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recently, the national medical insurance administration issued a statement saying "you cannot help with this kind of small favor, and you will be punished if you use someone else's medical insurance card fraudulently!" 》after the article, it received the attention of many netizens, and some netizens suggested that the editor could further explain the policy. in response to some of your questions, the editor has sorted out the answers, hoping to answer your questions.

question: can the money in my medical insurance card be used by my family?

answer: if the money in the employee medical insurance card you are talking about refers to the balance of the personal medical insurance account, this is ok. after participating in employee medical insurance, by applying for the employee medical insurance personal account "family mutual aid", the personal account can be authorized to be used by insured parents, spouses and children, for example, to pay for the personal out-of-pocket portion of legal medical expenses. wait.

for example, li ming's son li xiaoming is sick. 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.

question: how to apply for "family mutual aid"?

answer: insured persons (generally mutual aid recipients) can process online through the local area of ​​the national medical insurance service platform app, the wechat public account of the local medical insurance department, the official website and other "employee medical insurance personal account family mutual aid" functional modules. specifically, the channels are disclosed to the public by the medical insurance departments of each coordinating district; special groups such as the elderly who have difficulty operating smart devices can also apply at offline medical insurance halls.

q: can i use "family mutual aid" as long as i am a family member?

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

for example, li ming's mother, son and father-in-law all participate in employee medical insurance, and their personal accounts all have balances. among them, only his son has applied for family mutual aid with li ming, and li ming can only use the balance of his son's personal account to pay expenses. mom’s account cannot be used for mutual aid payment because she has not applied for the employee medical insurance personal account and family mutual aid. the father-in-law does not belong to the category of family mutual aid members and cannot handle family mutual aid.

the personal account fund in the medical insurance card of the employee medical insurance participant can be used by parents, spouse, and children, but it must meet two prerequisites: first, your parents, spouse, and children also participate in basic medical insurance (including employee medical insurance and resident medical insurance). medical insurance); second, you have applied for a personal account for employee medical insurance and family mutual aid. at the same time, it should be noted that: first, the family members do not include the parents of the spouse; second, the person being assisted cannot enjoy the medical insurance reimbursement treatment of the assisted person, that is, you can give the money in your personal account to your parents, but the parents cannot see the doctor. how much they can reimburse depends on the medical insurance system they participate in. those who participate in employee medical insurance will enjoy the corresponding benefits of employee medical insurance; those who participate in resident medical insurance will enjoy the corresponding benefits of resident medical insurance.

question: after applying for "family mutual aid", whose medical insurance card should i use for medical treatment and medicine purchase?

answer: in any case, the patient’s own medical insurance card must be used to purchase medicines. the family mutual aid policy "mutually aids" the money in the personal account of the employee's medical insurance participant's medical insurance card, not the medical insurance card itself.

the principle followed by medical insurance is "i participate in the insurance and i enjoy the benefits." this principle remains unchanged after family mutual assistance. the insured person still uses his or her own medical insurance card to see a doctor and enjoys his or her own medical insurance benefits according to regulations.

popular understanding is that money can be shared, but cards cannot be shared. this can reduce a lot of misunderstandings.

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

answer: not using one's own medical insurance card to register for medical treatment is "seeking medical treatment under false pretenses". at least it will suspend the online settlement of medical expenses, and at worst it will constitute an illegal crime.

the so-called "seeking medical treatment under false pretenses" refers to the act of fraudulently using other people's medical insurance certificates 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 assistance" as required.

article 17 of the "regulations on the supervision and administration of the use of medical security funds" clearly stipulates that "insured persons shall present their own medical security certificates to seek medical treatment and purchase medicines, and actively present them for inspection." article 41 also clearly states that “if one’s medical insurance certificate is given to others to use under false pretenses, causing losses to the medical insurance fund, he shall be ordered to return it; if it belongs to an insured person, the online settlement of medical expenses shall be suspended for 3 months to 12 months. month; anyone who uses other people’s medical insurance certificates to seek medical treatment or purchase medicines under false pretenses, causing losses to the medical fund, shall also be fined not less than 2 times but not more than 5 times the amount defrauded.” if the amount involved is relatively large and the circumstances are serious, it will also constitute a crime of fraud.

for example, "i can't help you with this kind of small favor. you will be punished if you use someone else's medical insurance card!" 》xiaoqing mentioned in the article, she directly used her cousin xiaolan’s medical insurance card to register for medical treatment, which is considered to be medical treatment under false pretenses. another example is xu from anhui province who used other people’s medical insurance cards to purchase medicines at a hospital, and enjoyed other people’s outpatient chronic disease reimbursement benefits. he defrauded the medical insurance co-ordination fund of more than 120,000 yuan, and obtained illegal gains of more than 15,000 yuan from secondary sales of medicines. he was eventually sentenced to two years and six months in prison and fined nt$5,000. xu's behavior not only constituted "seeking medical treatment under false pretense", but also constituted a crime. the court made a judgment on him in accordance with the relevant provisions of the criminal law.

question: if the elderly at home have difficulty moving, can their children buy medicines for them?

answer: yes. paragraph 2 of article 17 of the "regulations on the supervision and administration of the use of medical security 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 elderly people with limited mobility, children can purchase medicines on their behalf. however, when purchasing medicine, you need to use the medical insurance card of the person taking the medicine, and show the identity certificate of the principal and trustee.

remember: money in individual accounts of employee medical insurance can be pooled, but no one’s medical insurance card can be shared!

source: national medical insurance administration wechat official account

process editor: u070