Mainland employee medical insurance participants have set up a personal medical insurance account, which is mainly used to pay for personal expenses when seeking medical treatment and purchasing drugs.
In April 2021, the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Guarantee Mechanism of Basic Medical Insurance for Employees", which clarified that the scope of use of personal medical insurance accounts for employees will be expanded, from the original only for individual employees to be used by individual employees, to be used by family members. At present, the country has basically realized the mutual aid between family members in the same medical insurance co-ordination area of individual accounts, and some places have realized family mutual aid between different cities in the province, and are gradually working towards cross-provincial family mutual aid, providing convenience for the vast number of insured people to seek medical treatment and purchase medicines.
There are two things to be clarified: first, only employees who are insured by medical insurance have personal accounts; Only employee medical insurance participants can donate funds from their personal accounts to family members. The second is the personal account of the employee's medical insurance, where the money can be shared and the card cannot be shared. In any case, the patient's health insurance card must be used to purchase medicine.
At the same time, for the question "How to bind family members to a personal account?" "How can family members achieve mutual aid settlement when they see a doctor?" Some insured people may still be confused. In response to some of your questions, we have sorted out this, and hope to answer your questions.
What are the reasons that will lead to the unsuccessful mutual aid of medical insurance personal accounts?
Reason 1: If you don't have insurance, you can't bind the "mutual aid relationship" and can't use it
There are two prerequisites for family solidarity: First, the family members of the family are limited to parents, spouses and children, and do not include the parents or other relatives of the spouse. Second, family members must participate in basic medical insurance.
Reason 2: Mutual aid accounts ≠ family accounts
From time to time, some netizens report that they have bound the "medical insurance family account", but they have not been able to realize the "medical insurance personal account family mutual aid". In fact, the functions of the "family account" and the "family mutual aid" are different, and the problems to be solved are different, and they are two different operations.
The family account is to help the family show the medical insurance code, and it costs the family's medical insurance amount, which has nothing to do with the personal account of the bound person. If Li Ming takes his child to see a doctor and forgets his child's medical insurance card, he can add the child to his family account through his mobile phone, and the child's own medical insurance code will be automatically generated in the family account to help the child scan the code for medical treatment.
The mutual aid account is to give the amount of the bound person's medical insurance personal account to the family, and spend the money of the bound person to help the family "pay". After opening a medical insurance personal mutual aid account, parents, spouses, and children can use the balance of this mutual aid account to pay for expenses incurred when seeing a doctor and buying medicines.
When some insured people seek medical treatment, they only help their family members bind the "family account" and do not operate the "family mutual aid", resulting in the failure to realize the family mutual aid of the personal account.
Reason 3: The balance of the bound mutual aid person's personal account is zero and cannot be used
After successfully binding the "mutual aid relationship", if the balance of the mutual aid person's medical insurance personal account is 0, there will be a situation where the payment will not be made.
Reason 4: Not in the same medical insurance co-ordination area, can not be bound to the "mutual aid relationship"
At present, some provinces stipulate that only between immediate family members in the same medical insurance co-ordination area can mutual aid medical insurance personal accounts. Hebei, Jiangsu and other provinces have realized the mutual aid of individual accounts and families in different cities in the province. But at present, the personal account has not yet realized the cross-provincial mutual aid between family members, so this netizen and his father are insured in different provinces and cannot help the balance of the personal account.
In the actual process of medical treatment, if the use of the "Family Mutual Aid" personal account is not successful, you should not worry, see what kind of situation you belong to, find out the problem, and enjoy this policy smoothly.
How to properly bind the medical insurance personal account family mutual aid?
Warm reminder, the insured can be handled online through the local area of the national medical insurance service platform App, the WeChat official account of the local medical insurance department, the official website and other functional modules of the "Employee Medical Insurance Personal Account Family Mutual Aid", and the specific channels will be disclosed to the public by the medical insurance departments of the overall planning area. Taking Hebei Province as an example, there are the following steps:
1. Register and log in account: For example, employees and insureds in Hebei Province can use WeChat or Alipay to search for the "Hebei Smart Medical Insurance" applet, enter the login page of the "Hebei Smart Medical Insurance" applet, and log in to the applet by registering an account or a mobile phone number.
2. Binding kinship: After logging in to the "Hebei Smart Medical Insurance" applet, the employee insured enters the "Personal Account Mutual Aid" function in the business handling column, and clicks the "Add My Relative" button to enter the page for filling in the information of bound family members.
3. Fill in the information of family members: On the Add Relatives page, fill in the name, ID number, kinship and other information of the relatives to be bound as required to complete the kinship binding. The bound family members must be the participants who normally participate in the employee medical insurance or resident medical insurance in Hebei Province, and an employee insured person can bind up to 8 family members.
4. Family member management: The insured person can enter the personal account mutual aid management page and inquire about the bound relative account mutual aid consumption records and other information. If the relationship needs to be unbound, the employee insured person can select the family member who needs to be unbound and complete the unbinding operation through the "unbinding" operation.
5. Realize mutual aid settlement: When the bound relatives go to designated hospitals nationwide to see a doctor and use their own medical insurance code or medical insurance card to settle the settlement, the system will automatically complete the mutual aid settlement (no need to consult the hospital staff whether they support the mutual aid settlement of the account). It should be noted that if the relative is bound by more than one employee insured relatives, the system will automatically select the mutual aid person with the largest personal account balance at the time of settlement, if the balance of the mutual aid person's personal account is not enough to pay for this settlement, the insured person will not be able to achieve mutual aid settlement, and the system will not "make money" from multiple mutual aid accounts for settlement, and at this time, it is necessary to use other methods to continue settlement.
In addition, for special groups such as the elderly who have difficulty operating smart devices, they can also be handled in the offline medical insurance hall.
(Source丨National Health Insurance Administration)