Personal account money will shrink, but it can be shared by the whole family
Text｜”Caijing” reporterkingsmallXin Ying
Edit｜Wang Xiao
This is a reform involving 340 million insured persons.
On April 22, 2021, the Chinese government website announced the “Guiding Opinions of the General Office of the State Council on Establishing and Improving the Mechanism for Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Assistance Guarantee Mechanism.” This is the first major reform of personal accounts in the 23 years since the establishment of employee medical insurance.
Compared with the previous, the new regulations have three major changes: First, medical insurance will be reimbursed for future outpatient visits; second, family members can share the money in the medical insurance personal account; third, the medical insurance paid by the unit will no longer be credited to the personal account.
Next, all localities have a three-year transition period to implement the new regulations. A local medical insurance bureau official revealed that the local version of the implementation draft is currently being worked on.
Left-hand personal account, right-hand pooling account
The new regulations propose to start with chronic diseases such as hypertension and diabetes, which are burdensome, and gradually include the general outpatient medical expenses for frequently-occurring and common diseases into the scope of the overall planning fund.
The new regulations expand the scope of payment. Previously, pooled accounts were generally only used for inpatient medical care or outpatient treatment of specific diseases.
The entire basic medical insurance payment funds come from two parts of the medical insurance account, the personal account and the overall account.
The money in the personal account is, to put it bluntly, personal property, and its use is basically unlimited in terms of medical treatment. It can be used for medical treatment, medicine, and hospitalization. In the event of death, immigration, etc., personal account funds can be directly withdrawn.
The pooling account can be called everyone’s account, which is shared by all people who have paid the employee medical insurance. The account is not subject to personal control, and the transfer and cancellation of individual social security relationships will not affect the pooling account. Simply put, whoever is sick uses the money.
“Studies have shown that half of people have no balance in their personal accounts when they are 60 years old, and only relying on a little money each month has a low ability to protect them in outpatient treatment and medication.” Public Administration of Central China Normal University Said Wang Chaoqun, associate professor of the college.
The new regulations are also committed to solving this dilemma. Of course, this also requires more money to support the overall fund account. As a result, the new regulations adjusted the distribution of medical insurance premiums.
The money in the medical insurance account comes from individual payment and unit payment. The money in the previous personal account was all the personal medical insurance payment and 30% of the unit medical insurance payment.
After the new regulations are adjusted, what is paid by the individual is still put into the personal account, and all the payment by the unit goes to the overall fund. In a word, the overall fund account will be more than the 30% paid by the unit, and the money in the personal account will be less in the future.
Earlier, the money received in the personal account each month, one is the personal payment, which accounts for about 2% of the salary; the other part comes from 30% of the unit’s total payment, and the unit’s payment accounts for about 6% of the salary, so the unit payment in the personal account Part, accounting for about 1.8% of wages.
In the future, the money received in the personal account each month will only be the part of the personal payment. “Whether it is an in-service employee or a retiree, the monthly money in the personal account will probably be reduced by half.” A local medical insurance official introduced.
Family mutual aid in personal accounts
The new regulation proposes a new model for family mutual aid in personal accounts.
According to the new regulations, in addition to personal use, personal accounts can also be used to pay for the expenses incurred by their spouses, parents, and children seeking medical treatment in designated medical institutions, even including the purchase of drugs, medical equipment, and medical consumables in designated retail pharmacies. cost of.
In other words, young people who have a large balance in their personal accounts can use the balance for the medical expenses of their parents, children and other family members that meet the requirements.
For example, for an employee medical insurance participant, the elderly in the family only participates in the resident medical insurance. Wang Chaoqun believes that after the implementation of mutual aid, the elderly still have to bring their own medical insurance card to see a doctor and enjoy the reimbursement of resident medical insurance. When paying, the part that can be paid with the money in the personal account can be used for the children’s personal Funds in the account.
However, the new regulations do not yet have specific details on how to pay.
Moreover, the rule that the medical insurance card can only be used by the person has not changed.The Wuhan Municipal Medical Insurance Bureau publicly introduced that it still implements “one person, one card”, which is the same as an ID card, and it must be “dedicated for special cards.”
After reading the new regulations, a Beijing employee said that he really felt that it would be difficult for my parents to use my brother’s and me personal accounts in the future to see a doctor. My hukou, my brother, and my parents are not together. It is bound to prove my mother. It’s my mother.
In short, “the current medical insurance system cannot support payment for others, and technology upgrades are needed,” said Qiu Yulin, deputy director of the China Social Security Research Center at Renmin University of China.
Some places are being explored. Fujian has begun to implement family mutual aid in personal accounts. “On the local government service platform, any insured person in the family can open a mutual aid account, and parents (including the parents of the spouse), spouse, and children can be added to this account. Then in the personal account, more than 2,000 yuan When family members go to the hospital to see a doctor, they only need to bring their own medical insurance card, and they can directly use the money in the “family account” to pay.” Fujian Provincial Medical Insurance Bureau related Introduction by the person in charge.
In fact, in individual areas, such as Beijing, it can also be said that families share personal accounts. Because in Beijing, the money in the personal medical insurance account is directly credited to the employee’s Beijing bank card every month, and individuals can directly withdraw the money at any time to help pay for the family’s medical expenses and even any consumption.
The new regulations emphasize that the restricted area of personal accounts shall not be used for public health expenses, sports fitness or health care consumption, etc., and other expenditures that are not covered by basic medical insurance.
“Can it be used to purchase commercial health insurance in the future? This is also an investment in health protection, and there is still a lot of room for discussion.” The above-mentioned local medical insurance bureau official said.
Eventually, the number of people using a personal account will increase, and the National Medical Insurance Bureau also proposes to establish a dynamic management mechanism for the entire process of personal accounts, and strengthen the review of the use of personal accounts, settlement and other links.
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