From September 1st, Beijing medical insurance personal account funds will be used for targeted use, and from December 1 this year, family members (who must participate in Beijing medical insurance) medical insurance can be used together.
What can the funds in the medical insurance personal account be used for?
How does it work?
The Beijing News reporters have summarized and sorted out.
Applicable crowd: family mutual aid does not include siblings
There are two places for the amount paid by employees to participate in the basic medical insurance: the medical insurance reimbursement and payment pooling fund and the personal account.
From September 1st, all basic medical insurance premiums paid by employers will be included in the overall planning fund, and all basic medical insurance premiums paid by on-the-job employees will be included in individual accounts, and the funds in individual accounts should be earmarked for use.
It is worth noting that the personal account funds that have been transferred to the special passbook for medical insurance before September 1 can be withdrawn and used by the insured at any time in the future.
Therefore, citizens do not have to rush to the bank to queue up to withdraw cash.
After September 1st, in addition to the amount in the personal account being used for the payment of relevant medical insurance expenses, Beijing has also launched "outpatient mutual aid", that is, Beijing medical insurance insured members of family members (spouse, parents, children) can Mutual aid in the use of funds in individual accounts.
From October 15th, insured persons can apply for mutual aid use filing through the Beijing Medical Insurance Public Service Platform, the official website of the Beijing Municipal Medical Security Bureau, or the windows of handling agencies in various districts.
After the filing is successful, from December 1, 2022, the funds in the personal account can be used for mutual assistance.
Once again, remind all insured members that siblings are not included in the family members used by mutual aid.
When using the personal account of an insured person in a designated medical transfer institution or a designated retail pharmacy, the funds in the personal account of the insured should be used up first, and then the funds in the personal accounts of others should be used in the order of filing.
Use Route 1: Fixed-point payment of medical expenses
First, the funds in the personal account of the medical insurance card can be used to pay the medical expenses incurred by the insured employees in designated medical institutions or designated retail pharmacies, including medical treatment, medicine purchase, medical equipment, medical consumables, etc.
Taking December 1st this year as the node, before that, it can only be used by oneself, and after that, it can be used for mutual aid among family members.
Whether it is to settle with the funds in my account, or use other people's accounts after the funds in my account are used up, the payment password of my personal account is entered during settlement.
At present, there are more than 2,900 medical institutions designated by basic medical insurance in Beijing. In accordance with the regulations on the management of medical treatment of persons insured by Beijing basic medical insurance, except for the designated medical institutions selected by me, all designated traditional Chinese medicine hospitals, designated specialized hospitals, 49 designated hospitals in Beijing All designated Class A hospitals and all designated community health service institutions are designated hospitals common to insured persons, and there is no need to choose, and they can seek medical treatment according to regulations.
Use route 2: Participate in the city's urban and rural residents' basic medical insurance and long-term care insurance payment
According to the introduction of the Beijing Municipal Medical Insurance Bureau, starting from December 1, the funds in the medical insurance personal account can be used to pay for the basic medical insurance and long-term care insurance for urban and rural residents in Beijing.
In fact, on August 13 last year, the Beijing Municipal Medical Insurance Bureau issued the "Supplementary Notice on the Use Scope of Urban Employee Basic Medical Insurance Personal Accounts".
The notice shows that Beijing medical insurance personal accounts can be used to pay part of the medical expenses of spouses, parents, and children, and it also clarifies that personal payments for long-term care insurance in the city can be explored.
In recent years, Beijing has successively implemented long-term care insurance pilot projects. This year's government work report clearly stated for the first time that "full implementation of long-term care insurance".
The "Beijing 14th Five-Year Plan for the Development of Aging Careers" clearly states that commercial long-term care insurance should be explored as an effective supplement to policy-based long-term care insurance.
Support commercial insurance institutions to participate in policy-based long-term care insurance handling services.
From the perspective of specific implementation, the plan is to start from urban workers in 2022, and when conditions are ripe, urban and rural residents will be included in the insurance coverage.
Use method 3: Purchase "Beijing Pratt & Whitney Health Insurance"
Since September 1 this year, the insured can use the balance of the medical insurance personal account to purchase "Beijing Inclusive Health Insurance" for himself.
From December 1 this year, the insured can also use the balance of the medical insurance personal account to purchase "Beijing Inclusive Health Insurance" for spouses, parents and children who enjoy Beijing medical insurance benefits. When paying, they should ensure that the account funds can be paid in full.
In addition, according to policy adjustments, the threshold for serious illnesses for employees in 2022 will be reduced to 30,404 yuan, and the deductible for "Beijing Pratt & Whitney Health Insurance" will be simultaneously reduced.
That is, starting from 2022, the minimum payment standard for employee critical illness protection will be reduced from 39,525 yuan to 30,404 yuan.
The deductible amount of "Beijing Inclusive Health Insurance" is consistent with its starting payment standard. After the insured person enjoys the basic medical insurance for urban employees, the accumulated personal out-of-pocket medical expenses for outpatient and hospitalization within a year exceed the starting payment standard. The above part is "secondary reimbursement" by the urban workers' serious illness medical insurance.
60% will be reimbursed for the portion above the minimum payment standard of 50,000 yuan (i.e., 30,404 yuan to 80,404 yuan), and 70% of the portion above 50,000 yuan (i.e., 80,404 yuan) is reimbursed, and there is no ceiling.
After the critical illness insurance is reimbursed for the second time, the remaining medical expenses will be reimbursed by “Beijing Inclusive Health Insurance” if the reimbursement conditions are met. The proportion of compensation for healthy people is 80%, and the proportion of compensation for people with specific pre-existing diseases is 40%, further reducing large medical expenses. The financial burden of spending on households.
Use route 4: Seek medical treatment in other places
Starting from December 1 this year, insured persons in Beijing can use their personal accounts for direct settlement at designated medical institutions in the off-site filing co-ordination areas that have opened cross-provincial direct settlement-related businesses after going through the registration procedures for off-site medical treatment in accordance with regulations.
After going through the mutual aid account filing procedures, you can also use the mutual aid account for direct settlement.
Beijing News reporter Ma Jinqian
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