Insured persons need to inquire about the balance and usage of health accounts, which can be inquired at the window of medical insurance agencies at all levels, the self-service terminal in the handling hall or by calling 12333.
The health account is a fund account drawn from the actual balance of the personal medical account of the insured person of the basic medical insurance in this city, which is used for comprehensive health protection between himself, his parents, children and his spouse.
What is the source of funds for health accounts?
There are three sources of funds for health accounts:
1, the monthly fund for drug purchase and physical examination drawn from the actual balance of the insured's personal medical account.
2. The accumulated balance of individual medical account fund in each medical insurance year exceeds 3,000 yuan.
3. Interest income from health accounts, as well as income stipulated by other laws and regulations.
What are the main functions of a health account?
Main functions of health account:
1, offset part of my own medical expenses. When the insured person goes to the designated medical institution for medical treatment, he can use the personal medical account to pay the medical expenses in accordance with the provisions of the basic medical insurance, and at the same time, he can use the funds in the health account to offset the medical expenses that must be paid by the individual above the maximum payment limit of the basic medical insurance, supplementary medical insurance and supplementary medical insurance.
2. Family members help each other. Insured employees can establish a family medical network for parents, children, spouses and other family members who participate in the basic medical insurance for employees or urban and rural residents in this Municipality, and pay the medical expenses incurred by family members with insufficient balance of health accounts or no health accounts in designated medical institutions.
3. Buy medicine for physical examination to prevent immunity. Health account funds can be used to pay for the purchase of drugs in the medical insurance catalogue, 72 kinds of medical consumables and disinfection products in designated retail pharmacies; And pay the vaccine expenses and non-public medical expenses for physical examination in designated medical institutions.
4. Pay the family doctor to sign a contract to bear part of the expenses. Family doctor signing service fee 120 yuan/person/year, in which the contracted residents bear 20 yuan/person/year, which can be paid by personal cash or medical insurance health account, or by family health account when the medical insurance health account is insufficient.
5, expand the scope of use, for the "* * *" members to pay the basic medical insurance for urban and rural residents. From the medical insurance year of 20 17, the insured person can use the funds in his health account to pay the basic medical insurance premium for urban and rural residents for himself or his family members who have established the "family medical network", and offset the supplementary expenses of the insufficient payment period of the basic medical insurance when he retires, thus improving the efficiency of the medical insurance fund.
The out-of-pocket medical expenses incurred by the insured in designated medical institutions can be paid by the health account fund or the family medical fund. What are the specific contents of self-funded medical expenses?
Out-of-pocket expenses incurred in designated medical institutions specifically include:
1, medical expenses paid by individuals, such as the proportion of self-payment stipulated in the basic medical insurance, the minimum payment standard and the minimum payment standard of social pooling funds, and the maximum payment limit of pooling funds and supplementary medical insurance;
2, the basic medical insurance drugs and clinical treatment necessary drug costs, basic medical insurance diagnosis and treatment directory and clinical treatment necessary, in line with the provisions of Xiamen medical service price of medical treatment project costs;
3, the provisions of the Provincial People's Social Welfare Department paid by individual medical accounts, non-public medical expenses of vaccine costs;
4. Medical examination fee.
Are there any rules for using health accounts to buy medical consumables?
Yes
When the insured purchases 65,438+00 kinds of medical consumables, such as spectrum (medium and low) therapeutic devices, behind-the-ear hearing AIDS, wheelchairs, etc. Medical consumables purchased from health accounts and the catalogue of disinfection products must provide copies of diagnosis certificates or medical records related to disease treatment and rehabilitation issued by designated medical institutions at or above the second level, and also provide copies of social security cards. I would like to remind all insured persons that in each medical insurance year, the accumulated amount of using health accounts in designated retail pharmacies shall not exceed 5,000 yuan, of which the accumulated amount of purchasing drugs and disinfection products shall not exceed that of 300 yuan every month.
Can out-of-pocket medical expenses incurred by medical treatment in different places be paid by health account fund?
Of course.
According to the provisions of the medical treatment, resettlement or work personnel, in different places in accordance with the provisions of the "Xiamen medical insurance health account management approach" of medical expenses, can use health accounts and family medical * * * economic network funds to pay, according to the relevant provisions of the basic medical insurance settlement. In the networked areas of the province, social security cards can be directly used to pay for health accounts and family medical services.