1, medical insurance is divided into two parts: individual account and overall fund. Personal accounts are used to pay the medical expenses that should be borne by individuals for outpatient service, special diseases and hospitalization, and can also be used to pay the expenses incurred in purchasing medicines at designated retail pharmacies according to regulations; Personal account balance can be carried forward and inherited according to law. The medical insurance fund belongs to all insured persons and is managed by the social insurance agency. It is mainly used to pay general outpatient medical expenses, hospitalization medical expenses and special disease outpatient medical expenses according to regulations.
In other words, the money in your personal account is still your money. But! The money in the medical insurance pooling fund belongs to every medical insurance applicant. Its purpose is to share the disease risk through the mutual help of social groups in a certain area and solve the medical expenses of employees when they are seriously ill, which is also the last life-saving money for all of us! Therefore, when the personal balance in your social security card is insufficient and you need to use the money in this overall fund for reimbursement, if someone fraudulently uses your social security card for reimbursement, then this person will steal not only yours, but also everyone's last life-saving money!
Under what circumstances can the medical insurance card be used by family members?
1, Taizhou has a policy that the balance of medical insurance cards over the years can be used by family members, but three conditions must be met:
(1) The balance of personal account over the years exceeds 6,000 yuan;
(two) the total amount of the application for payment is more than 2000 yuan;
(three) after payment, the balance of funds in the personal account over the years is not less than 3000 yuan.
2. Guangzhou Municipal Bureau of Human Resources and Social Security: Yes, the insured can use the funds in his personal medical account to pay the following expenses for himself and his relatives:
(1) Pay the social medical insurance premium of this city;
(2) The medical expenses incurred in the designated medical institutions of medical insurance in this Municipality shall be borne by individuals;
(three) the cost of vaccination and physical examination in the designated medical institutions of medical insurance in this Municipality;
(4) the cost of purchasing drugs and medical consumables in the designated retail pharmacies of medical insurance in this city. When the relatives of the insured use the funds in the personal medical account of the insured to pay for medical expenses and medicines, they should show the insured medical insurance card and their valid identity documents to the designated medical and pharmaceutical institutions for verification and registration.
3. Chongqing Human Resources and Social Security Bureau: Yes, it can be divided into the following two situations:
(1) The relevant measures (only between employee medical insurance and employee medical insurance) shall be handled by the provider at the medical insurance agency in the place where he is insured. A social security card can only be associated with 1 person at a time. If you want to associate with others, you need to cancel your last association. Can not be provided to others for use at the same time; After my personal account is linked to the user, the user can always use the provider's personal account unless it is cancelled by the medical insurance agency. If the provider does not want to continue to provide his personal account to the user, he must cancel his association with the social security agency in the county where the provider is insured. ?
(2) Direct use of social security card (hospital opens HIS system). The user shall register for medical treatment with the ID card of himself and the personal account provider, and the original and photocopy of the Social Security Card. You can choose several other people's personal accounts to pay your own medical expenses at the same time, but you must provide the original and copy of your ID card and "social security card" every time.
Consequences of illegal use of medical insurance cards by others
First of all, fraudulent insurance requires legal responsibility.
Using someone else's medical insurance card to see a doctor or buy medicine is a kind of insurance fraud, which has violated laws and regulations. In this case, people who cheat insurance may have to bear legal responsibility, and some people have been sentenced for it.
An old lady with high blood pressure in Zhuji, Zhejiang Province, because she only participated in the basic medical insurance in cities and towns, the reimbursement rate of medical expenses was relatively small, and her husband's social security card could be overstated. The old lady asked her daughter to take her husband's social security card to fill the medicine. From 20 1 1 to 20 15, a certain * * reimbursed the medicine fee 1 more than ten thousand yuan. After the incident was exposed,
Medical insurance is divided into individual account and overall account. In some cases, the money in your personal account is your own money, so you can take it out directly or go to a drugstore to buy medicine. However, the money in the overall account is paid by all medical insurance providers, so as to help groups help each other share the risk of disease. If you don't pay medical insurance, you won't be eligible to use the money inside. It is illegal to use someone else's medical insurance card to see a doctor.
Second, it is the patient's own condition that affects the doctor's diagnosis of the patient.
The medical insurance card has the patient's identity information, and the doctor should make diagnosis and treatment according to the patient's age, body and medical history. If you use someone else's identity to see a doctor, it will affect the doctor's diagnosis and may also affect the treatment of your own illness.
For example, the breast cancer patient in the case can't tell the doctor that she gave birth because she used her daughter's identity, but the later treatment plan of breast cancer needs to take age as a reference factor. If the doctor treats you as a young woman, what is delayed is her own illness.
Third, the person who is finally fraudulently used will be implicated.
Don't think it's okay to lend your medical insurance card to others. In many cases, you will be implicated.
In this case, the female patient used her daughter's medical insurance card to see a doctor. After the patient's pathological examination report comes out, the system generates her daughter's name, and her daughter's medical record will be marked as "breast cancer". If her daughter buys commercial medical insurance in the future, the insurance company will think that she is not in good health and may refuse insurance or raise the premium.
So it is very dangerous to use someone else's medical insurance card to see a doctor. It is necessary to see a doctor regularly. Never take someone else's medical insurance card to see a doctor, and never lend your medical insurance card to others, even your mother!
Matters needing attention in the use of medical insurance card
1. No cashing: No unit or individual may violate the scope and requirements of the medical insurance card, and cashing is strictly prohibited.
2. The medical insurance cards of some provinces and cities can be used by the whole family: from the second half of this year, the surplus funds of medical insurance personal accounts of some provinces and cities such as Zhejiang Province and Guangzhou City can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, thus realizing mutual assistance among family members.
3, the following medical insurance will not be paid:
See a doctor in a non-designated medical institution or buy medicine in a non-designated retail pharmacy (except for emergency);
Self-injury caused by fighting, drug abuse or other illegal acts;
Treatment for alcoholism, suicide, self-mutilation, etc.;
Injuries caused by traffic accidents, medical accidents or other accidents;
And the situation that should be paid by individuals according to national or local regulations.
Related question and answer
1. Can I use my medical insurance card at home to see a doctor?
A medical insurance card can only be used by myself. If you can't lend it to others, if you are investigated, you will be in big trouble and lose more than you gain. However, some cities are also open to each other, so it is recommended to consult the local social security bureau before using them.
2. Why can't parents' medical insurance cards be used for their children?
Answer: medical insurance can only be used by yourself, and others can't use it. You can use the personal account limit of the medical insurance card to spend money, but you can't use the medical insurance card to reimburse your child for medical expenses, because medical insurance reimbursement is limited to your own use.
3. My family is ill. Can I use my medical insurance?
A: No, but now some cities have launched a family economic network. Family members under the same account can be bound together as long as there is insurance premium. If a family member is sick and his medical insurance is not enough, he can use the medical insurance fees of other family members.