EXHIBIT 10.5
Agreement for Medicare Service
Agreement on Medical Treatment Service of the Appointed Medical Treatment
Institutions in Charge of the Basic Medicare Service for Employees in
District-Class Department Directly under the Central Government
Party A: Social Security Department of Guangxi Zhuang Municipality
Party B: Nanning Tongji Hospital Co. Ltd.
In order to guarantee those insured working for district-class department
directly under central government to enjoy medical treatment services,according
to the Notice on the Interim Procedures of the Management of Appointed Medical
Treatment Institutions in Charge of the Basic Medicare service for Employees in
Cities and Towns (No.14 [1999] issued by Ministry of Labor & Social Security)
enacted by Ministry of Labor & Social Security, Ministry of Health and State
Administration of Traditional Chinese Medicine, and other relevant regulations
such as the Interim Procedures of the Basic Medical Treatment Insurance of the
Employee working for the district-class department directly under central
government. A has confirmed B as the appointed medical treatment institution and
both parties sign the following agreements.
Chapter 1 General Provision
Article 1 A and B shall seriously implement the national regulations
concerned and Management on the Basic Medical Treatment Insurance of the
Employee working for the district-class department directly under the central
government and its attached documents.
Article 2 A and B shall educate the insured and medical personnel to accord
with the regulations of medical treatment insurance. Both sides are authorized
to provide the other side with reasonable suggestions and accuse the other side
of or complain about the violation to regulations.
Article 3 B shall provide the basic medical treatment insurance service to
the insured and enhance internal management according to national laws,
regulations and this agreement, make and practice the relevant measures of the
basic medical treatment insurance policies and regulations and offer convenience
to the insured. B must appoint a leader with academic level in charge of the
operation of the basic medical treatment insurance and employ full-time
(part-time) administrators to operate well the management on appointed medical
treatment service together with A. B is responsible for providing A with the
information and data on basic medical treatment insurance. B should offer
assistance if A needs to look up the information and case history of the insured
or inquire the person involved.
Article 4 B should provide and transfer the materials of the basic medical
treatment insurance and the data of medical expenses settlement to A timely and
accurately in order that A can know well about the materials of B in time and
take real-time supervision.
Article 5 During the medical services if B violates the medical treatment
insurance policies and regulations of our region, does not implement the items
in this agreement and is complained because of the low quality medical service;
the insured enter the hospital under a false name or be hospitalized in
different stages; B reports more expenses than it should be and gains the
medical insurance funds by illegal methods, brings the new items, equipment or
technology into the payment scope of medical treatment insurance funds and
violates the expenses standard of our region and so on, A is authorized to
propose suggestions to B to make corrections in the specified time and refuse to
pay the expenses against the regulations when the behaviors mentioned above are
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proved to be true. If the behaviors seriously violate the regulations, A is
authorized to criticize, circulate the criticism note, suspend or terminate the
agreement.
Article 6 A shall provide B in time with the information of the insured
relating to B, pay the medical treatment expenses taken charge of by A to B and
report in time the variation of the policies, management system and operation
rules of the basic medical treatment insurance to B.
Article 7 After the contract is signed, B should hang the unified xxxx of the
appointed medical treatment institution made by A in the noticeable position,
set the "column of the medical treatment insurance policies" and the
"complaining box of the basic medical treatment insurance" and announce the main
policies of the basic medical treatment insurance and main points of this
agreement to the insured.
Chapter 2 Taking Medical Treatment Article 8 During the
procedure of diagnosis B shall strictly follow the
first-diagnosis-taking charge principle and the principles of treatment that
suits the diseases and reasonably take examination, diagnosis and prescription
in order to improve the quality of medical treatment.
Article 9 B shall insist on the principle of "base-on-patient" and provide
services warmly to the insured. B shall take serious inspection if the insured
complain the staffs of B about their bad manners. The cases will be strictly
dealt with according to relevant regulations if the situations are true.
Article 10 If there is any medical accident happening to the insured during
the diagnosis of B, B shall inform A in writing in 3 working days since the
accident happened. A can unilaterally terminate the contract if the medical
accidents have happened for many times causing serious consequences.
Article 11 B shall identify the identification, certificate and diseases
type of the insured seriously during the diagnosis.
1. B shall examine the insurance cards seriously when the insured register
on the out-patient and in-patient department and check the validity of the
certificates. A is not responsible for any expenses during the diagnosis with
invalid certificates.
2. If B discovers that the patient is not in accordance with the certificate
of medical insurance, B will refuse to keep the account and will hold the
certificate and inform A in time.
3. B shall examine whether the diseases of the insured are involved in the
payment scope of medical treatment insurance. Those caused by illegality and
crime, civil infringement, injuries resulting from self mistakes like fight,
over drunk, drug abuse, traffic accidents, suicide (excluding psychotic) and so
on, and those caused by injuries in work and procreation are not involved in the
payment scope of medical treatment insurance. Otherwise A will not pay any
expenses concerned.
Article 12 B shall set up case history of out-patient and in-patient
department. The insured must go hospital with case history. The records shall be
clear, accurate, complete and well kept for examination. Out-patient
prescription shall be preserved for at least 2 years and in-patient case history
shall be kept at least 15 years.
Article 13 B shall use the out-patient case history record, prescription,
note and settlement document etc. provided by A.
Article 14 B must promise to provide hospital beds within the basic medical
treatment service scope to the insured in this medical treatment institution.
Article 15 B shall strictly grasp the standard of hospitalization. A will not
be responsible for the expenses of medical treatment if those insured that
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discord with the in-patient conditions are hospitalized or stay in hospital only
in name or are hospitalized in different stages and so on. B will take relevant
responsibility if B denies those insured that accord with the conditions.
Article 16 B shall go through the procedures of leaving hospital for those
insured that accord with the conditions of leaving normally within 3 working
days (excluding the postpone caused by the insured themselves). A shall not be
responsible for the expenses increased by those that deliberately postpone the
time staying in hospital. If the insured refuse to leave hospital, B will stop
recording the accounts since the day when the insured are informed of leaving
and deal with them as the patients at their own expenses. A shall be informed
about this situation in time.
Article 17 B shall go through the procedures of transferring diagnosis and
treatment for the insured according to relevant regulations. B shall take the
responsibility for the damage of the insured that accord with the transferring
conditions caused by the late handling of B.
Article 18 If the costs of the services and medicines provided by B have
exceeded the scope of the basic medical treatment insurance and the insured need
to pay with their own expenses, this must be permitted and signed in writing by
the insured and their family members in advance. Otherwise the insured are
authorized to refuse the payment. B is responsible for the consequent disputes
and losses.
Chapter3 Management of Diagnosis and Treatment Items Article 19 B
shall strictly implement the regulations on the management of diagnosis and
treatment items by the state and the municipality .
Article 20 When the insured receive examination in other appointed medical
treatment institutions of A, B shall make good use of the result and avoid
unnecessary repeated examination.
Article 21 B shall reasonably control the medical treatment cost according to
the management of diagnosis and treatment items stipulated by A and is not
allowed to carry out the diagnosis and treatment far away from the medical
purpose. When the doctors examine the insured, the income of the treatment is
not allowed to directly connect with the salaries of the doctors and the income
of their departments. If B violates this term after the examination by A, A can
refuse to pay the relevant costs and exclude the relevant items from those
settled. If the circumstance is serious, A can unilaterally terminate the
agreement.
Article 22 After the contract is signed, if B implements new medical
treatment items outside the stipulations in the contract and these items are
included in the basic medical treatment items set by the department of labor &
social security of the municipality, they will be dealt with under the following
principles:
1. B applies A for adding new medical treatment items. 2. A will take
examination according to the application of B. During the
examination B shall provide A with the relevant materials and offer convenience
to A when A carries out on-the-spot investigation. A is obligated to keep secret
on the materials provided by B.
3. A shall complete the examination 20 working days after the application of
B (excluding the time when B makes supplementary application because of the
incompleteness of the materials).
Chapter 4 Management of Medicine
Article 23 A shall report in time the management policy on medicines of the
basic medical treatment insurance. B shall ensure the supply of the medicines
included in the list of medicines of the basic medical treatment insurance and
offer the reserved medicines list including the details such as the commodity
name, the common name, and types etc. according to the requirement of A.
Article 24 B shall strictly implement the regulations on medicine scope of
the basic medical treatment insurance of Guangxi Zhuang municipality. A will not
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be responsible for the costs of the exceeding part.
Article 25 The out-patient medicines of the insured in one prescription are
mainly for one kind of disease or for two kinds at most. B shall prescribe doses
of 3 to 5 days for common diseases, doses of 7 days for chronic diseases, doses
of no more than 14 days at most for special chronic diseases. The medicines the
insured take out of the hospital will be limited to doses of no more than 7
days. The medicines brought away shall be limited for the diseases in the first
diagnosis.
Article 26 B shall allow the insured to buy medicines outside the hospital
in the designated retail drug stores with prescription and their purchase can
not be interfered with. The prescription shall be clear and neat.
Article 27 The medicines provided by B shall have small packing in accordance
with the regulation of the basic medical treatment insurance on doses.
Article 28 A shall pay the expenses if B uses the pharmaceuticals produced
by B and listed in the scope of basic medical treatment insurance medicines. B
shall follow article 23 if the new pharmaceuticals produced by B apply for
entering the scope of basic medical treatment insurance medicines.
Article 29 The same type of medicines in the scope of the basic medical
treatment insurance medicine shall be used within the medicine bidding scope of
the government.
Article 30 A will not pay the exceeding parts if the prices violate the price
policies and are higher than the price settled by state or autonomous region
price department.
Article 31 If there are counterfeit and shoddy medicines that B provides to
the insured, A will not pay the costs of medicines and other relating medical
treatment expenses and will report to the medicine supervision management
department. If B or its staffs gather sales commissions of the medicines
illegally, A will take off all the expenses of those kinds of medicines after
confirming the truth.
Chapter 5 Payment
Article 32 Both A and B shall strictly implement the Interim Procedure on
Payment Settlement of the Basic Medical Treatment Insurance of the Employee
working for district-class department directly under the central government
Article 33 The in-patient expenses shall be paid off by item expenses
settlement according to the Interim Procedure on Payment Settlement of the Basic
Medical Treatment Insurance of the Employee working for district-class
department directly under the central government.
The medical expenses settlement of family patient bed will be paid off by the
same method as that of the in-patient expenses.
The medical expenses in observation xxxx will be recorded by B into the
settlement document and reported to A monthly and paid off by item expenses
settlement.
Article 34 B shall report the expenditure list of the medical treatment
expenses of the insured last month to A before the 10th each month for A's
examination.
Article 35 A will make a random inspection on the prescription for medicine
purchase outside the out-patient department on a regular schedule. Those
expenses violating the regulations will be deducted according to proportion.
The expenses of the insured in B within the scope of the basic medical
treatment insurance will be examined by A. The expenses under any of the
following condition will be deducted by A after being proved to be true and B
will take the responsibility.
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1. The clinical medicines, examination and treatment disaccord with the
disease diagnosis and record. The corresponding medicines and diagnosis items
are not recorded in the case history. The record in the case history is not in
accordance with the actual prescribed medicine.
2. Hospitalization in name (the in-patient insured do not receive medical
treatment in hospital or do not stay in hospital during the night).
3. Items outside the payment scope of medical treatment insurance are
included in the items within the payment scope of medical treatment insurance.
The treatment exceeds the standard and scope. The expenses are charged
repeatedly or more than the standard.
Article 36 If the insured have any medical accidents in B, they shall be
dealt with according to the management of medical accidents. A will not pay the
costs of the accidents or consequent expenses.
Article 37 If the insured complain about the unreasonable charge by B, B
shall return those payment after A examines and proves to be true.
Article 38 B makes an untrue report on the expenses violating the agreement
or its staffs conspiring with the insured get the medical treatment insurance
funds by cheating after A examines and proves to be true, the compensation for
breaking the contract will be deducted and this will be reported to the relevant
administrative department. If crime is suspected to be involved, A shall report
to the judiciary.
Article 39 B is responsible for charging the personal expenses paid by the
insured and should use the special receipt note.
Article 40 A shall complete the examination and settlement of the expenses in
30 days since the receipt of the expenses report offered by B and pay 90% of the
reasonable medical treatment expenses to B. The remaining 10% will be taken as
the guarantee fund. All the expenses will be paid off according to the result of
the annual examination before the end of March next year.
Chapter 6 Information Management
Article 41 A provides B with the installation and management of the remote
application software of Information System of Management on Medical Treatment
Insurance of the district-class department directly under the central government
and is responsible for training and instructing the personnel of B to operate
this system.
Article 42 A is responsible for the upgrade and maintenance of the remote
system of the medical treatment insurance information system and offer technical
support to B.
Article 43 B shall strictly follow the requirement of A on information and
the data of the insured provided to A shall be true and accurate.
1. The information such as name, standard, unit for accounting price etc. of
the medicines and medical service items in the computer management system of B
shall be in accordance with that in the database of A. If B finds that the
content of expenses items (including medicines) are not in accordance with that
in the information center, B shall report to A by the software provided by A and
start using the content replied by A after examination.
2. According to the requirement B shall upload and download the medical
treatment insurance data at least once for each day.
3. According to the requirement of the information management department of
A, B shall timely adjust the software, hardware and the communication between
the hospital and the data center. B will be responsible for the communication
cost.
4. B shall check the announcement column of medical treatment insurance
information and do well the jobs according to the information in the column
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announced by A. Any problems shall be reported to A in time. B shall be
responsible for the loss if the regulations are not followed.
Article 44 B shall establish a perfect system to enhance the management on
network security of medical treatment insurance information.
1. B shall appoint special person to operate the equipment and software used
in charging the medical treatment insurance expenses. If it is because of the
man-made mistakes resulting in data variation and loss or the damage of
equipment causing loss of funds or complaint by the insured, A will take off
some points in the annual examination according to the situations.
2. The medical insurance operators and administrators of B must be qualified
to use the computers only after they pass the examination through the training
of A.
3. B shall report in writing to the information management department of A if
B wants to increase the charging points or use standard interface linking to the
data center. A is responsible for the development, installation and management
of the interface software after approval and the costs are taken by B.
4. B shall make copies of the data everyday according to the requirement. B
will take full responsibility for the data loss caused by the collapse of the
system.
Article 45 B shall enhance the service of medical treatment insurance
information. If the following services are not provided to the insured, A will
take off some points in the annual examination according to the situations.
1. B is obligated to provide the insured with the services like personal
account inquiry, medical expenses inquiry, policy explanation etc.
2. B provides the insured with the 24-hour (including holiday) settlement
service for medical expense card and offers receipt notes and settlement
documents (including detailed list). B must deal the expenses that are confirmed
by the insured and B together and need to be corrected
Chapter 7 Dispute Resolution
Article 46 If there is any dispute during the implementation of the
agreement, both sides can resolve the disputes through consultation. If the
consultation is invalid, both sides can apply for arbitration or bring lawsuits
to court.
Chapter 8 Supplementary Provisions
Article 47 Term of the agreement: From January 1st, 2007 to December 31st,
2007
Article 48 If there is any adjustment of the national laws and regulations
during the implementation of the agreement, A and B shall amend the agreement
according to the new laws and regulations. Both sides can terminate the
agreement if no agreement has been reached. During the implementation of the
agreement B shall inform A about any variation of registered capital, service
conditions, service content, and legal representative etc.
Article 49 Both A and B shall inform the other side in writing 30 days in
advance with whatever reason to terminate the agreement.
Article 50 A and B can renew the agreement 30 days before the expiration of
the term.
Article 51 Those items unmentioned herein will be supplemented by exchange
of letters through the consultation between A and B and have the same legal
effect as this agreement.
Article 52 This agreement is in duplicate and each party holds one. All of
them are of the same effect.
Attachment 1: Examination standard of annual service quality of the appointed
medical treatment institutions in charge of the basic medical treatment
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insurance of the workers in the organizations under the direct jurisdiction of
center and region.
Attachment 2: Standard of annual examination on service quality of the
appointed medical treatment institutions in charge of the basic medical
treatment insurance of the Employee working for district-class department
directly under the central government.
Attachment 3: Standard of daily examination on service quality of the
appointed medical treatment institutions in charge of the basic medical
treatment insurance of the employee working for district-class department
directly under the central department.
Attachment 4: Standard of quality examination on the appointed medical
treatment institutions in charge of the basic medical treatment insurance of the
employee working for district-class department directly under the central
government.
A: Social Security Department of B: Nanning Tongji Hospital Co., Ltd
Guangxi Zhuang municipality (Seal) (Seal)
Legal representative (Sign): Legal representative (Sign):
January 1, 2007
