And the customer's health insurance card loan is also our insurance broker often encountered problems, I believe that you have also heard "the health insurance card to others will affect their own insurance, how not to lend to family members with!" When I googled it, I found a lot of different opinions. ..... If my family can't use it, won't I get beat up OR kicked out of the house?
So, I counted the cases encountered by the team, and decisively published an article, hoping that we can understand that the medical insurance card can be used for family members, how to use is compliant, and what is the situation belongs to the misuse of the rational treatment of the "medical insurance card borrowing", to protect their families at the same time, also protect their personal health records. The first thing you need to do is to get a good deal on your own personal health record.
Briefly explaining the social security card
Before discussing the implications of lending your card to someone else, let's briefly explain what the card is. There are two parts to the card: the personal account and the integrated account. The personal account for health insurance is made up of money deducted from our monthly paychecks, usually 2% of our paychecks, which is essentially our own money that we pay for as long as we follow the rules and use it as we please. The integrated account is the enterprise subsidy funds paid in, can be understood as a part of the state funds and other enterprises in the government to manage the money, the payment of people who are sick to reimbursement, is essentially an insurance. So, half of the health insurance card is private money (personal account), half is **** the same pool of insurance funds. No matter how much you pay, you enjoy the same reimbursement rate. The difference is the money inside the individual account. So health insurance is still a beneficial policy to narrow the gap between the rich and the poor.We will analyze the difference between different borrowing situations, which can be roughly divided into four cases: purchase of medicines, outpatient services, hospitalization, and medical checkups.
One of the most important things to remember is that you can't buy a new one without having to pay a lot of money for it.
1) buy drugs for loved ones in their own name registered (with a prescription)
In the case of hospital pharmacies and health insurance designated pharmacies to buy drugs, you have to come up with a prescription order from the doctor before the pharmacy will give you a prescription. If your name is on the prescription, even if you buy the medicine for someone else to take, the insurance company will recognize that you have the disease, and all of this will affect the life and health insurance policy. In this case, you have to tell the insurance company that you don't have this condition, and that you just used your card to buy medicine for someone else, and then wait for the insurance company's response. Some insurance companies will refuse to cover you (you'd rather be wrong than wrong), while others may arrange for you to have a medical checkup to prove your innocence.2 ) No prescription
When you go to a regular pharmacy to pick up your medication, you usually don't need a prescription, and you can pay for it with money from your personal account on your health insurance card. This is what most everyone encounters. For example, a family member has used your health insurance card to buy drugs for serious illnesses such as high blood pressure, heart disease, or diabetes at the pharmacy, or you've used your own health insurance card to buy some serious drugs for your parents, but do these prove that you actually have these illnesses? Will the insurance company find that you have concealed your health information before taking out the policy because of these records of drug purchases?The answer is no. This is simply a case of using your personal account on your health insurance card, which makes sense and is nothing to worry about!
Buying your grandparents some home remedies at the pharmacy shows that you are filial and responsible!This is the first time I've ever seen a woman with a high school diploma.
Should you make a health notification before you buy an insurance policy? So if you don't, will it affect your claim? The insurance company can't deny a claim based on the record of medication purchases alone. Unless the insurance company finds other stronger evidence, including but not limited to medical examination records, hospitalization and hospitalization records, to prove that you are indeed insured with a disease. If the insurance company refuses to pay the claim simply because of the medication, you can sue, and the law is "whoever claims, whoever proves". The law is "whoever claims, whoever proves", i.e., the insurance company will have to produce more evidence if it wants the court to uphold the denial.Two, outpatient visits
Ouyang's father visited the outpatient clinic, directly using Ouyang's health insurance card registration, get medicine, that record is directly under the name of Ouyang. If the card is lent out, then someone else will use your name to go to the regular hospital to see the outpatient clinic, and will definitely swipe your card when paying. This is the same as you go to the outpatient clinic, the hospital left cases, prescriptions on your name. When you buy insurance truthfully, you are bound to mention this issue, and if you do not tell the truth, there will be disputes in the future claims. But the question is, truthfully informed, the insurance company usually how to deal with it? Either the insurance company directly rejects the policy; or the insurance company feels that the diseases in your outpatient record are minor, and will require the insured to do a physical examination to prove their innocence. Further, being rejected is not the worst case scenario. In order to avoid the worse case scenario of "being rejected in the future", you have to be truthful when taking out the policy.Three, hospitalization claims
This is the most serious situation! The impact is also the biggest!
First of all, because who's health insurance card registered hospitalization, the record is who's; Secondly, let others pretend to use their own identity hospitalization, is the same as digging socialist health insurance wall corner, put the interests of the general public in the ah. Because the health insurance card lent to others for hospitalization, the discharge will be used to coordinate the account to reimbursement, this behavior has violated (Social Insurance Law, Article 88: fraud, forgery or other means of obtaining social insurance treatment, by the social insurance administrative department ordered the return of fraudulent social insurance, the fraudulent amount of more than two times five times the amount of the fine. Others hospitalized with your health insurance card reimbursement, then the insurance company will consider the insured person itself there is a risk of integrity, borrowing health insurance card is nothing more than in order to save money, for this reason, even personal credit can be disregarded, such a customer in the future to cheat the insurance of the moral risk may be very high, so the insurance company is usually directly refused insurance.So, in this case, in order to avoid disputes in the future claims, the insurance must also be truthful.
In this case, you still want to buy insurance? The smart thing to do is to recognize the hospitalization record yourself, and honestly go underwriting. If the disease is not serious, you can still fight.
Four, medical examination
Family members take your medical card to the hospital medical examination, you need to see whether the family members in your name to register medical examination. If you register directly with your card for a medical checkup, the record will naturally be yours. If the medical examination to find out what the problem, health information and asked the medical examination abnormalities, needless to say, the insurance must be health information, ready to go underwriting it. If you register for a medical examination in his own name, and finally just use your health insurance card personal account to pay, then there is no impact, which Ouyang himself have experienced. In conclusion:Besides buying medicine for your family at a regular pharmacy, keep your own health insurance card, and don't lend it out in any other case!
--------- ------- Updated August 28, 2020: Because pharmacies swipe your own health insurance card account balance to buy medicine , which is essentially a personal account balance payment behavior, and is not a consultation or medical behavior, in fact, in principle, should not affect the insured, if the health information questionnaire does not ask, essentially do not need to inform at all. However, most insurance companies now use a relatively conservative underwriting scale for this kind of behavior, i.e., "refusing to insure". In fact, how to use the balance of the personal account of the medical insurance card, who can use the problem, there has been no very clear regulations, a little "gray" flavor, which has the insurance company's relatively harsh underwriting standards. On 2020-08-26, the National Health Insurance Bureau formally announced to the community "on the establishment of a sound employees basic medical insurance outpatient **** relief protection mechanism of the guidance (draft)", hopefully from the legal level to solve this problem. (C) standardize the scope of use of individual accounts Individual accounts are mainly used to pay for out-of-pocket expenses within the scope of the policy incurred by insured employees at designated medical institutions or designated retail pharmacies. It can be used to pay for the medical expenses incurred by the employees themselves, their spouses, parents, and children at the designated medical institutions of the health insurance, as well as the expenses incurred by the individuals for the purchase of medicines and medical consumables at the designated retail pharmacies. Explore the use of individual accounts for the personal contributions of spouses, parents and children to participate in basic medical insurance for urban and rural residents, etc. Individual accounts may not be used for public **** health expenses, sports and fitness or health care consumption, or other expenditures that are not covered by basic medical insurance. Improve and perfect the use of personal accounts management methods, and do a good job of income and expenditure information statistics. The above text has made it clear that in the future, the money in your own account on your health insurance card can be used not only by yourself, but also by your parents, your spouse and your children, and not only can it be used for out-of-pocket medical payments at health insurance designated institutions, but also at pharmacies for your parents to buy medicines and medical equipment! So, lending your own health insurance card to your mom to buy medicine (not borrowing a card, but establishing a ****ji account balance in general) is no longer a gray behavior, but a normal consumer behavior in line with the norms of the use of health insurance cards! --------- ---------- ---------- - 20201208 Update In practice many insurance companies are still very much in the point of accidental borrowing of health insurance cards, you will see below to know. 20201208 Share: each insurance company on the social security card borrowed underwriting: Kunlun: truthfully inform, provide a complete medical report Everbright: refused to insure Tianan: such as borrowing to buy drugs need to provide a list of medicines, the insured medical report, the medical history of the person who visited the clinic as a supporting information underwriting; such as borrowing to register to see the doctor, it can only be based on the customer to see the doctor's situation of the underwriting, the great chance of Extension China Merchants: need to provide the borrower's relevant case information to prove it Tongfang: as with the local body condition, submit a list of medicines and the medical examination report of the insured person in recent years, and the result will be known only after the policy is taken out Taikang: refused to be insured Ruitai: underwritten according to the type of borrowed disease Heng'an: the general subject matter of the notification to be done, and it depends on the actual situation and the type of medication prescribed Sino-Eastern: as with the local body condition, submit a list and the medical examination report of the insured person, and the results can be known only after the policy is taken out Chinese-English: as with the local body condition, submit the list and my medical report of this year, and the result will be known only after the policy is taken out Centennial:Borrowed hospital visits and prescriptions for hypertension and cardiovascular diseases. Refusal of insurance; other diseases, you can provide the customer's medical examination report for the last 1-3 years as an underwriting assessment, and the results will be subject to underwriting. Great Wall:Medical insurance card loan history to buy hypertension and other drugs refused to insure ICBC:Provide proof of the Social Security Administration; provide a complete medical history of those who use the social security card; in some cases, can be arranged for physical examination; specific basic must be submitted to the examination of the gold indicators. Lujiazui:treat the body as if it were the body's own condition, tell the truth, submit a list and the report of my medical examination this year, and only know the results after the insurance Pearl River:the loaner confirmed medical records and prescriptions for medication, the social security person's medical examination report (the report needs to show that the social security person is healthy), and a written description (the description needs to be the loaner's signature and the person's signature) China Merchants Renhe:provide the actual medical records of the person who uses the medication Just fine Zhong Yi:Customers need to self-certify that their body has no medical history recorded by their hospitals, submit medical examination reports of consecutive years, and apply for change of enrollment stating the reason for borrowing social security card, and the underwriting will depend on the customer's situation. If the customer can not self-certification, then directly rejected everyone: the insurance need to truthfully inform the underwriting colleagues to judge. If you are lending to your family to buy cold medicine and other drugs that do not have a big impact, there is still a chance of coverage, but you must provide sufficient information to prove that the purchase is to help family members to buy, the disease has no direct impact on the critical illness. But overall, it's better not to lend out your health insurance card Credit Suisse:The health insurance card is borrowed, checking the corresponding disease items, informing the borrowing situation, and at the same time, providing their own examination report to prove that they do not have this disease.Huaxia: Provide a report within two years or cooperate with the medical examination
Evergrande: Provide the borrower's relevant case information to proveThis is our team statistics, because there may be changes, the specific need to determine with the Commissioner of the Department of Insurance in each place. So, you've got to be aware of what you're getting into, and what you're getting into. The company's website has been updated with the latest version of the website, which is now available on the website.
There is a good chance that you will be able to find your way to the insurance company to get your medical card lent to you, as long as you don't want to cheat on your insurance.
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