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q: can i use my medical insurance money for my family?

a: if the money you are talking about in the employee medical insurance refers to the balance in the individual medical insurance account, then yes. after joining the employee medical insurance, through the "family mutual aid" of the employee medical insurance individual account, the individual account can be authorized to be used by close relatives such as parents, spouses and children who have participated in the insurance, for example, to pay for the personal payment portion of compliant medical expenses.

for example, li ming's son li xiaoming is sick, and li xiaoming needs to pay 100 yuan for medical treatment and medicine. there is still a balance in li ming's employee medical insurance personal account. after applying for family mutual aid, li xiaoming can use the money in li ming's employee medical insurance personal account to pay the 100 yuan. this is family mutual aid.

q: how to apply for “family mutual aid”?

answer: insured persons (generally mutual aid persons) can handle the matter online through the "employee medical insurance personal account family mutual aid" function module in the local area of ​​the national medical insurance service platform app, the local medical insurance department's wechat public account, official website, etc. the specific channels will be made public to the society by the medical insurance departments of each pooling area; special groups such as the elderly who have difficulty operating smart devices can also handle it in offline medical insurance halls.

q: can all family members use “family mutual aid”?

a: no. only family members who have applied for family mutual assistance for employee medical insurance personal accounts can enjoy the personal account family mutual assistance policy.

for example, li ming's mother, son and father-in-law all participated in the employee medical insurance, and their personal accounts all had balances. among them, only his son and li ming applied for family mutual aid, and li ming could only use the balance of his son's personal account to pay the expenses. because the mother's account did not apply for family mutual aid for the employee medical insurance personal account, it could not be used for mutual aid payment. the father-in-law does not belong to the category of family mutual aid members and cannot apply for family mutual aid.

the personal account funds in the employee medical insurance participants can be used for parents, spouses, children and other close relatives, but two prerequisites must be met: first, your parents, spouse, children and other close relatives have also participated in the basic medical insurance (including employee medical insurance and resident medical insurance); second, you have applied for family mutual aid for the employee medical insurance personal account. at the same time, it should be noted that: first, family mutual aid members do not include the parents of the spouse; second, the mutual aided person cannot enjoy the medical insurance reimbursement benefits of the mutual aided person, that is, you can use the money in the personal account for your parents, but how much your parents can be reimbursed for medical treatment still depends on the medical insurance system they participate in. those who participate in employee medical insurance enjoy the corresponding benefits of employee medical insurance; those who participate in resident medical insurance enjoy the corresponding benefits of resident medical insurance.

question: after applying for "family mutual aid", whose card (code) should i use for medical treatment and drug purchase?

a: in any case, the patient's own card (code) must be used for medical treatment and drug purchase. the family mutual aid policy "mutual aids" the money in the personal medical insurance account of the employee medical insurance participant, not the card (code) itself.

the principle followed by medical insurance is "one who participates in the insurance will enjoy the benefits". this principle remains unchanged after family mutual aid. participants can still use their own medical insurance to see a doctor and enjoy their own medical insurance benefits according to regulations.

in layman's terms, money can be shared, but cards cannot be shared. this can reduce many misunderstandings.

q: what are the consequences of not using my own medical insurance for medical treatment?

answer: not using your own medical insurance to register for medical treatment is considered "seeking medical treatment under a false name". at the very least, your medical expenses online settlement will be suspended, and at worst, it will constitute a crime.

the so-called "seeking medical treatment under false names" is the act of using someone else's medical insurance certificate for the purpose of illegal possession, registering for medical treatment at designated medical institutions and enjoying medical insurance settlement benefits, thereby defrauding medical insurance funds. the "others" here refer to anyone other than the insured person, including family members who have not applied for "family mutual aid" as required.

article 17 of the regulations on supervision and administration of the use of medical security funds clearly stipulates that "insured persons shall use their own medical security certificates to seek medical treatment and purchase medicines, and shall actively present them for inspection". article 41 also clearly states that "if a person's medical security certificate is given to another person to use in his/her name, causing losses to the medical security fund, he/she shall be ordered to return it; if the person is an insured person, his/her medical expenses online settlement shall be suspended for 3 to 12 months; if another person's medical security certificate is used to seek medical treatment or purchase medicines in his/her name, causing losses to the medical fund, he/she shall also be fined not less than 2 times but not more than 5 times the amount defrauded." if the amount involved is large and the circumstances are serious, it will also constitute the crime of fraud.

for example, xiaoqing mentioned in the article "i can't help you with this kind of small favor. you will be punished for using someone else's medical insurance!" she directly used her cousin xiaolan's card to register for medical treatment, which is considered as impersonating someone else's name. another example is xu from anhui, who used someone else's card to see a doctor and buy medicine at a hospital, and enjoyed the reimbursement of other people's outpatient chronic disease treatment, defrauding more than 120,000 yuan of medical insurance funds, and re-selling the drugs for more than 15,000 yuan in illegal income. he was eventually sentenced to two years and six months in prison and fined 5,000 yuan. xu's behavior not only constituted "impersonating someone else's name to see a doctor", but also constituted a crime. the court made a judgment on him according to the relevant provisions of the criminal law.

question: the elderly in my family have difficulty moving around. can their children buy medicine for them?

a: yes. article 17, paragraph 2 of the regulations on supervision and administration of the use of medical insurance funds clearly stipulates: "if it is necessary to entrust another person to purchase medicines on your behalf for special reasons, the identity certificates of the entruster and the trustee shall be provided."

therefore, in special circumstances such as the elderly being unable to move, their children can buy medicine on their behalf. however, when buying medicine, they need to use the medical insurance of the person taking the medicine and show the identity certificates of the principal and the trustee.

remember: the money in the personal accounts of employee medical insurance can be shared, but no one’s card (code) can be shared!

(source: national health insurance administration)

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