Chinanews.com, September 1st (Xie Yiguan, China-News Financial Reporter) From September 1st, Beijing medical insurance personal account funds will be managed by bookkeeping, and the insured personnel cannot freely withdraw them, and realize targeted use, mainly used to pay the insured employees themselves. Medical expenses incurred in designated medical institutions or designated retail pharmacies.
How to use the medical insurance personal account when purchasing medicines at designated pharmacies in Beijing and seeing doctors at designated hospitals?
The Beijing Municipal Medical Security Bureau recently interpreted this.
Designated pharmacies to buy medicines
If an external prescription is used to purchase medicines, the insured person will go to the designated pharmacy to buy medicines with the social security card and the external prescription issued by the designated hospital, and the relevant expenses will be included in the payment scope of the basic medical insurance.
Designated pharmacies download out-of-pocket prescription information through the medical insurance information system for medical insurance decomposition. The drug expenses within the scope of medical insurance are directly paid by the medical insurance fund, and the other self-paid or self-paid parts that need to be paid by individuals are paid through my personal account (including mutual aid account). ), and the shortfall shall be made up by the insured in cash.
When the insured uses a personal account to pay, they need to enter the payment password of their personal account.
For example, if an insured person buys a drug, the original price is 840.77 yuan. After the medical insurance is broken down, the medical insurance pays 588.54 yuan, and the individual needs to pay 252.23 yuan.
If personal payment is required, it will be paid through the personal account first, and the shortfall will be made up in cash.
In the case of self-purchasing medicines, the expenses incurred by the insured persons for self-purchasing medicines, medical equipment, and medical consumables at designated pharmacies are not included in the payment scope of basic medical insurance.
However, you can use your social security card to use your personal account (including mutual aid account) for payment, and the insufficient part will be made up by the insured in cash.
Insured personnel need to enter their personal account payment password when using their personal account to pay.
Previous reports have shown that Beijing medical insurance participants in family members (spouse, parents, children) can use funds in their personal accounts to help each other.
The Beijing Municipal Medical Insurance Bureau has made it clear that the mutual aid account function will take effect from December 1, 2022.
Screenshot from the official account of Beijing Municipal Medical Insurance Bureau.
Appointed hospital visits
When registering at the outpatient (emergency) clinic, the insured person holds the medical insurance electronic certificate or social security card to register and pay the fee, and can use the personal account to pay for the personal burden without entering a password.
For example, the registration fee is 50 yuan, the medical insurance reimbursement is 40 yuan, and the remaining 10 yuan can be paid by personal account.
In terms of the settlement of outpatient (emergency) medical treatment fees, if the insured person's outpatient payment has passed the threshold, for example, the outpatient payment is 1260.92 yuan, of which the medical insurance pays 882.64 yuan, the individual pays 378.28 yuan, and the individual pays 378.28 yuan , will be paid through the personal account first, and the shortfall will be made up by cash.
Hold the medical insurance electronic certificate to pay the fee, use the personal account to pay the personal burden, without entering the password; pay the fee with the social security card, use the personal account to pay the personal burden, you need to enter the password, but the preset limit can be paid without password.
During the hospitalization registration process, the insured person needs to carry out the hospitalization registration with the medical insurance electronic certificate or social security card.
At the time of discharge settlement, if the insured’s hospitalization payment has not passed the threshold, for example, the hospitalization payment is 3026.14 yuan, of which the medical insurance payment is 1308.54 yuan, the personal payment is 1717.6 yuan, and the personal payment of 1717.6 yuan will be paid through the personal account first, and the shortfall will be paid by the personal account. Top up cash.
Whether you use a social security card or medical insurance electronic certificate for medical treatment, you need to enter a password, but you can preset a limit for password-free payment.
According to reports, insured persons can change their passwords, set limits without passwords, and check their personal account balances and usage through the Beijing Medical Insurance Public Service Platform, the official website of the Beijing Municipal Medical Insurance Bureau, or the windows of handling agencies in various districts.
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