Interprovincial Mutual Aid for Employee Basic Medical Insurance Personal Accounts
Procedural Rules (Trial)
Chapter 1: General Provisions
Article 1: These procedural rules are established to strengthen the management of interprovincial mutual aid for employee basic medical insurance personal accounts, standardize operational processes, promote coordinated business actions, and improve service efficiency, based on relevant documents such as the Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Mechanism for Employee Basic Medical Insurance and the Notice on Improving the Long-term Mechanism for Basic Medical Insurance Enrollment.
Article 2: The term “interprovincial mutual aid for employee basic medical insurance personal accounts” refers to the use of a unified national medical insurance information platform to set up a personal medical insurance wallet, define mutual aid limits, and enable employees to use personal account funds to pay for eligible medical expenses of close relatives at designated medical institutions and pharmacies, as well as for insurance premiums. The personal medical insurance wallet operates on a virtual limit basis.
Article 3: These rules apply to the management and service of interprovincial mutual aid for basic medical insurance participants.
Chapter 2: Roles and Responsibilities
Article 4: The interprovincial mutual aid process is managed uniformly with tiered responsibilities. National medical insurance authorities are responsible for formulating nationwide operational standards and processes, managing mutual aid funds, reconciling accounts, coordinating actions, and supporting information systems.
Article 5: Provincial medical insurance authorities are responsible for implementing interprovincial mutual aid processes and standards within their jurisdictions, managing funds, reconciling accounts, coordinating actions, and supporting information systems.
Article 6: Each coordinating region should carry out operations, fund management, coordination, and policy promotion within its area in accordance with national and provincial regulations.
Chapter 3: Management of Mutual Aid Relationships
Article 7: The scope of interprovincial mutual aid applies to close relatives of employee basic medical insurance participants. The beneficiaries must be enrolled in basic medical insurance, including employee or resident basic medical insurance. Close relatives include spouses, parents, children, siblings, grandparents, grandchildren, and great-grandchildren.
Article 8: Participants can establish or terminate mutual aid relationships through channels such as the National Medical Insurance Service Platform app, provincial medical insurance service platforms, or local medical insurance agency windows.
Article 9: When establishing a mutual aid relationship, the participant must sign a commitment letter ensuring the truthfulness and accuracy of the statements. One participant can establish relationships with multiple close relatives, and one beneficiary can receive aid from multiple close relatives.
Article 10: Both parties can voluntarily terminate the mutual aid relationship at any time. If either party’s medical insurance relationship ends or transfers across coordinating regions, the mutual aid relationship is automatically terminated.
Chapter 4: Management of Mutual Aid Limits
Article 11: Participants set mutual aid limits for beneficiaries through the medical insurance wallet. Once set, the participant cannot use that portion of personal account funds. Beneficiaries cannot re-share the received mutual aid limit with third parties. Beneficiaries can use the limit to settle eligible expenses.
Article 12: When establishing a mutual aid relationship via the National Medical Insurance Service Platform app, the national platform sends the relationship and limit information to the participant’s insurance region. That region records the information and returns confirmation. Upon successful response, the national platform pushes the information to the beneficiary’s insurance region, which records it accordingly.
When establishing through provincial platforms or local windows, the participant’s insurance region uploads the information to the national platform, which then pushes it to or allows download by the beneficiary’s insurance region for recording.
When the mutual aid limit is used, the beneficiary’s insurance region records usage information in real time and uploads it to the national platform. The participant’s insurance region downloads this usage information daily.
Article 13: Provinces may set frequency and amount limits for mutual aid transfers based on actual conditions to standardize fund management.
Article 14: Provinces may specify the payment order between personal accounts and the medical insurance wallet. When using the wallet limit, beneficiaries use it in the order the limits were set.
Article 15: When terminating the mutual aid relationship via the National Medical Insurance Service Platform app, any unused limit automatically returns to the participant’s personal account. The national platform sends the limit and usage information to both parties’ insurance regions for reconciliation. Upon successful reconciliation, the national platform pushes termination information, and both regions set the limit to zero. If reconciliation fails, the beneficiary’s insurance region syncs usage information to the national
