Has been implemented since July 1, 2022
After the implementation of outpatient financial security
Presumably Everyone also has some questions
What are the financial conditions?
What is the scope of payment?
How to bind family members for outpatient financial assistance
......
Let's take a look together!
1. Financial conditions
Individual medical insurance The account provider should be a normal insured person in our city (including four counties and one city). Family members specifically refer to the provider’s immediate relatives, including parents, spouse, and children. The user of the personal account should be a person who participates in the medical insurance for urban employees and urban and rural residents in our city and has normal treatment status.
2. Payment Scope
After passing the review, the financial account can be used for medical diagnosis and treatment in designated medical institutions and payment of resident medical insurance. In the later period, with the establishment of provincial-related drug platforms, it can also be used to purchase drugs, medical equipment, medical consumables, etc. at designated retail pharmacies.
*It needs to be emphasized that the personal account financial system is not "***used social security card" or "***used outpatient reimbursement amount". The bound objects (such as parents and children) still need to present their own medical insurance cards when seeking medical treatment in the outpatient clinic. If your medical insurance card does not have a personal account or the balance of your personal account is 0, financial payment will be made.
3. Personal account family financial operation process
1. Open the Wanshitong·City Order APP (Wanshitong-Wuhu Branch), click on the homepage or search directly .
2. If you are a member of employee medical insurance, select the place where your employee medical insurance is insured in the upper left corner, and click "Personal Account Financial Binding".
3. The "Notice of Binding Family Account of Employee Medical Insurance Outpatient Clinic" pops up on the interface. Please read it carefully, click the check box in the box, and then click Agree to enter the next interface.
4. Click Add Family Members on the interface, and the interface will pop up. Enter the ID number and contact number of your spouse, parents, and children (the system automatically queries the name of the insured person corresponding to the ID number), upload the marriage certificate, After verifying the resident household register and other supporting information, click Submit to complete the binding.
4. Questions and Answers on Personal Account Outpatient Financial Aid
1. After the implementation of outpatient financial aid, what is the reimbursement ratio for outpatient medical expenses? Is there a capping line?
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Answer: (1) Seek medical treatment locally. For active employees, the payment ratio of first-level designated medical institutions is 60%, that of second-level designated medical institutions is 55%, and that of third-level designated medical institutions is 50%. Retired employees are 5 percentage points higher than active employees by hospital level.
(2) Seeking medical treatment in other places. Retirees, long-term residents in other places, and permanent staff in other places who have registered for relocation in other places will be reimbursed according to the local employee medical insurance reimbursement ratio.
The minimum payment line for employees’ general outpatient expenses in a calendar year is 800 yuan, and the payment limit is 2,000 yuan. Payment limits are not carried forward or accumulated to the next year.
2. We elderly people cannot use mobile phones to bind "family member accounts", what should we do?
Answer: The outpatient clinic's family member account binding is online. Can be completed below. For online binding, you can log in to the Wanshitong APP or the "Wuhu Municipal Medical Security Bureau" WeChat public account "Convenient Services" and enter the "Anhui Medical Insurance Public Security Service - Wuhu City - Personal Account Economic Binding" module , follow the prompts to handle it. For offline processing, you can go to the window of the medical insurance agency in your district.
3. Can the relationship between grandfather and grandson be bound to the account of a family member to enjoy outpatient benefits?
Answer: The relationship between grandfather and grandson cannot be bound. Currently, family member account binding is limited to parents, spouses, and children.
4. When binding family members’ outpatient financial accounts, what should I do if the family members are not in the same household registration book, that is, the kinship cannot be proved?
Answer: At present, only Fill in the form according to the prescribed steps, that is, add the ID number of the spouse/parents/children, confirm that the name and other information are correct, and confirm the "Notice of Binding the Family Account of the Employee Medical Insurance Clinic". The purpose of the "Notice" is my commitment to fill in the form. The information and family relationships are accurate and true. Once an individual makes a commitment, he or she must bear corresponding responsibilities. If fraud or insurance fraud is involved in the future, it will be dealt with according to regulations.