国家医保局发布医保领域"高效办成一件事"2026年度第一批重点事项清单。其中明确，所有省份开通职 工医保个人账户跨省共济。 截至2026年1月初，337个统筹地区已开通医保钱包并实现跨省共济。 （文章来源：21世纪经济报道） 共济对象除直系亲属外，还包括兄弟姐妹、祖父母、外祖父母等近亲属，共济资金可用于支付被共济人 就医购药的个人负担费用、居民医保及长期护理保险个人缴费。 ...

北京商报讯（记者 和岳）2月10日，国家医保局发布医保领域"高效办成一件事"2026年度第一批重点事 项清单，其中明确，所有省份开通职工医保个人账户跨省共济。 根据此前印发的关于做好职工基本医疗保险个人账户跨省共济工作的通知，跨省共济的适用对象范围为 职工基本医疗保险参保人的近亲属，共济资金可用于支付被共济人就医购药的个人负担费用、居民医保 及长期护理保险个人缴费。截至今年1月初，337个统筹地区已开通医保钱包并实现跨省共济。此外，清 单明确，今年底前，全国80%的定点医疗机构实现即时结算；至少开展一批次国家组织药品和高值医用 耗材集中带量采购；基本实现住院分娩生育医疗费用省内跨统筹区直接结算。 清单还包括生育津贴直 接发放至个人、重点医院医保影像跨省调阅等服务事项。 ...

Core Viewpoint - The recent notification from the National Medical Insurance Administration and the Ministry of Finance aims to enhance the cross-province mutual aid of employee medical insurance personal accounts, expanding the scope of mutual aid to include more relatives [1][2]. Group 1: Changes in Mutual Aid Scope - The mutual aid scope for employee medical insurance personal accounts has been expanded from immediate family members (spouse, parents, children) to include "close relatives" as defined by the Civil Code, which encompasses siblings, grandparents, grandchildren, and more [1]. - The cross-province mutual aid initiative is set to officially launch on December 2, 2024, allowing insured individuals to transfer funds from their medical insurance accounts to close relatives who are also insured [2]. Group 2: New Management and Fund Allocation Requirements - The notification introduces new management requirements for mutual aid relationships, allowing these relationships to be voluntarily established or dissolved, and automatically terminating when the insured individual's medical insurance status changes [3]. - A unified medical insurance information platform will be used to establish personal medical insurance wallets, where mutual aid limits will be set, ensuring strict adherence to fund management regulations [3]. Group 3: Functionality and Limitations of Mutual Aid Funds - Funds from personal accounts can be used to cover medical expenses incurred by close relatives at designated medical institutions, as well as for purchasing approved medications and medical supplies [4]. - It is important to note that while funds can be shared, the medical insurance cards cannot be shared, meaning that both parties must use their own cards to access benefits [4].

Core Viewpoint - The National Healthcare Security Administration and the Ministry of Finance have issued a notice to enhance the cross-provincial pooling of employee basic medical insurance personal accounts, expanding the scope of shared usage among family members. Group 1: Family Pooling of Medical Insurance Accounts - The employee medical insurance system in China has combined social pooling and personal accounts since its establishment in 1998, allowing personal account funds to cover individual medical expenses [1] - In 2021, the scope of family pooling was expanded to include spouses, parents, and children, and by July 2024, it will further include "close relatives" as defined by the Civil Code [1] Group 2: Cross-Provincial Pooling Implementation - The nationwide implementation of cross-provincial pooling was officially launched on December 2, 2024, in Suzhou, Jiangsu, allowing insured individuals to transfer funds to close relatives who are also insured [2] - The new notice introduces management requirements for pooling relationships, allowing voluntary establishment or dissolution of these relationships, which will automatically end with changes in the insured person's status [3] Group 3: Regulations on Pooling Funds - The notice specifies that personal account funds can be used for medical expenses incurred by close relatives at designated medical institutions and for purchasing approved medications and medical supplies [4] - It clarifies that while funds can be pooled, the eligibility for reimbursement and benefits must be accessed through individual medical insurance cards, meaning "money can be pooled, but cards cannot be shared" [4] - The pooling funds will follow the same clearing process as cross-provincial medical expenses, with a unified national clearing system in place [4]

Core Viewpoint - The recent notification from the National Healthcare Security Administration and the Ministry of Finance aims to enhance the cross-provincial mutual aid system for employee basic medical insurance personal accounts, expanding the scope of mutual aid to include more relatives [1][2]. Group 1: Mutual Aid System Changes - The mutual aid system for employee medical insurance personal accounts has been expanded to include "close relatives," defined as spouses, parents, children, siblings, grandparents, grandchildren, and others as per the Civil Code [1]. - The cross-provincial mutual aid system is officially launched, allowing insured individuals to transfer funds from their medical insurance accounts to their close relatives who are also insured [1][2]. Group 2: Management and Regulations - New requirements for managing mutual aid relationships have been established, allowing mutual aid relationships to be voluntarily created or dissolved, and automatically terminated when an insured person's medical insurance status changes [2]. - A unified medical insurance information platform will manage mutual aid limits through a personal medical insurance wallet, ensuring strict adherence to fund management regulations [2]. Group 3: Fund Usage and Limitations - Funds from personal medical insurance accounts can be used to cover medical expenses for close relatives at designated medical institutions and pharmacies, as well as for personal contributions to other insurance types [3]. - It is emphasized that while funds can be shared, the medical insurance cards cannot be used interchangeably, meaning that each individual must use their own card to access benefits [3].

Group 1 - The core point of the news is the comprehensive increase in maternity insurance benefits in Beijing starting from January 2026, aimed at enhancing the support for childbirth and improving the maternity insurance system [1][2] - The reimbursement standard for prenatal check-up expenses under maternity insurance for female employees in Beijing will be raised from a maximum of 3,000 yuan to 100% reimbursement for expenses within 3,000 yuan, and 30% for expenses exceeding 3,000 yuan, with a maximum fund payment of 10,000 yuan [1] - New categories of individuals, including flexible employment workers, retirees, and insured residents, will also be eligible for reimbursement of prenatal check-up medical expenses under the maternity insurance standards [2] Group 2 - The personal account of employee medical insurance will be expanded for cross-province mutual assistance starting January 2026, allowing funds to be used nationwide [3][4] - The mutual assistance policy will apply to the close relatives of insured employees, enabling them to use the personal account funds for medical expenses incurred by family members [4][9] - The mutual assistance funds can be used for personal medical expenses, resident insurance, and long-term care insurance payments, enhancing the family support function of the medical insurance system [4][8] Group 3 - The implementation of cross-province mutual assistance for personal accounts is already operational in 337 regions across 21 provinces, including Sichuan, Jiangsu, and Shandong [8][11] - The definition of close relatives includes spouses, parents, children, siblings, grandparents, and grandchildren, allowing for a broader range of family members to benefit from the mutual assistance policy [9][7] - Different regions may have specific requirements for binding close relatives to the mutual assistance accounts, indicating a need for awareness of local policies [13]

Core Viewpoint - The National Healthcare Security Administration and the Ministry of Finance have issued a notice to enhance the cross-provincial mutual aid of personal accounts in employee basic medical insurance, allowing insured individuals to use their personal account funds for family members across provinces [1]. Group 1: Cross-Provincial Mutual Aid - Cross-provincial mutual aid allows insured individuals to use their personal account funds for family members in different provinces, benefiting those who work away from home [1]. - Eligible mutual aid recipients include not only direct relatives such as spouses, parents, and children but also siblings, grandparents, grandchildren, and other close relatives, with one person able to establish mutual aid relationships with multiple individuals [1]. Group 2: Eligible Expenditures - Funds from the employee medical insurance personal account can be used to cover personal medical expenses incurred by close relatives at designated medical institutions, as well as for purchasing approved medications, medical devices, and supplies at designated retail pharmacies [1]. - Additionally, these funds can be used for personal contributions to urban and rural resident basic medical insurance and long-term care insurance [1]. Group 3: Usage of Mutual Aid Funds - The mutual aid funds are managed through a "medical insurance wallet," which is linked to the individual's medical insurance code, requiring both the donor and recipient to activate their medical insurance wallets [2]. - The process to activate and use the medical insurance wallet involves logging into the National Medical Insurance Service Platform App, confirming usage, and submitting transfer requests, with a limit of three transfers per day and a maximum of 2000 yuan per transfer [2]. Group 4: Reimbursement and Policy Implications - The mutual aid does not affect the reimbursement qualifications, benefits, or policies of the recipient's medical insurance; the reimbursement will follow the local resident insurance rules regardless of the source of funds [3]. - Medical actions and diagnoses of family members using the mutual aid funds will not be recorded under the insured individual's name, ensuring no negative impact on future insurance participation [3].

Core Viewpoint - The National Healthcare Security Administration and the Ministry of Finance have issued a notice to enhance the cross-provincial mutual aid for employee basic medical insurance personal accounts, allowing insured individuals to use their personal account funds for family members in different provinces [1] Group 1: Cross-Provincial Mutual Aid - Cross-provincial mutual aid allows insured individuals to use their personal account funds for family members, such as those working away from home, enabling them to cover medical expenses for relatives in their hometown [1] Group 2: Eligible Recipients - The notice specifies that eligible recipients for mutual aid include not only direct relatives like spouses, parents, and children but also siblings, grandparents, grandchildren, and other close relatives, allowing one person to establish mutual aid relationships with multiple individuals [2] Group 3: Eligible Expenses - Funds from the employee medical insurance personal account can be used to pay for personal medical expenses incurred by close relatives at designated medical institutions, purchase approved medications and medical supplies at designated retail pharmacies, and cover personal contributions to urban and rural resident basic medical insurance and long-term care insurance [3] Group 4: Fund Transfer Process - The transfer of personal account funds to eligible recipients is facilitated through the Medical Insurance Wallet, which is linked to the individual's medical insurance code. Both the donor and recipient must activate their Medical Insurance Wallets to enable fund transfers [4] Group 5: Transfer Limitations - Each Medical Insurance Wallet account is limited to three transfers per day, with a maximum transfer amount of 2000 yuan per transaction. If the transfer exceeds these limits, additional documentation may be required [9] Group 6: Reimbursement Implications - Mutual aid from personal accounts does not affect the reimbursement qualifications, benefits, or policies of the recipient. For instance, if an employee uses their personal account funds to assist a parent enrolled in resident insurance, the parent's reimbursement terms remain unchanged and are based on their own insurance coverage [9]

Core Viewpoint - The National Healthcare Security Administration and the Ministry of Finance have issued a notice to enhance the cross-provincial mutual aid for personal accounts in basic medical insurance, expanding the scope from provincial to national level [1] Group 1: Policy Changes - The new policy allows insured individuals to use their personal account funds for their close relatives across provinces, facilitating support for family members who may be working away from home [3] - The eligible beneficiaries include close relatives such as spouses, parents, children, siblings, grandparents, and grandchildren, who must also be insured under basic medical insurance [3] Group 2: Implementation Mechanism - To utilize the mutual aid, both the contributor and the beneficiary must open a medical insurance wallet, which is linked to their personal medical insurance code [4] - The funds from the personal account can cover out-of-pocket medical expenses incurred by the beneficiaries at designated medical institutions and pharmacies, as well as personal contributions to other insurance plans [3][4] Group 3: Financial Impact - Over the past five years, the mutual aid from personal accounts has exceeded 100 billion yuan, benefiting over 78 million individuals [6][8] - The policy has progressively expanded the mutual aid scope from city-level to provincial and now to national levels, with 337 healthcare coordination areas implementing cross-provincial mutual aid [8]

Core Viewpoint - The implementation of cross-provincial mutual aid for personal medical insurance accounts aims to alleviate the medical expense burden on families by allowing insured individuals to use their personal account funds for their close relatives' medical needs across provinces [1][2]. Group 1: Policy Implementation - The National Healthcare Security Administration and the Ministry of Finance issued a notification on January 9 to accelerate the realization of cross-provincial mutual aid for employee basic medical insurance personal accounts [1]. - The policy supports the use of personal account funds for near relatives' medical expenses, including medical treatment and medication purchases [1][2]. Group 2: Eligible Participants - The notification specifies that eligible mutual aid recipients include close relatives of the insured, such as spouses, parents, children, siblings, grandparents, and grandchildren [3]. - Both employee basic medical insurance and urban-rural resident basic medical insurance participants can be mutual aid recipients [3]. Group 3: Usage of Mutual Aid Funds - Mutual aid funds can be used to cover personal medical expenses incurred by close relatives at designated medical institutions and for purchasing approved medications and medical supplies [4]. - Funds can also be allocated for personal contributions to urban-rural resident basic medical insurance and long-term care insurance [4]. Group 4: Fund Management and Settlement - A national unified medical insurance information platform will establish a personal medical insurance wallet, allowing mutual aid contributors to set mutual aid limits for recipients [5]. - The mutual aid limit will be managed virtually, ensuring that the medical insurance fund remains secure, and unused limits will revert to the contributor's account upon termination of the mutual aid relationship [5]. - Monthly full settlement of expenses incurred through cross-provincial mutual aid will follow a unified national clearing process, with dynamic adjustments to fund scale [5]. Group 5: Future Outlook - The 2025 National Medical Security Work Conference confirmed the goal of fully realizing cross-provincial mutual aid for employee medical insurance personal accounts [6]. - The gradual implementation of this policy is expected to provide significant support for families separated by distance, enhancing their sense of security and connection [6].