In addition, the use of health insurance cards, policies and management of different provinces and cities have different provisions. For example, in Beijing, there is no balance on the card, which is similar to a membership card, and the doctor will focus on whether the patient is on the card. In Hebei Province, there is a balance on the card, and the card can be used in pharmacies to purchase medicines. Even in other provinces and cities, the balance of the card can be used to buy milk, toothpaste, toothbrushes and other household items in the pharmacy.
The General Office of the State Council on April 22 released "on the establishment of a sound employee basic medical insurance outpatient **** relief protection mechanism of the guiding opinions" (hereinafter referred to as "Opinions"), the opinions put forward to standardize the scope of use of the individual account of the employee's health insurance, the individual account is mainly used to pay for the insured person in the designated medical institutions or designated retail pharmacy out-of-pocket expenses occurring within the scope of the policy. It can be used to pay for the medical expenses incurred by the insured person and his/her spouse, parents and children in the designated medical institutions, as well as the expenses incurred by the insured person in the designated retail pharmacies for the purchase of medicines, medical equipments, medical consumables, which are borne by the insured person.
The key point is that although the personal account of an insured employee's health insurance card can be used to pay for the personal expenses incurred by his or her family members when they visit a medical institution and the expenses incurred by individuals when they buy medicines at a pharmacy, it cannot be used for reimbursement of the overall reimbursement! It means that the family members of the insured employee can't be reimbursed without medical insurance in the hospital, but the balance of the individual account of the insured employee can be used for the part of personal expenses!
Medicare card lending refers to the medical insurance card lent to others, in the name of the medical insurance card myself to register to see a doctor, and enjoy the national health insurance reimbursement treatment.
The phenomenon of medical insurance card lending is very common, unaware that this behavior is illegal!
China's first Regulations on the Supervision and Management of the Use of Medical Insurance Funds (hereinafter referred to as the "Regulations") have been adopted by the State Council's 117th executive meeting on December 9, 2020, and will come into force on May 1, 2021.
Among them, Article 21 of the Regulations stipulates that "the medical insurance fund is earmarked for exclusive use, and no organization or individual may appropriate or misappropriate it." It can be seen that the reimbursement amount in the medical insurance card belongs to the national fund, once misappropriated or misappropriated, will bear legal responsibility.
At the same time, the "Regulations" Article 41 provides that individuals with their own medical insurance vouchers to others under false pretenses to use the situation, by the administrative department of medical security ordered to correct; cause the loss of medical insurance fund, ordered to return; belonging to the insured person, suspend its medical expenses network settlement for 3 months to 12 months. During the period of suspension of medical expenses network settlement, the lender will not be able to use the medical insurance card reimbursement in time when they are sick, so the loss is not worth the gain. Moreover, if an individual, for the purpose of fraudulently obtaining the medical insurance fund, hands over his medical insurance card to another person to use it under false name, resulting in loss of the medical insurance fund, he shall also be fined by the administrative department of medical insurance at a rate of not less than two but not more than five times of the amount of fraudulently obtaining the medical insurance card.
In addition, if the medical insurance card is lent to other people to go to the hospital for consultation, medical checkups, or hospitalization, the card will leave a detailed record, which may affect the card's own participation in commercial insurance or claims.
The State Council's "Opinions" finally made it clear that the people's governments at the provincial level should, in accordance with the requirements of this opinion, make overall arrangements, scientific decision-making, and introduce implementation measures before the end of December 2021 to guide the integrated regions to promote the implementation of the transition period can be set up for about three years, and gradually realize the objectives of the reform. The coordinated areas should combine the local reality, further clarify and refine the policy provisions, properly handle the policy connection before and after the reform, to ensure a smooth transition of the treatment of insured persons, carry out the relevant work to further standardize the policy standards.
Medicare is actually a mutual assistance process that brings together the money of the insured, so that the healthy people can help those who have diseases. Participants can only enjoy health insurance benefits after they have paid their fees. Lending one's health insurance card to others without authorization will result in the loss of the country's limited health insurance fund. The medical insurance fund is the people's life-saving money, only strict compliance with the provisions of the relevant laws and regulations and policies of the medical insurance, in order to help others, but also to help our own .