Provisions for Supervision of Drug Distribution
Commissioner of SFDA
Provisions for Supervision of Drug Distribution
(SFDA Decree No.26)
The Provisions for Supervision of Drug Distribution, adopted at the executive meeting of the State Food and Drug Administration on December 8, 2006, is hereby promulgated and shall go into effect as of May 1, 2007.
Shao Mingli
Commissioner of SFDA
January 31, 2007
Provisions for Supervision of Drug Distribution
Chapter I
Article 1 These Provisions are formulated for the purposes of strengthening drug supervision, regulating drug distribution order and ensuring drug quality in accordance with the Drug Administration Law of the People’s Republic of China (hereinafter referred to as Drug Administration Law), the Regulations for Implementation of the Drug Administration Law of the People’s Republic of China (hereinafter referred to as Regulations for Implementation of the Drug Administration Law) and the requirements of the relevant law and regulations.
Article 2 Any institutions or individuals engaged in the purchase, sales and supervision of drugs in the People’s Republic of China shall abide by the Provisions.
Article 3 Drug manufacturers, distributors and medical institutions shall be responsible for the quality of the drugs that they produce, distribute or use.
Drug manufacturers and distributors shall carry out reforms and innovations in the direction of pharmaceutical logistics provided that drug quality is assured.
Article 4 The drug regulatory departments encourage individuals and organizations to involve in the social supervision on drug distribution. Individuals or organizations have the right to report or accuse of any violation of the Provisions to the drug regulatory departments.
Chapter II Supervision on Drug Purchase and Sales by Manufacturers and Distributors
Article 5 Drug manufacturers or distributors shall be responsible for their drug purchases and sales, and liable for the purchases and sales activities of their sales staff or offices in the name of their enterprise.
Article 6 Drug manufacturers or distributors shall train their purchase and sales staff on drug related laws, regulations and professional knowledge, and establish training records including time, venue, content and trainees.
Article 7 Drug manufacturers or distributors shall strengthen the management of the sales staff and set up specific rules for their sales behaviors.
Article 8 Drug manufacturers or distributors shall not store or spot trade drugs on the premises not approved by the drug regulatory departments.
Article 9 Drug manufacturers shall sell drugs that they produce in the name of themselves, and shall not sell any drug that they produce for contract manufacturing or any drugs produced by others.
Article 10 Where a drug manufacturer or wholesaler sells drugs, it shall provide the following materials:
(1) Copies of the Drug Manufacturing Certificate or Drug Supply Certificate, stamped with the seal of the enterprise, and the business license;
(2) Copies of the approval documents for the drug to be sold, stamped with the seal of the enterprise ;
(3) For import drug sales, relevant proof documents should be provided in accordance with the related provisions of the State.
Where a drug manufacturer or wholesaler sends any of its sales staff to sell drugs, it shall, in addition to the materials prescribed in the previous paragraph of this Article, provide a copy of the authorization letter with the seal of the enterprise. The original authorization letter shall contain the authorized drugs, regions and time of validity for drug sales, indicate the identity card numbers of the sales staff, and be stamped with the enterprise seal and legal representative seal (or signature). The sales staff shall show the original authorization letter and identity card for the check by drug purchasers.
Article 11 Where a drug manufacturer or wholesaler sells drugs, it shall provide sales document indicating supplier’s name, drug name, manufacturer, batch number, quantity, price, etc.
Where a drug retailer sells drugs, it shall provide sales document indicating drug name, manufacturer, quantity, price, batch number, etc.
Article 12 Where a drug manufacturer or distributor purchases drugs, it shall request, examine and retain the relevant certificates and documents of the supplier in accordance with the requirements set forth in Article 10 of the Provisions, and request and retain sales document in accordance with the requirements set forth in Article 11 of the Provisions.
The documents retained by the drug manufacturer or distributor in accordance with the previous paragraph of this Article shall be kept till one year after the date of expiry, but not less than three years.
Article 13 Where a drug manufacturer or distributor knows or should know that any person without certificates produces or distributes drugs, it shall not provide the person with any drug.
Article 14 A drug manufacturer or distributor shall not provide premises, qualifications documents, notes, etc. as conveniences for others to distribute drugs in its own name.
Article 15 A drug manufacturer or distributor shall not spot trade drugs by means of exhibition, exposition, trade fair, commodity fair or product promotion event.
Article 16 A drug distributor shall not purchase or sell pharmaceutical preparations prepared by medical institutions.
Article 17 A drug distributor shall not change its distribution mode without approval of the drug regulatory department.
A drug distributor shall operate within the approved distribution scope in the Drug Supply Certificate.
Article 18 A drug retailer shall, pursuant to the requirements of drug classification regulations set forth by the State Food and Drug Administration, sell prescription drugs in the presence of prescriptions.
Any drug retailer selling prescription drugs or Class A non-prescription drugs shall, in the absence of its licensed pharmacists and other qualified pharmaceutical professionals, put up a public notice and stop selling prescription drugs and Class A non-prescription drugs.
Article 19 For drugs that need low-temperature or cold storage as specified in drug insert sheets, the drug manufacturer or distributor shall transport and store the drugs with low-temperature or cold storage facilities in accordance with the relevant provisions.
When finding any drug manufacturer or distributor violates the requirements in the previous paragraph of this article, the drug regulatory department shall seal up or seize the drugs concerned immediately and deal with the matter in accordance with law.
Article 20 A drug manufacturer or distributor shall not provide the public with prescription drug or Class A non-prescription drug by means of tie-in sale, offering free drugs in association with sales of drug or commodity sale, etc.
Article 21 A drug manufacturer or distributor shall not sell prescription drugs directly to the public by post or over internet.
Article 22 Any illegal purchase of drugs is prohibited.
Chapter III Supervision on Drug Purchase and Storage by Medical Institutions
Article 23 The pharmacy established by a medical institution shall have the premise, equipment, storage facilities, hygienic environment, and pharmaceutical professionals required for drug dispensing. It shall also have the drug quality control units or personnel, and establish a system for drug storage.
Article 24 Where a medical insititution purchases drugs, it shall request, examine and retain the relevant certificates, documents and notes of the supplier in accordance with the requirements set forth in Article 12 of the Provisions.
Article 25 Where a medical institution purchases drugs, it shall establish and apply an examination and acceptance system, and keep authentic and complete purchase records. Purchase records shall indicate the adopted name of the drug in China, manufacturer (for Chinese crude drug, the origin should be noted), dosage form, date of expiry, drug approval number, supplier, quantity, price and date of purchase.
Drug purchase records shall be kept till one year after the date of expiry, but not less than three years.
Article 26 A medical institution shall establish and apply a system for drug storage and maintenance, and take necessary measures to ensure drug quality, such as cold storage, protection against freeze and humidity, ventilation, moisture proof, protection from direct light and fire, and avoidance of insects and rodents.
A medical institution shall store drugs and non-drug products separately; Chinese crude drugs, prepared slices of Chinese crude drugs, pharmaceuticals, and traditional Chinese medicine preparations shall be stored separately by category.
Article 27 A medical institution or family planning technical service institution shall not directly provide drugs for patients without diagnosis or treatment.
Article 28 A medical institution shall not sell prescription drugs directly to the public by post or over internet.
Article 29 Where a medical institution purchases drugs via a centralized tendering, it shall comply with the relevant requirements of the Drug Administration Law, Regulations for Implementation of the Drug Administration Law and the Provisions.
Chapter IV Legal Liabilities
Article 30 In any of the following circumstances, the drug manufacturer or distributor shall be instructed to rectify within a time limit and given a disciplinary warning; and if the drug manufacturer or distributor fails to do so, it shall be fined not less than RMB 5,000 yuan but not more than RMB 20,000 yuan:
(1) any drug manufacturer or distributor in violation of Article 6 of the Provisions;
(2) any drug manufacturer or wholesaler in violation of the first paragraph of Article 11 of the Provisions;
(3) any drug manufacturer or distributor, in violation of Article 12 of the Provisions, failing to keep the relevant documents as required.
Article 31 Any drug manufacturer or distributor in violation of Article 7 of the Provisions shall be given a disciplinary warning and instructed to rectify within a time limit.
Article 32 In accordance with the provisions in Article 73 of the Drug Administration Law, in any of the following circumstances, the drugs illegally sold and the illegal gains therefrom shall be confiscated, and the drug manufacturer or distributor shall be fined not less than two times but not more than five times the value of the drugs illegally sold:
(1) any drug manufacturer or distributor, in violation of Article 8 of the Provisions, spot trading drugs on the premises not approved by the drug regulatory departments.
(2) any drug manufacturer in violation of Article 9 of the Provisions;
(3) any drug manufacturer or distributor in violation of Article 15 of the Provisions;
(4) any drug distributor in violation of Article 17 of the Provisions.
Article 33 Any drug manufacturer or distributor, in violation of Article 8 of the Provisions, storing drugs on the premises not approved by the drug regulatory departments，shall be punished pursuant to the provisions in Article 74 of the Regulations for Implementation of the Drug Administration Law.
Article 34 Any drug retailer in violation of the provisions in the second paragraph of Article 11 of the Provisions shall be instructed to rectify and given a disciplinary warning; and if the drug retailer fails to do so within a time limit, it shall be fined not more than RMB 500 yuan.
Article 35 Where a drug manufacturer or distributor, in violation of Article 13 of the Provisions, knows or should know that any person without certificates produces or distributes drugs, but still provide the person with drugs, they shall be given a disciplinary warning, instructed to rectify and fined not more than RMB 10,000 yuan. If the circumstances are serious, they shall be fined not less than RMB 10,000 yuan but not more than RMB 30,000 yuan.
Article 36 Drug manufacturers and distributors in violation of Article 14 of the Provisions shall be punished pursuant to the provisions in Article 82 of the Drug Administration Law.
Article 37 Where a drug distributor, in violation of Article 16 of the Provisions, purchases or sells pharmaceutical preparations dispensed by medical institutions, it shall be punished pursuant to the provisions in Article 80 of the Drug Administration Law.
Article 38 Any drug retailer in violation of the first paragraph of Article 18 of the Provisions shall be instructed to rectify within a time limit and given a disciplinary warning; if it fails to do so or the circumstances are serious, it shall be fined not more than RMB 1,000 yuan.
Where a drug retailer, in violation of the second paragraph of Article 18 of the Provisions, sells prescription drugs or Class A non-prescription drugs in absence of licensed pharmacists or other qualified pharmaceutical professionals, it shall be instructed to rectify within a time limit and given a disciplinary warning; if it fails to do so, it shall be fined not more than RMB 1,000 yuan.
Article 39 Where a drug manufacturer or wholesaler, in violation of Article 19 of the Provisions, fails to transport drugs under low-temperature or cold storage conditions as specified in insert sheets, it shall be given a disciplinary warning and instructed to rectify within a time limit; if it fails to do as instructed, it shall be fined not less than RMB 5,000 yuan but not more than RMB 20,000 yuan. Where the drugs concerned are legally proved to be counterfeit or substandard drugs, the drug manufacturer or wholesaler shall be punished in accordance with the relevant provisions of the Drug Administration Law.
Where a drug manufacturer or wholesaler, in violation of Article 19 of the Provisions, fails to store drugs under low-temperature or cold storage conditions as specified in insert sheets, it shall be punished pursuant to the provisions in Article 79 of the Drug Administration Law. Where the drugs concerned are legally proved to be counterfeit or substandard drugs, the drug manufacturer or wholesaler shall be punished in accordance with the relevant provisions of the Drug Administration Law.
Article 40 Any drug manufacturer or distributor in violation of Article 20 of the Provisions shall be instructed to rectify within a time limit and given a disciplinary warning; if the drug manufacturer or distributor fails to do so or the circumstances are serious, they shall be fined not more than two times the value of the free drugs offered, but not more than RMB 30,000 yuan.
Article 41 Any institution, in violation of Article 23 to Article 27 of the Provisions, shall be instructed to rectify within a time limit; if the circumstances are serious, it shall be announced.
Article 42 Where a drug manufacturer or distributor in violation of Article 21 of the Provisions or a medical institution in violation of Article 28 of the Provisions sells prescription drugs directly to the public by post, over internet, etc., they shall be instructed to rectify, given a disciplinary warning, and fined not more than two times the value of the drugs sold, but not more than RMB 30,000 yuan.
Article 43 Any illegal purchase of drugs, in violation of Article 22 of the Provisions, shall be punished pursuant to the provisions in Article 73 of the Drug Administration Law.
Article 44 Where a drug regulatory department or its staff that neglects its duty fails to stop or punish illegal activities that should be stopped or punished, administrative sanctions shall be imposed to the person directly in charge and other persons directly responsible. If a crime is constituted, criminal liabilities shall be investigated in accordance with law.
Chapter V Supplementary Provisions
Article 45 Spot trading of drugs in the Provisions refers to the activity that drug manufacturers, distributors or their appointed sales staff carry and sell drugs to unspecified objects on spot other than the premises approved by the drug regulatory departments.
Article 46 With respect to the supervision on the distribution of specially controlled drugs, vaccines, and military medicines, if otherwise provided by the relevant laws, regulations and provisions, they shall prevail.
Article 47 The Provisions shall come into force as of May 1, 2007. As of the date when the Provisions goes into effect, the Provisions for Supervision of Drug Distribution (Interim) (SFDA Decree No.7) implemented on August 1, 1999 shall be annulled therefrom.
衡水市城镇职工基本医疗保险实施方案
河北省衡水市人民政府
关于印发《衡水市城镇职工基本医疗保险实施方案》的通知
衡水市人民政府
关于印发《衡水市城镇职工基本医疗保险实施方案》的通知
衡政〔2002〕8号
各县市区人民政府，开发区管委会，市直各部门，中省直驻衡有关单位：
《衡水市城镇职工基本医疗保险实施方案》已经市政府第20次常务会议讨论通过，并报经省政府批准，现印发给你们，望认真贯彻执行。
二○○二年一月九日
衡水市城镇职工基本医疗保险实施方案
第一章 总 则
第一条 根据《国务院关于建立城镇职工基本医疗保险制度的决定》（国发〔1998〕44号）和《河北省人民政府关于印发河北省城镇职工基本医疗保险制度总体规划的通知》（冀政〔1999〕12号）精神，结合本市实际情况，制定本方案。
第二条 城镇职工基本医疗保险制度改革的主要任务是：在全市范围内建立城镇职工基本医疗保险制度，即适应社会主义市场经济体制，根据财政、企业和个人的承受能力，建立保障职工基本医疗需求的社会医疗保险制度。
第三条 建立城镇职工基本医疗保险制度的原则是：基本医疗保险水平要与我市生产力发展水平相适应；城镇所有用人单位及其职工都要参加基本医疗保险，实行属地管理；基本医疗保险费由用人单位和职工双方共同缴纳，以收定支，收支平衡；基本医疗保险基金实行社会统筹和个人帐户相结合。
第四条 本方案适用于本市境内的城镇所有用人单位，包括国家机关、事业单位、社会团体、民办非企业单位和企业（国有企业、集体企业、股份制企业、外商投资企业、私营企业）及其职工、退休人员。乡镇企业及其职工、城镇个体经济组织业主及其从业人员原则上暂不参加基本医疗保险，待条件成熟后再逐步纳入基本医疗保险范围。
第五条 我市城镇职工基本医疗保险实行市、县（市、区）两级统筹，以后逐步过渡到全市统筹。县（市、区）实施办法由县（市、区）制定，报市人民政府审批。所有用人单位及其职工按照属地管理原则，参加所在地统筹地区的基本医疗保险。
第二章 医疗保险管理和经办机构职责
第六条 市劳动保障行政部门负责本市城镇职工基本医疗保险工作。主要工作职责是：
1、贯彻落实国家和省有关城镇职工基本医疗保险政策规定；
2、拟定本市医疗保险的有关政策规定；
3、会同卫生、医药等部门制定定点医疗机构和定点零售药店的资格审定办法，并负责对审查合格的医疗机构和零售药店颁发证书；
4、根据国家和省有关规定，组织有关部门制定本市城镇职工基本医疗保险的有关配套政策；
5、监督检查基本医疗保险政策法规的执行情况，加强对医疗保险工作的组织、协调；
6、受理有关医疗保险的争议；
7、对模范遵守或违反医疗保险政策、规定的单位和个人进行奖惩；
8、其他应由市劳动保障行政部门负责的工作。
第七条 医疗保险经办机构负责具体经办全市城镇职工基本医疗保险业务。其主要职责是：
1、负责基本医疗保险基金的筹集、管理和支付；
2、负责编制城镇职工基本医疗保险基金预决算；
3、负责执行行政部门授权或指派对定点医疗机构和定点零售药店有关业务事宜的决定，并按规定与定点医疗机构、定点零售药店签订医疗保险服务合同，同时对其有关业务工作给予指导和管理；
4、办理参保单位和职工参保的有关手续；
5、受理参保单位、职工有关医疗保险业务的查询；
6、提出改进和完善医疗保险工作的建议和意见；
7、做好相应的配套服务工作；
8、医疗保险经办机构接受劳动保障、财政、审计等行政部门和参保者的监督。
第三章 医疗保险基金的收缴和管理
第八条 城镇职工的医疗保险费，由用人单位和职工个人共同缴纳。
用人单位按本单位上年度职工工资总额的6%缴纳，职工按本人上年度工资总额的2%缴纳。
职工缴费月工资标准不得低于上年度职工统筹地区社会平均工资的60%，低于60%的以60%为缴费基数；也不得高于300%，高出部分免缴医疗保险费。
退休人员个人不缴纳医疗保险费。
第九条 医疗保险费缴纳标准的调整，由市人民政府根据省规定及本市经济发展、工资增长等因素适当调整，任何部门和单位不得擅自提高或降低。
基本医疗保险费的征缴，按照国务院《社会保险费征缴暂行条例》、劳动和社会保障部《社会保险费申报缴纳管理暂行办法》、《社会保险费征缴监督检查办法》执行。用人单位必须按月向医疗保险经办机构足额缴纳基本医疗保险费。
第十条 医疗保险费的缴纳方式，由医疗保险经办机构与用人单位签订合同，或委托开户银行从其帐户中扣缴。职工个人应缴纳的医疗保险费，由用人单位从其工资中代为扣缴。参保单位必须于每年6月30日前向医疗保险经办机构申报参保人员名单及其上年度职工月平均工资总额、养老金（退休金）总额，由医疗保险经办机构核定当年7月至次年6月缴费基数。
第十一条 用人单位未按规定缴纳和代扣医疗保险费的，医疗保险经办机构应当责令其限期缴纳；逾期仍不缴纳的，除补缴欠缴数额外，从欠缴之日起，按日加收2‰的滞纳金。滞纳金并入医疗保险统筹基金。
第十二条 国有企业下岗职工的基本医疗保险费，包括单位缴费和个人缴费，均由行业或企业再就业服务中心按照本市上年度职工月平均工资的60%为基数缴纳。
领取失业救济金期间的失业人员的基本医疗保险费，包括单位缴费和个人缴费，均由失业保险经办机构按照本市上年度职工月平均工资的60%为基数缴纳。
第十三条 依法宣告破产的用人单位，在清偿债务时，应当优先清偿所欠缴的基本医疗保险费和缴足退休人员以后所需（计算至70周岁）的基本医疗保险费。
用人单位合并、兼并、转让的，由承担其债权、债务的用人单位缴纳原用人单位欠缴的基本医疗保险费。
第十四条 用人单位应当向职工代表大会报告基本医疗保险费的缴纳情况，自觉接受用人单位工会和职工的监督。
第十五条 用人单位缴纳基本医疗保险费的列支渠道，党政机关和财政供给的事业单位由同级财政按原拨款渠道划拨；差额、自收自支事业单位和企业，从福利费中列支，福利费不足的部分，可以从公益金中列支，也可经同级财政部门核准后列入成本。
第十六条 医疗保险基金实行收支两条线管理，纳入财政专户，实行专项储存、专款专用，任何单位和个人不得挤占挪用。起步阶段，原公费医疗费和劳保医疗费要单独列账管理。
第十七条 基本医疗保险基金的计息方法：当年筹集的基本医疗保险金，按银行活期存款利率计息；上年结转的基金本息，按银行3个月期整存整取利率计息；历年结存资金，比照银行3年期零存整取储蓄存款利率计息。
第四章 基本医疗保险统筹基金和个人帐户的建立
第十八条 基本医疗保险基金实行社会统筹和个人帐户相结合。
1、在职职工个人缴纳的基本医疗保险费全部计入个人帐户。
2、用人单位缴费划入个人帐户的金额，在职职工以上年度本人工资总额为基数，退休人员以上年度退休金为基数，依据人员年龄结构情况及便于操作管理等因素，确定分段比例。
用人单位的缴费部分按下列比例划入个人帐户：年龄不足45周岁的，按本人工资总额的0.6%（加上个人缴费的2%，共为2.6%）；45周岁及其以上的，按本人工资总额的0.7%（加上个人缴费的2%，共为2.7%）。退休人员以本人上年度退休费为基数，按3%的比例全部从用人单位缴纳的基本医疗保险费中划入。
第十九条 个人帐户的本金和利息为参保人员个人所有，只限于支付医疗费用，可以结转使用和依法继承。职工调动工作时，个人帐户随之转移。
出境定居者，个人帐户余额一次性支付给本人。
参保人死亡，个人帐户余额按《继承法》规定一次性支付给继承人，如无继承人，转入基本医疗保险统筹基金。
第二十条 用人单位缴纳的基本医疗保险费，按规定计入个人帐户之外的部分全部计入职工基本医疗保险统筹基金。
第五章 医疗保险服务
第二十一条 本市所有经卫生行政部门批准并取得《医疗机构执业许可证》的综合医院、中医医院、专科医院、门诊部、医务室、社区卫生服务机构等医疗机构和所有持有《药品经营企业许可证》、《药品经营企业合格证》、《营业执照》，并经药品监督管理部门年审合格的国有、集体零售药店，愿意承担城镇职工基本医疗保险服务的，均有资格申请定点。
第二十二条 定点医疗机构和定点零售药店应严格执行职工基本医疗保险的有关规定，遵照“因病施治、合理检查、合理用药、科学配伍”，能用国产药不用进口、合资药的原则，规范医疗、药品服务行为，为参保人员提供优质的基本医疗服务。
第二十三条 市劳动保障行政部门根据申报单位的申请，对其资格进行审查，凡符合条件的医疗机构和零售药店均可被批准成为定点医疗保险服务机构，并发给定点医疗机构和定点零售药店证书。同时向社会公布，供参保人选择。
第二十四条 定点医疗机构和定点零售药店应配备专（兼）职管理人员，与医疗保险经办机构共同做好定点医疗服务管理工作。
第二十五条 定点医疗机构对持有享受基本医疗保险有效证件的人员，经确诊患有疾病需住院治疗的，在该患者缴纳住院预付金后，应当及时安排住院治疗。
参保人员出院时，由定点医疗机构开具住院医疗费用清单，除应由个人负担的部分医疗费外，其余由医疗保险经办机构支付。
第二十六条 定点医疗机构应当大力发展社区医疗服务，提高医疗服务质量，降低医疗服务成本。
第二十七条 定点医疗机构对参保人员进行治疗时，必须遵守职工基本医疗保险服务项目的规定，超规定提供医疗、服务或者使用范围以外的检查及药品所发生的费用，医疗保险经办机构不予支付。
第二十八条 参保人员可以选择三至五家定点医疗机构就医，也可按各定点医疗机构开具的处方到定点零售药店购药。
第二十九条 定点医疗机构对参保人员住院治疗时，应当使用收费明细表。
医疗保险经办机构和参保人员，有权查询病案、医嘱、收费清单和处方，定点医疗机构应当给予方便，不得拒绝。
第三十条 特殊检查治疗实行审批制度。对未经审批的特殊检查治疗，定点医疗机构应当拒绝。否则，医疗保险经办机构拒付其发生的费用。
第三十一条 定点零售药店对参保人员提供处方外配服务，要按照定点医疗机构医师的签名处方配购，除处方医师外任何人不得更改外配方的配伍和剂量。
第三十二条 定点零售药店要建立健全处方配药责任制。处方配药要严格按照处方、配药、复核的程序进行，并保存处方两年以上备核查。外配处方必须由定点医疗机构医师开具，有医师签名和定点医疗机构盖章。所配药品必须经药剂师审核签字后方可发药。
第三十三条 定点医疗机构应按《衡水市城镇职工基本医疗保险定点医疗机构管理暂行办法》执行，保障参保人员基本医疗。
第三十四条 卫生、医药管理部门要配合城镇职工基本医疗保险制度改革，协助医疗保险经办机构开展工作，积极进行医药卫生体制改革。要建立医、药分开核算，分别管理制度，形成医疗服务和零售药品流通的竞争机制，合理控制医药费水平。要加强对医疗机构和零售药店的管理和监督，规范医疗服务行为，提高服务质量，优化医疗卫生资源配置，积极发展社区卫生服务以适应基本医疗保险的需要。
第六章 基本医疗保险费用结算
第三十五条 定点医疗机构和定点零售药店应严格执行《衡水市城镇职工基本医疗保险医疗费用结算管理暂行办法》，做到合理收费，项目清楚。
第三十六条 统筹基金和个人帐户分开核算，互不挤占。个人帐户用于支付门诊医疗费，统筹基金用于支付住院医疗费和门诊可纳入统筹基金支付的特殊疾病。
第三十七条 门诊医疗费用支付。参保人员在定点医疗机构和定点零售药店发生的门诊医疗费和药费，从个人帐户中支付，超支自理。
第三十八条 住院医疗费用支付。参保人员在定点医疗机构发生的符合基本医疗保险规定的住院费用，属于统筹基金支付的部分，由定点医疗机构与医疗保险经办机构结算；属于个人负担的部分，由定点医疗机构与个人结算。住院时，个人须向定点医疗机构预交一定数额的自付预付金，用于支付个人负担的费用，具体金额由定点医疗机构根据病情确定。
第三十九条 统筹基金的起付标准，控制在统筹地区职工年平均工资的11%，初次住院的起付标准为统筹地区职工年平均工资的10%。对不同级别医院和转往外省市医院的，其起付标准原则上有所区别。
1、住一级及其以下医疗机构的，在职职工为9%，退休人员为7%；住二级医疗机构的，在职职工为11%，退休人员为9%；住三级医疗机构的，在职职工为13%，退休人员为11%。对一个年度内多次住院的，其起付标准可依次降低。
2、参保人员住院期间实施特殊检查、特殊治疗、特殊手术和使用“乙类目录”的药品所发生的费用，个人负担20%。
城镇个体劳动者参加基本医疗保险，必须在其缴纳基本医疗保险费满1年以后，方可按规定支付应由统筹基金支付的医疗费用。
参保人员住院治疗终结，可出院仍不出院者，则其住院医疗费用自治疗终结日起由个人自理。
3、超过起付标准部分的医疗费主要由统筹基金支付，但个人也要负担一定比例。
个人负担比例为：起付标准以上至5000元的部分，在职职工为35%，退休人员为33%；超过5000元至10000元的部分，在职职工为30%，退休人员为27%；10000元以上部分至最高支付限额部分，在职职工为25%，退休人员为23%。
第四十条 统筹基金的使用要严格限制在基本医疗保险服务范围、项目、设施标准和基本医疗保险药品目录、费用开支范围之内，超出部分不予支付，由职工个人自付。
第四十一条 异地安置和长期异地居住在一年以上的人员参加基本医疗保险，按照属地原则由单位和个人向所在地医疗保险经办机构缴纳职工基本医疗保险费。
第四十二条 统筹基金年度内支付给参保人员的医疗费最高限额为本市上年度职工平均工资的4倍。
第四十三条 超过最高支付限额的医疗费用，可以通过医疗保险经办机构组织的补充医疗保险、工会组织的职工互助保险、商业保险机构开展的商业医疗保险或当地政府救济以及社会资助等途径解决。具体办法另定。
第四十四条 个人帐户有结余的，可以用于支付住院医疗费用中属于个人负担的部分。 第四十五条 党政机关、社会团体的工作人员和财政供给的事业单位职工、“两院”院士、省管优秀专家、省级以上劳模、获得亚洲、世界冠军的运动员，在参加基本医疗保险的基础上，享受公务员补助政策。具体办法由市劳动保障行政部门会同财政等部门根据国家和省的有关规定另行制定。
第四十六条 工伤、生育所需医疗费用不列入基本医疗保险支付范围。已参加工伤、生育保险的，按工伤、生育保险有关规定支付。没有参加工伤、生育保险的，按原渠道列支。
第四十七条 用人单位和参保人员必须按规定不间断缴纳基本医疗保险费。中断缴费时，暂停使用统筹基金支付其医疗费用。在此期间该单位参保人员发生的医疗费和由此引起的一切后果，由参保单位自行负责。参保人员个人帐户有余额的，可继续享受个人帐户规定开支的医疗待遇。只有用人单位和参保人员按规定补缴基本医疗保险费后，方可按规定使用统筹基金支付医疗费用。
第七章 医疗监督和奖惩办法
第四十八条 基本医疗保险的奖惩管理工作。由劳动保障行政管理部门组织财政、卫生、物价、审计等部门，对医疗保险经办机构、定点医疗机构、定点零售药店、参保单位和参保人员执行基本医疗保险的情况进行监督检查，并实行奖惩。
第四十九条 职工基本医疗保险经办机构、定点医疗机构、定点零售药店、参保单位应认真贯彻执行城镇职工基本医疗保险的各项政策和规定，加强自身建设，共同做好基本医疗保险工作。对模范执行各项政策、规定，在基本医疗保险工作中作出贡献，符合下列条件之一的单位及个人，给予表彰和奖励。
1、严格执行城镇职工基本医疗保险的有关政策和规定，在加强管理、合理使用基本医疗保险基金、堵塞漏洞、节约开支方面做出显著成绩的；
2、坚持原则，不徇私情，主动举报或及时处理单位或他人在基本医疗保险管理中的违规行为的。
第五十条医疗保险经办机构及其工作人员有下列行为之一者，视情节轻重，分别给予通报批评、行政处分、直至追究法律责任。
1、不严格执行城镇职工基本医疗保险的有关政策和规定，不认真履行城镇职工基本医疗保险服务合同，造成不良影响的；
2、利用职权和工作之便贪污、挪用城镇职工基本医疗保险统筹基金的；
3、因工作失职造成不良影响，或因违反财经纪律造成基本医疗保险统筹基金损失的；
4、有其他违规违纪行为的。
第五十一条 定点医疗机构和定点零售药店及其工作人员有下列行为之一者，除追回不合理医疗费用外，视情节轻重，给予通报批评，责令定点医疗机构、定点零售药店限期整改，拒不整改或整改不力的，取消定点资格。
1、不严格执行城镇职工基本医疗保险的各项政策和规定，不认真履行城镇职工基本医疗保险服务合同，造成不良影响的；
2、故意为人、证、卡不符者开具基本医疗保险处方，开具检查、治疗申请单，收治住院以及弄虚作假，造成基本医疗保险统筹基金流失的；
3、将非基本医疗保险统筹基金支付的检查、治疗项目或自费药品费用列入统筹基金支付范围的；
4、不严格执行物价、财政部门制定的收费标准，擅自提价，任意增加收费项目的；
5、为牟取私利而增加基本医疗保险统筹基金开支及有其它违反基本医疗保险规定行为的。
第五十二条 参保单位及其参保人员有下列行为之一的，除追回不合理费用外，视情节轻重，给予通报批评。
1、将非参保对象列入职工基本医疗保险范围的；
2、瞒报职工工资总额，少缴城镇职工基本医疗保险费的；
3、弄虚作假、虚报医药费的；
4、将本人的医疗保险证、卡转借他人就诊的；
5、持他人的医疗保险证、卡冒名就诊的；
6、有其它违反基本医疗保险有关规定行为的。
第八章 附则
第五十三条 离休人员、老红军的医疗待遇不变，医疗费用按原资金渠道解决。
第五十四条 二等乙级以上革命伤残军人的医疗待遇不变，医疗费按原资金渠道解决，由医疗保险经办机构单独列帐管理。医疗费支付不足部分由同级政府帮助解决。
第五十五条对突发性、流行性疾病和自然灾害等不可抗拒因素造成的大范围急、危、重病人抢救的医疗费用，由政府综合协调解决。
第五十六条 本实施方案由市劳动保障行政部门组织实施并负责解释。
第五十七条 本实施方案实施前的医药费欠帐，仍由原资金渠道解决。
第五十八条 本实施方案从2002年1月1日起实行。此前与本实施方案不一致的文件规定自行废止。