On December 31 last year, the General Office of the People's Government of Guangdong Province issued the "Implementation Measures for the Outpatient Mutual Assistance Guarantee of Basic Medical Insurance for Employees in Guangdong Province", which clearly established and improved the outpatient mutual assistance guarantee mechanism and improved the overall treatment level of ordinary outpatient treatment for the insured personnel of the basic medical insurance for employees. In addition, the personal account of employee medical insurance has become a "family account", which further expands and regulates the scope of use of personal accounts.
Article 9 of the Measures stipulates that the personal account of medical insurance can be used to pay for the medical expenses borne by individuals when they and their spouses, parents and children seek medical treatment in designated medical institutions; the expenses borne by individuals in purchasing drugs, medical devices and medical consumables at designated retail pharmacies; the individual contributions of spouses, parents and children participating in resident medical insurance; the payment fees incurred by insured persons who have not reached the minimum payment period for employee medical insurance when they retire; and the cost of "treating diseases" in accordance with the regulations of traditional Chinese medicine that meet the requirements incurred by individuals in designated medical institutions. Fees and other expenses in accordance with national and provincial regulations.
"This means that the personal account of employee medical insurance is not limited to their own use, but also can become a 'family account' to pay for the medical expenses incurred by immediate family members in designated medical institutions." For example, the relevant person in charge of the Municipal Medical Security Bureau, Mr. A, who is in his prime and in good health, usually hardly uses the money in the medical insurance card, while the elderly and infirm parents often see a doctor, and the money in the medical insurance card is "not enough to make ends meet". Now, he can use this "sleeping" money for out-of-pocket expenses for his parents to see a doctor and buy medicine.
It should be noted that the Measures stipulate that personal accounts may not be used for fitness, public health or health care consumption. At the same time, we will establish a dynamic management mechanism for the whole process of personal accounts, do a good job in registering revenue and expenditure information, severely crack down on fraud and insurance fraud, maintain the safety of the fund, and protect the rights and interests of insurance.
For incumbents who transfer and renew the medical insurance relationship of employees, retirees who live in different places for a long time, enlisted personnel, and those who have settled abroad, the "Measures" stipulate in the management of personal accounts: If an insured person transfers the medical insurance relationship between cities in the province, the personal account funds are used across cities, and are not transferred or withdrawn; if the insured person transfers the medical insurance relationship of employees across provinces, the personal account funds are transferred with them in principle, and when special circumstances cannot be transferred, they can be transferred to their bank accounts. In principle, the individual account needs to select a designated medical and health institution for treatment, which is generally "one year". If it is necessary to change the selected medical and health institution due to circumstances such as the relocation of the place of residence, the applicant may apply to the local medical security agency or the designated designated medical and health institution for the change procedure. Except for the need for first aid and rescue, the pooled fund will not be paid by the pooled fund if the insured person is not referred to the outpatient clinic of a non-selected medical and health institution.
The reporter learned that at present, in accordance with the unified requirements of the province, the details of the implementation of outpatient mutual assistance guarantee and personal account reform in our city are being formulated, please pay attention to the official release of the Huizhou Medical Security Bureau for details.