Health insurance participants in China have personal accounts for medical insurance.Redingtonrise34It is mainly used to pay for the expenses borne by individuals when they seek medical treatment and purchase drugs.
In April 2021, the General Office of the State Council issued the guidance on establishing and improving the out-patient benefit guarantee Mechanism of Workers' basic Medical Insurance, which clearly expanded the scope of use of employees' personal medical insurance accounts so that they could only be used by individual employees, so that they could be used by family members. At present, the whole country has basically realized the assistance of individual accounts among family members in the same health insurance co-ordination area, and some places have achieved family assistance between different cities in the province, and are gradually working towards cross-provincial families, providing convenience for the broad masses of insured people to seek medical treatment and purchase medicine.
There are two things to be specially explained: first, only employees who participate in medical insurance have personal accounts; and only those who participate in employee medical insurance can contribute individual account funds to family members. Second, the employee medical insurance personal account, the money can be shared, the card can not be shared. In any case, the patient's own health insurance card must be used to buy medicine.
At the same time, for "how to bind a personal account to a family member relationship"Redingtonrise34? " "how can family members achieve fraternity settlement when they see a doctor?" And so on, some participants may still be confused. In view of some of your questions, this has been combed, hoping to answer your questions.
What are the reasons for the failure of Medicare individual accounts?
Reason 1: if there is no insurance, you cannot bind the "almsgiving relationship" and cannot use it.
There are two prerequisites for family almsgiving: first, the family members of almsgiving are limited to parents, spouses and children, and do not include parents or other relatives of spouses. Second, freemason family members must participate in basic medical insurance.
Reason 2: Masonic account ≠ kinship account
From time to time, some netizens report that they have bound the "medical insurance family account", but have not been able to realize the "medical insurance personal account family aid". In fact, the functions of "family account" and "family aid" are different, and the problems to be solved are different, which are two different operations.
Family account, is to help the family to show the health insurance code, spend the family's health insurance quota, has nothing to do with the binding person's personal account. For example, if Li Ming takes the child to see a doctor and forgets the medical insurance card for the child, he can add the child to his family account through his mobile phone, and the family account will automatically generate the child's own medical insurance code and help the child scan the code for medical treatment.
The almsgiving account is to give the amount of the bound person's personal health insurance account to the family, and spend the bound person's money to "pay the bill" for the family. After opening the individual medical insurance account, parents, spouses and children can all use the balance of this account to pay for the expenses incurred when they see a doctor and buy medicine.
When some insured persons seek medical treatment, they only help their families bind "family accounts" and do not operate "family sympathies", resulting in the failure to realize individual accounts and family sympathies.
Reason 3: the balance of the bound freemason personal account is zero and cannot be used
After successfully binding the "freemason", if the balance of the individual account of the freemason is 0, there will be a situation that can not be paid.
Reason 4: not in the same health insurance co-ordinated area, can not be bound to the "economic relationship"
At present, some provinces stipulate that individual medical insurance accounts can be co-financed only among immediate family members in the same health insurance planning area. Hebei, Jiangsu and other provinces have realized the cooperation of individual accounts and families between different cities in the province. But at present, the personal account has not yet achieved inter-provincial assistance among family members, so the netizen and his father are insured in different provinces, and are still unable to help each other with the balance of his personal account.
In the actual process of seeking medical treatment, if the use of the personal account of "family relief" is not successful, don't worry, see what kind of situation you belong to, find out where the problem lies, and enjoy this policy smoothly.
How to bind the individual account of health insurance correctly?
Warm reminder, the insured can realize online processing through the functional modules of "employee medical insurance personal account and family assistance", such as the national health insurance service platform App local special area, the local health insurance department's official Wechat account, and the official website, and the specific ways are made public by the medical insurance departments of each co-ordinated area. Take Hebei Province as an example, there are the following steps:
1. Register and login account: take the insured workers in Hebei Province as an example, you can use Wechat or Alipay to search for "Hebei Wisdom Medical Insurance" Mini Program, enter the "Hebei Wisdom Medical Insurance" Mini Program login page, and log in to Mini Program quickly through a registered account or mobile phone number.
2. Bind kinship: after logging in to the "Hebei Wisdom Medical Insurance" Mini Program, the employee insured will enter the "personal account almsgiving" function in the business processing column, and click the "add my relatives" button to enter the binding family member information filling page.
3. Fill in the family member information: on the add kinship page, fill in the relative name, relative certificate number, kinship and other information that need to be bound as required to complete the relative binding. The bound family members must be the insured who normally participate in the medical insurance for workers or residents in Hebei Province, and a worker can bind up to 8 family members.
4. Family member management: the insured can enter the individual account alchemy management page and query the bound relatives' account alchemy consumption records and other information. If the binding relationship needs to be unbound, the employee insured can choose the family members who need to be unbound and complete the relationship unbinding through the "unbinding" operation.
5. Realize the alimony settlement: when the bound relatives go to the designated hospitals nationwide to see a doctor using their own medical insurance code or medical insurance card, the system automatically completes the alchemy settlement (there is no need to consult the hospital staff whether they support the account). It should be noted that if the relative is bound by multiple employee insured relatives, the system will automatically select the freemason with the largest individual account balance at the time of settlement. If the individual account balance of the freemason is not enough to cover the settlement, the insured will not be able to achieve alms settlement, and the system will not "collect money" from multiple freemasons' accounts. At this time, it is necessary to use other methods to continue settlement.
In addition, special groups such as the elderly who have difficulties in operating smart devices can also be handled offline in the health insurance hall.