Guiding opinions on commercial insurance institutions participating in the new rural cooperative medical service

Hello, the law stipulates the Social Insurance Law of People's Republic of China (PRC), but the following documents are the main legal basis.

Notice of the General Office of the State Council on Forwarding the Opinions of the Ministry of Health and Other Departments on Establishing a New Rural Cooperative Medical System

Guo Ban Fa [2003] No.3

People's governments of all provinces, autonomous regions and municipalities directly under the Central Government, ministries and commissions and institutions directly under the State Council:

The opinions of the Ministry of Health, the Ministry of Finance and the Ministry of Agriculture on establishing a new rural cooperative medical system have been approved by the State Council and are hereby forwarded to you. Please implement it carefully.

2003 1 month 16

My opinion on establishing a new rural cooperative medical system

Ministry of Health, Ministry of Finance and Ministry of Agriculture

(2003 1 month 10)

The establishment of a new rural cooperative medical system is an important part of rural health work in the new period, and it is a concrete embodiment of practicing Theory of Three Represents, which is of great significance to improving farmers' health level, promoting rural economic development and maintaining social stability. According to the Decision of Central the State Council on Further Strengthening Rural Health Work (Zhong Fa [2002]13), we hereby put forward the following opinions.

I. Objectives and principles

The new rural cooperative medical system is a medical assistance system for farmers, which is organized, guided and supported by the government, with farmers participating voluntarily, and financed by individuals, collectives and the government. From 2003 onwards, all provinces, autonomous regions and municipalities directly under the Central Government should choose at least 2-3 counties (cities) to carry out pilot projects first, and gradually push them away after gaining experience. By 20 10, we will achieve the goal of establishing a new rural cooperative medical system covering rural residents throughout the country, reduce the economic burden of farmers due to illness, and improve their health level.

The establishment of a new rural cooperative medical system should follow the following principles:

(a) voluntary participation, multi-party financing. Farmers voluntarily participate in the new rural cooperative medical system with their families as a unit, abide by relevant rules and regulations, and pay cooperative medical funds in full and on time; The township (town) village collective should give financial support; The central and local governments at all levels should arrange certain special funds to support them every year.

(2) Support by income to ensure moderation. The new rural cooperative medical system should adhere to the principle of balance of payments, which not only ensures the continuous and effective operation of this system, but also enables farmers to enjoy the most basic medical services.

(three) pilot, and gradually promote. The establishment of a new rural cooperative medical system must proceed from reality, sum up experience through pilot projects, constantly improve and develop steadily. With the development of rural social economy and the increase of farmers' income, the socialization and anti-risk ability of the new rural cooperative medical system should be gradually improved.

Second, organization and management.

(a) the new rural cooperative medical system is generally coordinated by the county (city). Where the conditions are not available, the township (town) can also make overall planning at the initial stage and gradually transition to the county (city).

(two) in accordance with the principle of streamlining and high efficiency, the establishment of a new rural cooperative medical system management system. Provincial and municipal people's governments set up rural cooperative medical care coordination groups composed of health, finance, agriculture, civil affairs, auditing and poverty alleviation departments. Health administrative departments at all levels should set up special rural cooperative medical management institutions, in principle, do not increase the establishment.

The people's government at the county level shall set up a rural cooperative medical management committee composed of relevant departments and farmers' representatives who participate in cooperative medical care, and be responsible for the relevant organization, coordination, management and guidance. The Committee has an agency responsible for specific business work, and its personnel are adjusted by the people's government at the county level. According to the needs in the township (town) can set up institutions (personnel) or entrust the relevant agencies to manage. The personnel and working funds of the agency shall be included in the financial budget at the same level, and shall not be extracted from the rural cooperative medical fund.

Three. Funding standard

The new rural cooperative medical system implements a financing mechanism that combines individual contributions, collective support and government funding.

(a) the annual payment standard of individual farmers is not less than 10 yuan, and the payment standard can be raised in areas with good economic conditions. Whether the employees of township enterprises (excluding those who participate in the new rural cooperative medical system with farmers' families as the unit) participate in the new rural cooperative medical system shall be determined by the people's government at the county level.

(two) conditional rural collective economic organizations should give appropriate support to the local new rural cooperative medical system. The types of rural collective economic organizations supporting the new rural cooperative medical system and the standard of capital contribution shall be determined by the people's government at the county level, but the collective capital contribution shall not be apportioned to farmers. Encourage social organizations and individuals to fund the new rural cooperative medical system.

(three) the local financial subsidies to farmers participating in the new rural cooperative medical system every year are not less than per capita 10 yuan, and the specific subsidy standards and grading burden ratio are determined by the provincial people's government. In the economically developed eastern region, local governments at all levels can appropriately increase investment. Since 2003, the central government has arranged per capita 10 yuan subsidy funds for farmers participating in the new rural cooperative medical system in the central and western regions except cities and towns through special transfer payments every year.

Fourth, fund management.

Rural cooperative medical fund is a private social fund with voluntary contributions from farmers, collective support and government contribution. Management should be carried out in accordance with the principles of revenue and expenditure, balance of payments and openness, fairness and justice. Must be earmarked, special storage, shall not be misappropriated.

(a) the rural cooperative medical fund is managed by the rural cooperative medical management committee and its dispatched offices. Rural cooperative medical care agencies should set up special accounts for rural cooperative medical care funds in state-owned commercial banks recognized by the CMC to ensure the safety and integrity of funds, establish and improve the rules and regulations for the management of rural cooperative medical care funds, reasonably raise and timely review and pay rural cooperative medical care funds according to regulations.

(II) The individual contributions of farmers and the funds supported by rural collective economic organizations in the rural cooperative medical fund shall, in principle, be collected annually by the agency (personnel) established by the rural cooperative medical service agency in the township (town) or entrusted by relevant institutions and deposited in the special account of the rural cooperative medical fund; Local financial support funds shall be allocated to the special account of rural cooperative medical fund by local financial departments at all levels according to the actual number of people participating in the new rural cooperative medical system; The special funds for the central government to subsidize the new rural cooperative medical system in the central and western regions shall be approved by the Ministry of Finance according to the actual number of people participating in the new rural cooperative medical system in each region and the availability of funds, and allocated to the provincial finance. The central and local governments at all levels should ensure that the subsidy funds are allocated to the special account of rural cooperative medical care fund in time and in full, and gradually improve the allocation method of subsidy funds through the pilot project of new rural cooperative medical care, simplifying the procedures as much as possible and facilitating the operation. It is necessary to combine the reform and improvement of the financial treasury management system and gradually realize direct financial payment. The specific subsidy measures for new rural cooperative medical care funds shall be studied and formulated by the Ministry of Finance in consultation with relevant departments.

(three) the rural cooperative medical fund is mainly used to subsidize the large medical expenses or hospitalization expenses of farmers participating in the new rural cooperative medical system. Where conditions permit, a combination of large medical expenses subsidies and small medical expenses subsidies can be implemented, which not only improves the ability to resist risks, but also takes into account the interests of farmers. Arrange a routine physical examination for farmers who have participated in the new rural cooperative medical system and have not used the rural cooperative medical fund during the year. All provinces, autonomous regions and municipalities directly under the central government should formulate a list of basic drugs for reimbursement of rural cooperative medical care. Counties (cities) should scientifically and reasonably determine the payment scope, payment standard and amount of rural cooperative medical fund according to the total amount of funds raised and local conditions, and determine the specific inspection items and methods of routine physical examination to prevent the rural cooperative medical fund from overspending or excessive balance.

(four) to strengthen the supervision of rural cooperative medical fund. Rural cooperative medical institutions should regularly report to the rural cooperative medical management committee on the income and expenditure and use of rural cooperative medical funds; Take measures such as posting, regularly announce the specific income and expenditure and use of rural cooperative medical fund to the society, and ensure the participation, information and supervision rights of participating farmers. The people's government at the county level may, according to local conditions, set up a rural cooperative medical supervision committee composed of relevant government departments and farmers' representatives who participate in the cooperative medical system, and regularly inspect and supervise the use and management of rural cooperative medical funds. The rural cooperative medical management committee shall regularly report its work to the supervision committee and the people's congress at the same level, and take the initiative to accept supervision. The audit department shall regularly audit the income and expenditure and management of the rural cooperative medical fund.

Verb (abbreviation of verb) medical service management

Strengthen the construction of rural health service network, strengthen the industry management of rural medical and health institutions, actively promote the reform of rural medical and health system, and constantly improve the ability and level of medical and health services so that farmers can get better medical services. All regions should choose rural cooperative medical service institutions in rural health institutions according to the situation, strengthen supervision and implement dynamic management. It is necessary to improve and implement various diagnosis and treatment norms and management systems, ensure service quality, improve service efficiency and control medical expenses.

Organization and implementation of intransitive verbs

(a) the people's governments at the provincial level should formulate measures for the management of the new rural cooperative medical system, select pilot counties (cities) in line with the principle of farmers' high enthusiasm for participating in insurance, strong financial affordability and good management foundation, and actively and steadily carry out the pilot work of the new rural cooperative medical system. The focus of the pilot work is to explore the management system, financing mechanism and operation mechanism of the new rural cooperative medical system. The people's governments at the county level shall formulate specific plans, and the relevant departments at all levels shall organize their implementation under the unified leadership of the people's governments at the same level.

(2) Effectively strengthen the publicity and education of the new rural cooperative medical system, adopt various forms to publicize the significance of the new rural cooperative medical system and local specific practices, guide farmers to continuously enhance their awareness of self-care and mutual assistance, and mobilize farmers to actively participate in the new rural cooperative medical system voluntarily. The payment obligations performed by farmers participating in cooperative medical care cannot be regarded as increasing the burden on farmers.

Establishing a new rural cooperative medical system is an effective way to help farmers resist the risk of major diseases and an important measure to promote the reform and development of rural health, with strong policies and arduous tasks. All regions and relevant departments should attach great importance to it, strengthen leadership, implement policies and measures, do a good job in pilot projects, sum up experience, and actively and steadily do this work.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.