The employees' medical insurance participants in our country have personal medical insurance accounts, which are mainly used to pay the personal expenses when they go to the hospital to purchase medicines.

In April 2021, the General Office of the State Council issued the Guiding Opinions on Establishing and Improving the Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism for Employees, which clearly defined that the scope of use of the personal account of medical insurance for employees should be expanded from the original use only by employees to the use of mutual aid for family members. At present, the whole country has basically realized the mutual aid of individual accounts among family members in the same medical insurance planning area, and some places have realized the mutual aid of families in different cities in the province. They are gradually making efforts to help cross provincial families, providing convenience for the majority of insured people to seek medical treatment and purchase medicine.

There are two matters to be noted: first, only employees with medical insurance have personal accounts; Only the employee medical insurance participants can donate the funds in their personal accounts to family members. The second is the personal account of medical insurance for employees. Money can be shared, but cards cannot be shared. In any case, the patient's medical insurance card must be used for medical treatment and drug purchase.

At the same time, some insured people may still be confused about "how to bind personal accounts to family member relationships" and "how to achieve mutual financial settlement for family members' medical treatment?". We have sorted out some of your questions and hope to answer your questions.

What are the reasons for the failure of medical insurance individual account mutual aid?

Reason 1: "Masonic relationship" cannot be bound and used without insurance

There are two preconditions for family solidarity: one is that the family members of solidarity are only limited to parents, spouses and children, not including the parents or other relatives of the spouse. Second, the family members who help each other must participate in the basic medical insurance.

  Reason 2: Mutual aid account ≠ kinship account

From time to time, netizens report that they have bound to the "medical insurance kinship account", but have not yet been able to achieve "medical insurance personal account family solidarity". In fact, the functions of "family account" and "family assistance" are different, and the problems to be solved are different, which are two different operations.

Familiarity account is to help family members display their medical insurance code, and spend their medical insurance quota, which has nothing to do with the personal account of the bound person. For example, if Li Ming takes a child to see a doctor and forgets his medical insurance card, he can add the child to his family account through his mobile phone. The family account will automatically generate the child's own medical insurance code and help the child scan the code for medical treatment.

The mutual aid account is to give the amount of the individual medical insurance account of the binding person to the family, and spend the money of the binding person to help the family "pay the bill". After opening the individual medical insurance account for mutual aid, parents, spouses and children can use the balance of the account to pay for medical expenses.

When some insured people went to hospital, they only bound "family account" for their families, but did not operate "family assistance", which led to the failure of family assistance with personal accounts.

  Reason 3: The balance of the individual account of the bound mason is zero and cannot be used

After the "Masonic relationship" is successfully bound, if the balance of the individual medical insurance account of the Mason is 0, the payment will not be made.

Reason 4: Not in the same medical insurance planning area, and cannot be bound to "mutual aid relationship"

At present, some provinces stipulate that only direct relatives in the same medical insurance planning area can contribute to individual medical insurance accounts. Hebei, Jiangsu and other provinces have achieved mutual assistance between individual account families in different cities of the province. However, at present, the individual account has not yet achieved cross provincial assistance among family members, so this netizen and his father are insured in different provinces, and they cannot help the balance of the individual account.

In the actual medical treatment process, if the personal account of "family assistance" is not used successfully, you should not worry, see what kind of situation you belong to, find out the problem, and enjoy this policy smoothly.

  How to correctly bind medical insurance individual account and family mutual aid?

Warm prompt: the insured can realize online processing through the functional modules of "individual account and family assistance of employee medical insurance", such as the national medical insurance service platform App local area, the local medical insurance department WeChat public account, and the official website. The specific way is open to the public by the medical insurance department of each planning area. Taking Hebei Province as an example, there are the following steps:

  1、 Register login account : Take the insurance of employees in Hebei Province as an example, you can use WeChat or Alipay to search for the "Hebei Smart Medical Insurance" applet, enter the "Hebei Smart Medical Insurance" applet login page, and log in the applet through the quick login method of registered account or mobile phone number.

  2、 Binding kinship After logging into the "Hebei Smart Medical Insurance" applet, the employee insured can enter the "Individual Account Mutual Aid" function in the business processing column, click the "Add My Relatives" button, and enter the bound family member information filling page.

  3、 Fill in family member information : On the page of adding relatives, fill in the relatives' names, relatives' ID numbers, relatives and other information to be bound as required to complete the relatives binding. The bound family members must be the insured persons who normally participate in employee medical insurance or resident medical insurance in Hebei Province. One employee insured person can bind up to 8 family members.

  4、 Family member management : The insured can enter the individual account mutual aid management page to query the information such as the tied relative account mutual aid consumption records. If it is necessary to unbind the relationship, the employee insured can select the family members to unbind and complete the relationship unbinding through the "unbind" operation.

  5、 Realize mutual settlement : When the bound relatives go to the designated hospitals nationwide for medical treatment and use their own medical insurance code or medical insurance card for settlement, the system automatically completes the financial settlement (without consulting the hospital staff whether they support the financial settlement of accounts). It should be noted that if the relative is bound by multiple insured relatives of employees, the system will automatically select the mason with the largest personal account balance for settlement. If the balance of the mason's personal account is not enough to pay for this settlement, the insured person cannot achieve financial settlement, and the system will not "raise money" from multiple mason accounts for settlement, At this time, you need to use other methods to continue settlement.

In addition, special groups such as the elderly who are difficult to operate intelligent devices can also be handled offline in the medical insurance hall.