Last week, we talked about the topic of "can the money in the medical insurance card buy medicine for relatives", and everyone learned about the medical insurance family mutual aid mechanism. Xiaobian found that some netizens in the background asked why sometimes the money in the medical insurance account could not be given to the family, and today we will continue to talk about this topic.
01
Medical insurance family mutual aid mechanism
In April 2021, the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Guarantee Mechanism for Basic Medical Insurance for Employees", which provides us with key ideas to solve this problem. The Guiding Opinions clarify the expansion of the function of individual accounts for employee medical insurance, from the previous restriction on the user himself/herself, to include family members.
It is reported that at present, the vast majority of areas in the country have realized medical mutual aid between family members, and are rapidly expanding to cross-provincial mutual aid.
For the personal account of employees' medical insurance and its family mutual aid mechanism, the policy has two clear requirements that are worth noting.
First of all, the eligibility to set up a personal account is limited to employees who are already insured, and only they can activate the function of using the funds in the personal account for family members.
Secondly, no matter when and where, when and where you go to the doctor to buy medicines, you must show your medical insurance card in accordance with the regulations.
This means that "money can be shared, cards cannot be shared" has become a core rule in this policy.
Although since the introduction of the policy, many insured employees have enjoyed the benefits of family mutual aid in medical insurance personal accounts, some employees will still encounter some troubles in actual operation. These problems can be broadly boiled down to the following four main reasons.
02
What are the reasons for the unsuccessful mutual aid function of medical insurance personal accounts?
1. Mandatory condition for participation: Only when family members have been insured and enrolled in basic medical insurance can they be included in the scope of mutual aid insurance, and relatives who are not under this condition cannot receive mutual aid benefits.
2. Confusion between mutual aid accounts and family accounts: The functions and usage scenarios of the two are completely different. In short, the "family account" is mainly to help family members display the medical insurance code and realize medical payment; The "mutual aid account" is allowed to bind the amount of the medical insurance personal account to "pay" for the family.
3. Mutual Aid Account Balance of Zero: A Mutual Aid Account Balance of Zero means that mutual aid payments cannot be made, so it is essential to maintain an appropriate account balance.
4. Restrictions on overall planning and region: At present, the cross-provincial mutual aid function of medical insurance personal accounts has not yet been realized, and some employees have been hindered from enjoying the family mutual aid policy.
03
How to bind the medical insurance personal account family mutual aid?
With the support of big data and information technology, the insured can operate through online channels such as the local special area of the national platform app for medical insurance services, the WeChat official account or official website of the local medical insurance agency. The following is an example of Hebei Province to introduce several simple and effective operation steps.
1) Register a login account: Use WeChat or Alipay to search for the "Hebei Smart Medical Insurance" applet, and then choose the appropriate method to log in.
2) Bind kinship: Enter the "Personal Account Mutual Aid" function module and click the "Add My Relative" button.
3) Fill in the information of family members: fill in the name, ID number of the relative, kinship and other information that needs to be bound as required.
4) Family member management: You can view the information such as the mutual aid consumption records of the bound relative account, and unbind it if necessary.
5) Mutual aid settlement: When the payee settles in the designated hospital, the system will automatically call the mutual aid account limit for payment. It should be noted that if the relatives are bound to mutual aid by multiple people, the system will select the mutual aid person with the largest balance in the personal account for settlement.
If the balance is insufficient to achieve mutual aid settlement, the system will not pool money from other accounts to settle the settlement. In this case, you will need to use another method to continue the settlement.
For special groups such as the elderly who have difficulty operating smart devices, they can try to handle it in the offline medical insurance hall.
Write at the end
Although the current medical insurance personal account mutual aid mechanism has brought many conveniences, inter-provincial mutual aid is still an area to be broken through. It is our unremitting pursuit to provide better medical insurance services for employees and ensure that every medical insurance fund gives full play to the maximum benefits.
We believe that with the development of science and technology and the improvement of policies, the medical insurance system in the mainland will be more mature in the future, more suitable for the needs of social development, and provide better medical security for the whole people.