Last year, the health insurance card allowed family members to help each other, which made it convenient for many people. However, recently, the National Health Insurance Administration has clearly issued a document stating that it may be illegal and criminal to use the medical insurance card for others.
This can confuse many people, now, can the family's medical insurance card be used?
You can only use your health insurance card
The Health Insurance Bureau mentioned a case where a girl was sick and hospitalized, and because she did not have medical insurance, she borrowed a relative's medical insurance to use it.
The relatives are of the same age as hers, and during the surgical treatment process in the hospital, a series of procedures such as medical insurance reimbursement were used, which did not arouse the suspicion of the hospital.
Later, this relative was also sick and hospitalized, and when she used her medical insurance card to see a doctor, the hospital found out that she had previously undergone relevant medical treatment, and then learned that her medical insurance card had been lent to someone else to use.
The medical insurance department immediately interviewed the girl who fraudulently used the medical insurance card of her relatives and imposed an administrative penalty on her. The medical insurance premium of 2,663.1 yuan received for the previous hospitalization was returned, and a fine of 5,326.2 yuan was twice as high as that was imposed.
In the field of medical insurance card use, this kind of use of other people's medical insurance cards is not allowed, and if you use other people's medical insurance cards to fraudulently receive reimbursement of medical insurance funds during medical treatment, you are already suspected of committing a crime.
But for this situation, many people will be very confused, because the relevant departments have also issued clear regulations before, and the medical insurance card can be shared between relatives. In specific policies, this is referred to as "mutual aid".
The girls above are related to their relatives, so don't they fall within the scope of mutual aid?
Mutual aid uses personal account balances
Mutual aid is another concept in the medical insurance policy, which is completely different from the situation of lending the medical insurance card to relatives and friends at will.
On this issue, many people had a misunderstanding at the beginning, and some netizens shared their medical experience.
When a family member was sick and hospitalized, he thought that he could share his medical insurance card with the sharing policy he had seen on the news before, so he took his medical insurance card to register and pay the bill. The hospital reminded the patient's family that this method is not a mutual aid and is not allowed.
The correct operation is to assume that your family member is sick and incurs treatment expenses after hospitalization, the part of the personal out-of-pocket expenses involved can be paid with the money in your medical insurance card according to the mutual aid policy.
In other words, if a relative or friend is sick, directly give them their own medical insurance card, and in the whole process, in addition to the treatment costs they need to pay, part of it will be reimbursed according to the proportion. And this part of the reimbursement of funds cannot be used by mutual aid, but can only be used by themselves.
In addition to the strict limitation of the scope of mutual aid, there are also clear requirements for the people targeted by the mutual aid policy.
According to the previous explanation of the National Health Insurance Bureau, individual medical insurance accounts can be used with close relatives such as parents, children, and spouses, and if the relationship between the two parties exceeds this scope, mutual aid is also not allowed.
In other words, only when close relatives are sick or buy medicine, according to the provisions of the mutual aid policy, both parties can use the money in each other's personal accounts in each other's medical insurance cards.
For example, Xiao Ming's father is hospitalized for surgery, and when he registers, he needs to use Xiao Ming's father's identity information to register for treatment. When paying the expenses, Xiao Ming proved his paternity with the patient to the hospital, and then he could use his medical insurance card to settle the part of the medical expenses that need to be paid personally.
To put it more simply, the money in the medical insurance card paid for medical treatment can be exchanged between family members. Some people may wonder if this is still their own money, so why bother?
The money is indeed its own, but after the money is in the health insurance card, it is strictly limited in the scope of use before there is no mutual aid policy.
From personal use only to family use
Each medical insurance account corresponds to an individual, and the personal amount in the previous account can only be used by oneself. Since the money in the medical insurance card cannot be withdrawn casually, if the individual does not incur medical expenses, the money in the card will accumulate year by year.
According to the data given by the National Health Insurance Bureau, as of 2020, the amount in personal accounts has accumulated more than 1 trillion yuan. This money can neither be withdrawn nor generate income like a bank account, and for an individual, if not used, it is like "dead money" because it is not in circulation.
After the implementation of the mutual aid policy, the money in the personal account can be shared among family members, and this money is equivalent to revitalization, which can maximize its protective role.
For example, most young people are employees of medical insurance after joining the work, and the money in the personal account of medical insurance is accumulating, and because young people are healthy and do not use it much, this money is continuing to be idle.
If the elderly parents in the family need to see a doctor, before there is no mutual aid policy, regardless of whether the parents have medical insurance or not, they will pay an additional fee.
After the introduction of the mutual aid policy, if there is a lot of savings in the personal account, then it can be used in the medical payment of the family, which can reduce the unnecessary burden.
In essence, although the use of personal money is still the maximum, it is equivalent to maximizing the utilization of funds in the medical insurance card.
Therefore, this is completely different from the situation of sharing health insurance cards.
Health insurance cards cannot be shared
The current medical insurance policy is divided into employee medical insurance and urban and rural residents' medical insurance, no matter what type of medical insurance, personal medical insurance cards and medical insurance accounts cannot be shared with others.
Everyone's health insurance account is like a pool of liquid funds. Individuals pay a portion of the cost of medical treatment, and the rest of the expenses are reimbursed according to a certain percentage.
And the reimbursement payment is the cost of circulating in the pool of funds. This money pools together to form a much larger pool of public funds. Each medical insurance account corresponds to an accessible channel, and once an individual falls ill and seeks medical treatment, he or she can receive financial support through the public pool.
The above situation is the essence of medical insurance. The money in the public fund pool is shared with the society and each insured person, so in the process of use, in order to achieve fairness and justice, it must correspond to the specific insured individual.
It is in this situation that everyone's medical insurance account must not be lent to others at will.
Because this involves the withdrawal of fees from the public pool, if the health insurance card is allowed to be shared at will, fairness will no longer exist.
Moreover, medical insurance cards are shared at will, and there are also cases of fraud and arbitrage of medical insurance funds. The original intention of the pooling of funds in the public fund pool is to ensure that the insured can use the medical treatment fairly, and if the money is arbitrarily withdrawn or even defrauded, it is each insured person who suffers.
It is worth mentioning that even if the personal funds in the medical insurance card can be used by family members, the corresponding procedures must be completed in advance.
How to use Mutual Aid
At present, the procedures are all carried out online. Taking Jiangsu Province as an example, you can download the medical insurance cloud mobile application in Jiangsu Province.
After logging in to the app with your personal account, you will see a prompt for "Family Solidarity" inside the app.
Next, according to the prompts, you can bind different mutual aid family members separately. Fill in the name, age, ID number, relationship with the mutual aid and other information in detail.
It is worth mentioning that there is a time limit for Freemasonry, and the date can be chosen by yourself, such as 10 years, 20 years or more.
When the operation is completed, the part of the personal expenses incurred in the next hospitalization or to the designated hospital to buy medicine can be paid through the money in the mutual aid account.
In addition, in addition to the provincial medical insurance cloud mobile application, the country also has a medical insurance service platform mobile application. After downloading, you will also log in with your identity information, and the next steps will be roughly the same as those mentioned above.
In other words, the family members must go through the corresponding procedures to use the money in the personal account of medical insurance. If you do not go through the procedures mentioned above, you will not be able to use it at the same time of payment.
The meaning of mutual aid
The current medical insurance system for employees in mainland China has been implemented for more than 20 years, and the funds in individual accounts are composed of individual payment fees and unit allocation expenses.
This part of the cost is mainly used for outpatient medical expenses, and the model of "combining unified accounts" is an institutional model formed under a specific history. In the eyes of industry insiders, this model is currently facing many shortcomings.
Its biggest limitation is the lack of social mutual benefit, because for a long time it was limited to personal use, and this part of the funds was difficult to make full use.
Statistics show that 40% of the balance of the medical insurance fund is the funds of personal accounts. Among them, 80% of the personal accounts are healthy young adults. Some groups with high overall income can even accumulate tens of thousands of yuan in their personal accounts.
On the other hand, the elderly who have retired do not have enough money in their personal accounts for outpatient expenses.
According to the statistics of the National Health Insurance Bureau, in 2021, the average medical cost of employees is 2,097 yuan, while the cost of retirees is 8,002 yuan. In terms of hospitalization rate, 9.9% of active employees and 39.5% of retired employees were hospitalized.
Therefore, the implementation of the mutual aid policy now is to break down the original barriers, so that the funds in the personal account can circulate among family members. In this way, this part of the money that has been paid can also maximize its effect.
Previously, through the investigation of the personal accounts of insured employees, it can also be found that the funds in the personal accounts of retirees' medical insurance are generally less than 730 yuan, and with the increase of age, this cost is further reduced to 162 yuan.
From this perspective, it can also be seen that the elderly in the medical insurance group can protect their medical needs to the greatest extent through the mutual assistance between family members.
epilogue
The essence of the mutual aid policy is to let the medical insurance funds circulate to the greatest extent and play the greatest role, so that those in need can benefit.
The mutual aid between family members also makes the circulation of medical insurance funds more evenly among individuals. It eliminates the barriers of accounts and uses them through mutual aid, which can minimize the burden of medical treatment for the public.
Resources:
"This kind of small favor can't help the fraudulent use of other people's medical insurance cards will be punished" National Health Security Administration, April 25, 2024
"Employee Medical Insurance Ushers in Major Changes - Mutual Aid Use of Personal Accounts Benefiting Family Members" Economic Times, April 28, 2021
"How to Look at the Reform of Outpatient Mutual Aid Security", People's Daily, February 16, 2023
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