In April 2021, the mainland proposed to appropriately expand the scope of use of employees' personal medical insurance accounts, from paying for their own medical treatment, to allowing family members to help each other and use personal accounts to pay for medical expenses within the scope of the policy, that is, "family mutual aid". The "family mutual aid" policy solves the problem that the personal accounts of healthy people within the family are accumulating more and more, and the personal accounts of the insured who are more sick are insufficient.
So, how to handle the "family mutual aid" of medical insurance? Which relatives are eligible for the Medicare "Family Mutual Aid"? What does the medical insurance "family mutual aid" share? Recently, the National Health Insurance Administration responded to related questions.
How can the medical insurance personal account be shared with the whole family?
The National Health Insurance Administration reminds that the insured can handle it online through the local special 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 co-ordination districts; Special groups such as the elderly who have difficulty operating smart devices can also handle it in the offline medical insurance hall.
The National Health Insurance Administration emphasizes that the premise for employee medical insurance participants to handle "family mutual aid" is that the parents, spouses and children of the insured also participate in basic medical insurance, including employee medical insurance and resident medical insurance. It should also be noted that family members are limited to the parents, spouse and children mentioned above, and do not include the spouse's parents and other relatives.
Xu Dasong, Chief of the Medical Insurance Department of Guangxin District People's Hospital of Shangrao City: Often the parents of children are relatively young, and their account funds have accumulated more. However, children, especially when they are younger, have a higher probability of developing the disease and a higher probability of using it, and their benefits are the most obvious after using a mutual aid account.
The creator of the mutual aid account must be an employee medical insurance participant
To put it simply, the "family mutual aid" of medical insurance refers to the money in the personal account of the employee's medical insurance, which can be used by family members. That is, by creating a family mutual aid account, the balance in the person's medical insurance account is authorized to be shared with spouse, children and parents. How can I share my personal account with my family? What are the requirements?
- First of all, the creator of the family mutual aid account must be an insured person of the employee medical insurance;
- Second, the scope of Freemasonry is limited to the parents, spouse and children of the founders themselves, and they are all covered by basic medical insurance.
It is the money in the personal account that is mutually beneficial, not the health insurance card itself
Some insured people have proposed that after applying for "family mutual aid", whose medical insurance card should be used for medical treatment and drug purchase? Can a family member go to the doctor with my health insurance card?
In response, the National Health Insurance Administration responded that in any case, the patient's own medical insurance card must be used to purchase drugs for medical treatment. The family is given money in a personal account, not a health insurance card.
According to the National Health Insurance Administration:
- The principle followed by medical insurance is "I am insured, I enjoy the treatment";
- After the family mutual aid, the principle remains unchanged, and the insured person still uses his or her own medical insurance card to see a doctor and enjoy his own medical insurance treatment according to the regulations;
- The family mutual aid policy "mutual aid" is the money in the personal account of the employee's medical insurance card, not the medical insurance card itself;
- Not using one's medical insurance card to register for medical treatment is "impersonation for medical treatment", which will suspend the online settlement of medical expenses at least and constitute a violation of the law at worst.
Generally speaking, it means that the insured can give the money in the personal account to the parents and other family members, but the reimbursement and reimbursement of the parents' medical treatment is still based on the medical insurance system they participate in.
If it is in special circumstances such as the elderly who have difficulty moving, children can purchase medicines on their behalf. However, when purchasing medicines, you need to use the patient's own medical insurance card and show the identity of the principal and the trustee.
Family accounts ≠ family mutual aid
In the process of handling medical insurance family mutual aid, there is another concept not to be confused, that is, the family account is not equal to family mutual aid.
The family account is a convenient function launched by the National Medical Insurance Administration on the "National Medical Insurance Service" App in order to facilitate the elderly and children to apply for medical insurance electronic vouchers, which solves the problem of not carrying a "physical card". The family account supports the addition of family members in different places across the country, that is, after the guardian adds the family account on his mobile phone, he can help them show the electronic voucher of medical insurance for registration, drug purchase and settlement, but it cannot realize the sharing of funds in the personal account of employee medical insurance.
Therefore, just binding the "family account" through the medical insurance electronic voucher cannot directly use the family mutual aid funds, and it is also necessary to apply for a personal account family mutual aid.
Source: CCTV