and workers with industrial injuries outside the co-ordination area may choose the agreed medical institutions at the place where accidents happen.

Treatment.

In the absence of a co-ordinate agreement for the medical workers to be treated by the medical institutions, the employing units shall report to the agencies in time the injured workers.

The situation and treatment of medical institutions, and wait until the condition is stable, turn back to the medical treatment institutions in the area as a whole.

The injured workers need to be treated because of the recurrence of old injuries. The employer shall apply to the agency for diagnosis based on the diagnosis of the medical institution.

Please, after approval, be included in the scope of industrial injury insurance medical service management.

Employers, work-related injury workers and agencies need to deal with disputes arising from the treatment of old wound recurrence.

The diagnosis of the constitution was confirmed after the appraisal by the labor capacity appraisal committee.

Three. Define the responsibilities of the medical service main body of the industrial injury insurance agreement.

The agencies should strengthen the management, supervision and inspection of the medical expenses for work-related injury insurance according to the agreement.

In accordance with the stipulations and agreements, medical expenses for workers in industrial accidents should be paid in time, and medical expenses management system for work-related injury insurance should be established and improved.

Statistical analysis of expenses and regular hearing of medical institutions' views on improvement; coordination agreements.

Matters relating to industrial injury insurance and medical services of medical institutions and employers and work-related injury workers.

Work-related injury insurance agreement, medical institutions should identify specialized agencies and provide specialized (Part-time) staff, establish and improve the internal management system.

Do well the propaganda and training of medical workers' industrial injury insurance policies and regulations; strictly implement the catalogue of work-related injury insurance programs and drug list.

And the standard of hospitalization service, we should achieve reasonable inspection, reasonable treatment, rational drug use, reasonable charges, and make good preparations in accordance with the agreement.

Management of work-related injuries and medical expenses, and submit the checklist for workers' expense on time.

In time, the relevant medical materials such as medical certificate should be issued.

In case of any of the following situations, the two parties may terminate the agreement:

(1) when the agreement expires, one of the parties proposes to terminate the agreement.

(two) during the execution of the agreement, one party violates the agreement and the two sides can not reach an agreement through consultation.

(three) the agreement can not be fulfilled because of the merger and dissolution of the medical institution.

If a medical institution considers that the agency fails to fulfill the relevant agreement or regulation, it may apply for administrative reconsideration according to law, and shall make an administrative reply.

Those who refuse to accept reconsideration may bring lawsuits in accordance with the law.

Four. Standardize the cost management of medical service in work-related injury insurance agreements.

The level of medical insurance for industrial injury insurance should be compatible with the level of economic and social development in China at present.

The reasonable needs of treatment should also ensure the rational use of industrial injury insurance funds.

Provisions on the management of work-related injuries, such as the catalogue of drugs for occupational injury insurance, the catalogue of treatment items and the standards of hospitalization service, etc.

Medical expenses and rehabilitation expenses, including workers' work injuries, have been paid by medical insurance funds, employers or employees.

Medical expenses for work-related injuries shall be paid by the agencies from the industrial injury insurance fund.

The expenses incurred by the workers in the treatment of non occupational injuries and the expenses that will continue to occur if they refuse to discharge from the hospital.

The expenses incurred in the treatment of other medical institutions and other relevant provisions of industrial injury insurance without approval by the agencies.

The industrial injury insurance fund will not be paid.

The workers who are injured in industrial accidents have been treated in accordance with the regulations on the handling of medical accidents.

Five. Strengthen the leadership of the agreement management work on medical service for work-related injuries.

Labor security, health and Chinese medicine administrative departments at all levels should actively organize, coordinate and supervise their respective functions.

We should work closely together to do well in the work of agreement management of industrial injury insurance medical services.

We should seriously carry out industrial injury insurance policy.

The publicity and training of the policy should give full play to the enthusiasm and initiative of the employers in the medical service of industrial injury insurance, and mobilize and guide them.

The employing units shall assist the agencies and the medical institutions concerned to do well the related management and service work of the injured workers.

Major in implementation

Please report to the labor security, health and Chinese medicine management departments in time.

February 27th, two, seven