Citizens: How to use the basic medical insurance for employees and family members to help each other?

Municipal Medical Insurance Administration: The new system is currently being improved

"I heard that the basic medical insurance for employees can be used by family members, how should it be operated?" Need to bind a card? On December 22, Mr. Liu, a citizen, called the People's Livelihood Hotline of Wulanchabu Daily and asked how the basic medical insurance of employees can be used by family members.

Mr. Liu told reporters that he saw a message from the WeChat public account of the Wulanchabu Medical Security Bureau in September this year about the outpatient mutual assistance guarantee of basic medical insurance for employees. One of the articles in the message regulates the scope of use of personal accounts, which mentions that the number of beneficiaries is expanded from the insured to the employees themselves and their spouses, parents and children.

"Recently my father was unwell and needed to go to the hospital for treatment. I am our municipal medical insurance, due to my usual health, the medical insurance card is not used, the current balance is more than 10,000 yuan. "If you can use the money in my health insurance card, you can alleviate some of the economic pressure." But what are the specific procedures? ”

There are also people who have the same questions as Mr. Liu, as well as Ms. Zhang, a citizen. Ms. Zhang told reporters that she had heard from friends that the basic medical insurance for employees could be used by family members, but she had not specifically understood how to use it.

"My child recently fell ill and was hospitalized, and in addition to the part that can be reimbursed, it also costs a lot of money to bear the part of the individual." Ms. Zhang said, "If you can pay for the personal part with my or my lover's health insurance card, it is really a good thing." However, I asked the people around me that no one had ever handled such a business, so could they be used? How to use it? ”

With the public's questions, the reporter came to the Ulanqab City Medical Insurance Administration in the morning to understand.

According to the staff of the Treatment Guarantee and Service Management Section of the Medical Insurance Administration of Wulanchabu City, the Medical Security Bureau of the Inner Mongolia Autonomous Region issued the Notice on Doing a Good Job in the Work Related to the Individual Accounts of the Basic Medical Insurance of Employees in 2021 (Nei Medical Insurance Office Zi [2021] No. 71) and the Notice on Further Optimizing the Process of Using The Funds of the Individual Accounts of the Basic Medical Insurance of Employees in the Whole Region (Nei Medical Insurance Office [2021] No. 20). The notice makes it clear that the personal account of the basic medical insurance for employees is used by the employee himself or herself and extended to the use of family members for mutual assistance. From August 1, 2021, the scope of use of personal accounts will be extended to cover the personally borne medical expenses incurred by the insured persons, their spouses, parents and children in designated medical institutions, as well as the expenses borne by individuals incurred in purchasing drugs at designated retail pharmacies.

The operation process of personal account funds and family solidarity in designated medical institutions is adjusted as follows: At present, the second-level code of medical category "98 account mutual aid" has been added to the original medical insurance business system, and medical security departments at all levels are requested to guide relevant designated medical institutions and make corresponding procedures adjustments at the hospital end according to the latest interface document "Inner Mongolia Autonomous Region Designated Hospital Interface Specification v3.08 .pdf" (Annex 1); Then the authorizer fills in the "Commitment to authorize the use of the insured employee account" (Annex 2) at the relevant window of the designated medical institution, and provides the original social security card, and the staff of the designated medical institution reads the balance of the authorizer's social security card and informs the authorizer of the balance; the staff of the designated medical institution pre-settles the patient's local medical expenses, confirms the amount that needs to be paid in cash and informs the authorizer. The authorizer confirms the withholding amount according to the cash payment amount and the balance of the social security card; the staff of the designated medical institution reads the authorized person's social security card and registers for medical treatment in the medical category of "account mutual assistance" (this category is the new medical category). According to the amount of withholding confirmed by the authorizer, the fee is approved in the Class A directory, and the account payment is selected for settlement after the approval fee is successful; the remaining part of the medical expenses after the completion of the personal account family mutual assistance payment are settled according to the normal procedures; the designated medical institution submits the account mutual assistance statement and the "Commitment to the Authorized Use of the Insured Employee Account" (Annex 2) to the medical insurance agency for settlement on a monthly basis.

"Regarding the public's questions, the new system is currently being improved and will not be able to be used until the new system is perfected." Staff of the Ulanqab City Health Insurance Administration said.

(Xu Nan)