Core Viewpoint - The article emphasizes the importance of understanding the Medical Insurance Fund Management Regulations to protect the interests of insured individuals and ensure the proper use of the medical insurance fund [1] Rights of Insured Individuals - Insured individuals have the right to seek medical treatment and purchase medications, and they can request accurate expense receipts and related documents from designated medical institutions [2] - They are entitled to receive medical insurance consultation services and can suggest improvements regarding the use of the medical insurance fund [2] - Insured individuals have the right to supervise administrative departments, medical insurance agencies, and designated medical institutions [2] - They possess the right to make statements, defend themselves, and can initiate administrative reviews and lawsuits as per the law [2] Obligations of Insured Individuals - Insured individuals must present their medical insurance credentials when seeking treatment or purchasing medications and should allow for verification [3] - They are responsible for safeguarding their medical insurance credentials to prevent unauthorized use, and if they need to authorize someone else to purchase medications, they must provide identification for both parties [3] - Insured individuals must enjoy medical insurance benefits according to regulations and are prohibited from receiving duplicate benefits [3] - They are not allowed to sell medications or accept cash, goods, or other illegal benefits while utilizing their medical insurance benefits [4] Violations of Medical Insurance Fund Regulations - Individuals engaging in certain behaviors, such as allowing others to use their medical insurance credentials, fraudulently obtaining duplicate benefits, or selling medications for illegal gains, may face corrective actions and potential suspension of medical expense settlement for 3 to 12 months [4] - Those who commit fraud with the intent to deceive the medical insurance fund may face penalties, including fines ranging from two to five times the amount fraudulently obtained [7] Consequences for Non-Compliance - Insured individuals suspected of fraud who refuse to cooperate with investigations may have their medical expense settlement suspended, requiring them to pay all medical costs upfront during the suspension period [8] - If found guilty of fraud, they will be penalized according to the relevant regulations; if not guilty, they will be settled according to the rules [8] Reporting Fraudulent Activities - Whistleblowers must provide detailed materials and evidence, including the name and identity of the accused, the nature of the alleged violations, and relevant documentation, and they will bear legal responsibility for the content of their reports [9]