The National Healthcare Security Administration and the Ministry of Finance issued the “Inter-provincial Mutual Aid Procedures for Individual Accounts of Employee Basic Medical Insurance (Trial)”, standardizing inter-provincial mutual aid for individual accounts of employee basic medical insurance. Who can become mutual aid recipients, what expenses can mutual aid funds be used for, how can the mutual aid provider’s personal account funds be used by the recipient… Regarding these concerns, what provisions does this national-level operational guide make? To achieve full implementation by the end of the year, what policy support still needs to be streamlined across regions?
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How to view the importance of the “Inter-provincial Mutual Aid Procedures for Individual Accounts of Employee Basic Medical Insurance (Trial)”?
National Healthcare Security Administration Medical Insurance Center Director Wang Fang: The National Healthcare Security Administration and the Ministry of Finance issued the “Inter-provincial Mutual Aid Procedures for Individual Accounts of Employee Basic Medical Insurance (Trial)”. Its main significance is to address the needs of insured individuals for inter-provincial mutual aid of personal accounts, further expand the scope of mutual aid, and further reduce the burden of medical expenses on insured individuals.
Compared with previous intra-provincial mutual aid, the biggest breakthrough is the establishment of a personal medical insurance wallet based on the national unified information platform. Through this carrier, the goal of inter-provincial mutual aid of personal accounts has been accelerated. This new policy further optimizes the personal account system, breaks geographical restrictions, strengthens the family mutual aid function, and expands the scope of personal mutual aid from within the province to the whole country. Thus, the money in the employee medical insurance personal account can not only be used for family members within the province but also across provinces. This further activates dormant personal account funds, converting them into family health security funds.
Does the recipient of mutual aid need to be insured?
Wang Fang: This time, the scope of inter-provincial mutual aid recipients includes close relatives of the employee basic medical insurance insured, including spouses, parents, children, siblings, grandparents, maternal grandparents, grandchildren, and great-grandchildren. At the same time, the insured should also be a participant in basic medical insurance, and the recipient should either be enrolled in employee basic medical insurance or urban and rural resident basic medical insurance. The mutual aid provider sets a mutual aid limit for the recipient through the medical insurance wallet. When the recipient incurs eligible medical expenses, they can use the mutual aid limit to pay. The medical insurance can cover the recipient’s out-of-pocket expenses for medical treatment and medication, resident medical insurance, long-term care insurance, and personal insurance premiums.
This document mainly regulates the work of inter-provincial mutual aid of personal accounts and does not change the current regulations on medical insurance participation and payment.
How to verify the authenticity of relatives? How to prevent fraudulent use of relatives’ identities?
Wang Fang: For example, siblings are indeed within the scope of mutual aid. To make it easier for the public to enjoy the benefits, the National Healthcare Security Administration has guided local authorities to optimize the processing procedure, which roughly involves three steps:
1. Establish a mutual aid relationship: The mutual aid provider signs a commitment letter, promising the truth and accuracy of the information;
2. Set a mutual aid limit for the recipient;
3. When the mutual aid relationship takes effect, the medical insurance system transmits relevant data information, allowing the recipient to use the mutual aid function in scenarios such as medical treatment, medication, and insurance payment.
Although we implement a commitment system to simplify procedures, supporting measures such as intelligent audit supervision and monitoring of fund flows will follow.
According to this document, when siblings establish a mutual aid relationship and set a mutual aid limit, it does not represent actual medical insurance fund expenditure. Only when the recipient incurs expenses, such as medical treatment or medication, does the actual medical insurance fund expenditure occur. This method reduces the occurrence of violations through the establishment of institutional design mechanisms.
What clearing and adjustment mechanisms are used to motivate local authorities to promote inter-provincial mutual aid?
China Academy of Labor and Social Security Sciences Medical Insurance Research Office Director Wang Zongfan: First, the use of personal accounts mainly involves the insured person having the right to choose how to use their own personal account. It does not involve another medical insurance pooling fund, which is usually used by government pooling. The use of personal accounts involves choice.
In the use of personal accounts, some regions may see inflows while others see outflows. This situation may be related to the accumulation of personal accounts and
