The National Healthcare Security Administration and the Ministry of Finance have jointly issued a trial regulation concerning the cross-provincial sharing of personal accounts for basic medical insurance for employees, effective from June 5th. This notice outlines the eligible participants, the scope of medical expenses that can be covered using the shared funds, and the operational procedures involved.
The regulation specifies that the policy applies to the close relatives of insured individuals under the basic medical insurance for employees. These relatives must themselves be participants in either the basic medical insurance for employees or the basic medical insurance for urban and rural residents. Eligible close relatives include spouses, parents, children, siblings, grandparents, grandchildren, and other specified relations. One insured individual can establish sharing relationships with multiple relatives, and a single relative can also receive support from multiple insured individuals.
Unlocking 1.4 Trillion Yuan in Dormant Funds
According to the National Healthcare Security Administration's statistical bulletin, the cumulative balance in personal accounts for employee medical insurance reached approximately 1.4 trillion yuan by the end of 2024. Why have these funds remained largely idle, and what impact will cross-provincial sharing have on mobilizing medical insurance funds?
A senior healthcare insurance expert pointed out that the core issue of idle funds in personal accounts stems from a structural contradiction caused by the separation of the individual and the funds. Traditional policies restricted account usage to the holder, leading to significant accumulation among younger, healthier individuals while older, sicker family members faced out-of-pocket payment pressures. Furthermore, geographical barriers have effectively "locked" around 1.4 trillion yuan in funds at individuals' work locations, preventing migrant workers from using these resources to support relatives in their hometowns.
The expert believes the comprehensive implementation of cross-provincial sharing serves to "awaken dormant funds." Through the "medical insurance wallet" digital tool, previously closed personal accounts are transformed into a "family health fund" that transcends provincial boundaries. These funds can now be directly used to settle out-of-pocket medical expenses for family members in different locations or to pay premiums for their basic medical insurance. This move not only breaks down geographical restrictions and mobilizes trillions in idle capital but also extends the system from societal-level "major pooling" to family-level "minor pooling." It enables familial care to cross distances, providing immediate relief. This practically reduces the financial burden of supporting family members and medical costs across regions while making the overall operation of the medical insurance fund more efficient and compassionate.
Eligible Items and Usage Procedures
The notice states that the shared funds can be used to pay for out-of-pocket medical expenses incurred by the supported relative at designated medical institutions. They can also cover personal costs for purchasing eligible medications, medical devices, and consumables at designated retail pharmacies.
Additionally, the shared funds can be used to pay the individual's contribution portion for the supported relative's basic medical insurance for urban and rural residents or long-term care insurance, and this payment must be made in full.
What happens if the balance in the sharing account is insufficient to cover the insurance premium? The expert clarified that if the balance is insufficient, the system will not complete the payment. Partial payments using the available balance are not permitted; the account must have sufficient funds before the transaction can be reprocessed.
Furthermore, the notice indicates that the sharing relationship will be automatically terminated if the insurance relationship of either the account holder or the supported relative ends or is transferred across different pooling regions. How should "termination of the insurance relationship or cross-pooling region transfer" be understood, and if conditions are met again, can the relationship be re-established?
The expert explained that "termination of the insurance relationship" refers to a participant ceasing coverage due to retirement, death, or voluntary withdrawal. "Cross-pooling region transfer" means moving the insurance relationship from one region to another, such as due to a job relocation. In both cases, the existing sharing relationship is automatically dissolved due to the change in参保 status. As long as both parties meet the policy requirements again—the account holder is an employee medical insurance participant and the supported relative is a close family member who is a basic medical insurance participant—a new cross-provincial sharing relationship can be re-established at any time following the prescribed procedures.
Operationally, participants can establish or terminate sharing relationships through various channels, including the National Healthcare Security Administration's mobile app, provincial-level医保 service platforms, or service windows at local医保 agencies.
The notice also specifies that once an account holder allocates a sharing额度 for a relative through the medical insurance wallet, the funds within that额度 can no longer be used by the account holder. Furthermore, the supported relative is not permitted to re-share the received额度 with a third party.
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