Multi-place employee medical insurance opens personal account family mutual aid
The level of medical insurance for family members has been greatly improved
□ Reporter Chen Lei
After learning about the opening of personal account family mutual aid for Beijing employee medical insurance from December 1, Yan Wei (pseudonym), who lives in Fengtai District, Beijing, added his 12-year-old son as an object of mutual aid.
my country's employee medical insurance implements a security model that combines social pooling and personal accounts.
The principal and interest of the personal account are owned by the individual and can only be used for basic medical insurance expenses.
A reporter from the "Rule of Law Daily" combed through the public information and found that since 2022, Beijing, Tianjin, Shanghai, Hunchun City, Jilin Province and other places have launched the implementation of employee medical insurance personal account family mutual aid, which means that the employee medical insurance personal account Funds have been extended from being limited to employees themselves to being available to family members (including spouses, parents, and children).
Experts interviewed believe that the funds in personal medical insurance accounts of employees can be used for related medical (insurance) expenses of family members, which has significant positive significance, increases the mutual assistance function of family members, and improves the medical security level of family members.
It is recommended to evaluate the implementation of the family mutual aid system for employees' medical insurance personal accounts in a timely manner in the future, and improve the management methods for the use of personal accounts on the basis of summarizing practical experience.
Dedicated funds for personal account
Activate the Mutual Aid function
Yan Wei is in his early 40s this year and works in a state-owned enterprise in Beijing. He has participated in employee medical insurance for 15 years and currently has more than 350 yuan in his personal account for medical insurance every month.
His wife works in an intermediary agency in Beijing and also participates in employee medical insurance, with a monthly medical insurance personal account of more than 160 yuan.
Their child was born in 2010. At that time, he participated in the basic medical insurance for urban and rural residents in Beijing, commonly known as "one old and one young" insurance, and did not have a personal account for medical insurance.
According to the previous Beijing employee medical insurance policy, the medical insurance personal account corresponds to the special medical insurance passbook issued by the Bank of Beijing, and the principal and interest in it are at the individual's disposal.
Yan Wei usually goes to the bank to withdraw cash every six months, which is used for his son's usual medical treatment and medicine.
According to the Beijing Municipal Basic Medical Insurance Policy for Urban and Rural Residents, the medical reimbursement status of insured persons in 2022 is as follows: when going to a tertiary hospital to see an outpatient, the minimum payment standard is 550 yuan, and the medical insurance fund will reimburse the medical expenses that exceed the minimum payment standard and are below the cap line 50%; to be hospitalized in a tertiary hospital, the minimum payment standard is 1,300 yuan, and the minimum payment standard for children is halved to 650 yuan, and 75% of the medical expenses above the minimum payment standard and below the ceiling line are reimbursed.
In March of this year, Beijing issued the "Implementation Measures for Improving the Outpatient Mutual Aid Mechanism of Basic Medical Insurance for Beijing Employees"; in August, the "Notice of Beijing Municipal Medical Security Bureau on Adjusting the Basic Medical Insurance for Urban Employees in the City" was issued.
Accordingly, starting from September 1, personal account funds will be managed by bookkeeping, earmarked for special purposes, and insured persons cannot withdraw them.
After learning the news that "Beijing employees' medical insurance personal accounts are no longer free to withdraw", Yan Wei hurriedly went to the bank to queue up to withdraw the cash in the medical insurance passbook before September 1.
In his perception, after September 1, when he takes his son to the hospital for medical treatment, he can no longer use the cash in the passbook for medical insurance as before, and the personal account only has the function of bookkeeping.
Just when Yan Wei was quite confused about this policy change, the Beijing Municipal Medical Security Bureau announced that starting from December 1, employees' medical insurance will be opened for personal account family mutual aid.
Accordingly, the employee medical insurance personal account can be used to pay the medical expenses borne by the insured person himself and his spouse, parents, and children in designated medical institutions, as well as to purchase drugs, medical devices, and medical consumables in designated retail pharmacies. expenses borne by individuals.
In addition, personal accounts are also explored to be used to pay the personal contributions of the insured persons themselves, their spouses, parents, and children to participate in the city's urban and rural residents' basic medical insurance and long-term care insurance.
For Yan Wei, after opening the personal account family mutual aid for employee medical insurance, it is equivalent to fixing his previous practice in a systematic way, eliminating the possibility of arbitrarily disposing of personal account funds.
After researching the policy, Yan Wei found that the realization of family mutual aid requires the employees to complete the record.
On December 22, he logged on to the official website of the Beijing Municipal Medical Security Bureau, followed the steps to complete the filing of mutual aid for family members of the medical insurance personal account, and added his son as a mutual aid object.
A large amount of medical insurance funds precipitated
Family solidarity is imperative
In August this year, Shanghai launched the family mutual aid for employees' medical insurance personal accounts.
However, unlike Beijing, Shanghai has not been allowed to withdraw funds from employees' medical insurance personal accounts, and can only be used for medical treatment.
Sun Yu (pseudonym) is 44 years old this year, works in a technology company in Shanghai, and participates in the Shanghai employee medical insurance, with a monthly medical insurance personal account of more than 500 yuan.
He has an 8-year-old daughter who has participated in the Shanghai Urban and Rural Residents Medical Insurance.
According to Sun Yu, before August this year, if he took his daughter to the hospital for medical treatment, in addition to the part reimbursed by the medical insurance for urban and rural residents, he could only pay for the part he borne separately, and could not use his personal medical insurance account funds.
After Shanghai launched the family mutual aid for employees' medical insurance personal accounts, Sun Yu bound her daughter's information to the mutual aid account.
This means that the balance in his medical insurance personal account can be used to pay for his daughter's medical expenses.
The reporter sorted out the public information and found that since 2022, Tianjin, Hunchun City, Jilin Province and other places have launched employee medical insurance personal account family mutual aid.
In addition, from January 1, 2023, Sichuan Province, Ganzhou City, Jiangxi Province and other places will expand the use of personal account funds and allow family members to help each other.
Qiu Yulin, a professor at the China Social Security Research Center of Renmin University of China, believes that according to the policy, funds from personal medical insurance accounts of employees can be used for related medical (insurance) expenses of family members. The scope of fund use improves the efficiency of fund use.
According to Xiang Chunhua, a lecturer at the School of Law of the China Institute of Labor Relations, the implementation of employee medical insurance personal account mutual aid among family members has greatly improved the medical security level of family members and reduced the medical burden of family members when they seek medical treatment.
Xiang Chunhua also mentioned that the launch of employee medical insurance personal account family mutual aid in various places is actually implementing the requirements of the central government.
In April 2021, in accordance with the deployment of the Central Committee of the Communist Party of China and the State Council on deepening the reform of the medical security system, the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Security Mechanism for Basic Medical Insurance for Employees" (hereinafter referred to as the "Guiding Opinions"), proposing Improve and improve the management methods for the use of personal accounts, and do a good job of statistics on income and expenditure information.
According to the "Guiding Opinions", the personal account can be used to pay the medical expenses borne by the insured person himself and his spouse, parents, and children in designated medical institutions, and to purchase medicines, medical devices, and medical consumables in designated retail pharmacies. Expenses incurred by individuals.
It is also possible to explore personal accounts for personal payment of spouses, parents, and children participating in basic medical insurance for urban and rural residents.
According to Qiu Yulin, in 1998, the State Council promulgated the "Decision on Establishing the Basic Medical Insurance System for Urban Employees", which determined the system model of the basic medical insurance for urban employees "combining pooling and accounting" and created individual accounts.
Twenty-four years have passed, and the current personal accounts have basically achieved the two goals of "guaranteeing the smooth progress of the reform" and "stimulating the enthusiasm of individuals to pay fees".
However, personal accounts are not only helpless to control medical expenses at present, but will limit the function of medical insurance and even promote the waste of medical resources.
According to the "2021 Statistical Bulletin on National Medical Security Development" issued by the National Medical Security Administration, in 2021, the cumulative balance of employees' medical insurance personal accounts will be 1,175.398 billion yuan, accounting for 66.46% of the cumulative balance of the pooling fund.
"A large amount of funds in personal accounts that lack mutual assistance and mutual assistance has accumulated a large amount of funds, weakening the function of the overall planning fund to play the law of large numbers for strategic purchases. Therefore, it is imperative to reform the personal medical insurance accounts of employees and increase family mutual assistance protection." Qiu Yulin said, this is exactly what The background of the implementation of medical insurance personal account family mutual aid.
The "2021 Statistical Bulletin on the Development of National Medical Security Businesses" shows that by the end of 2021, the number of employees participating in medical insurance in my country was 354.31 million, and the number of urban and rural residents with basic medical insurance was 1,008.66 million.
In Xiang Chunhua's view, the data show that the majority of people in our country participate in the medical insurance for urban and rural residents. The reimbursement rate is relatively high, and the reimbursement ratio is lower than that of employees' medical insurance, and the medical burden is relatively heavy. It is urgent to reduce their medical burden through personal account and family mutual aid.
Dynamic assessment of implementation
Gradually expand the scope of mutual aid
Xiang Chunhua analyzed that the country’s introduction of the family mutual aid system for employees’ medical insurance personal accounts is based on the fact that there are too many balance funds in the current personal accounts. The next step is to evaluate the implementation of the employee medical insurance personal account family mutual aid system in time, and then Decide how to finalize the personal account usage management system in the future.
In his view, after a certain period of implementation of the family mutual aid system for employee medical insurance personal accounts, if the balance of the personal account shrinks quickly and does not bottom out, the current system can continue to be implemented; if the personal account still has a considerable balance , the current system does not rule out continuing to expand the scope of mutual aid objects and the scope of use of funds, and improve the management methods for the use of personal accounts on the basis of summarizing practical experience.
Xiang Chunhua believes that according to the current employee medical insurance management system, family mutual aid with personal accounts is sustainable, and the scope of the current family mutual aid with personal accounts should gradually expand to a wider range of family members in the future, such as immediate relatives and brothers and sisters.
At the same time, according to the implementation of family mutual aid in personal accounts in the future, if there is still a considerable amount of surplus funds, it may be considered to continue to expand the scope of fund use and use them for insured persons to purchase commercial insurance with social security functions such as inclusive insurance, or even purchase pure insurance. Commercial health and medical insurance to help build a multi-level medical security system.
In June 2021, the National Medical Security Administration announced the Medical Security Law (draft for comments), which is divided into 8 chapters and 70 articles on medical insurance financing and treatment, fund management, medical services, public management services, supervision and management, and legal responsibilities. Provisions were made.
In May 2022, the "2022 Legislative Work Plan of the Standing Committee of the National People's Congress" was announced. Among the preparatory deliberation items, including the formulation of a medical security law, "relevant parties should promptly carry out research and drafting work."
So, in the future, does family mutual aid for individual accounts of employee medical insurance need to be raised to the legislative level?
Xiang Chunhua believes that the main basis for my country's medical insurance system to run for many years is normative documents; in 2011, the Social Insurance Law was promulgated and implemented. Relatively weak, but also relatively principled.
"Our country is drafting a medical security law, and we look forward to promulgating it as soon as possible." Xiang Chunhua said, however, as for the relatively policy-oriented institutional reforms such as employee medical insurance personal accounts, it is unlikely that my country's social security system has been fully finalized. It is suitable to introduce laws and regulations to standardize, but should mainly rely on policies to promote reforms, and adjust at any time according to the balance of personal account funds during the implementation of the system.
(Rule of Law Daily)