Workflow
职工医保门诊统筹待遇政策
icon
Search documents
“医保额度年底会清零”,是谣言!
Jin Rong Shi Bao· 2025-11-20 02:03
Core Viewpoint - The rumor regarding the "clearing of medical insurance balances at year-end" is unfounded, as multiple local medical insurance departments have confirmed that personal account funds can be carried over and used in the following year [2][3]. Group 1: Medical Insurance System Design - The current medical insurance system in China consists of a pooled fund and personal accounts, where the pooled fund covers medical expenses and personal accounts are for individual expenses [2]. - Unused funds in personal accounts will roll over to the next year, and there is no mechanism for "clearing" these funds [2][3]. - For urban residents under the basic medical insurance scheme, there is no concept of a personal account, thus no issue of balance clearing exists [2]. Group 2: Understanding of Medical Insurance Policies - Many individuals lack understanding of outpatient insurance policies, leading to belief in the rumors [4]. - Outpatient insurance allows for reimbursement of ordinary outpatient expenses after reaching a certain threshold, with an annual maximum reimbursement limit set [4]. - The annual maximum reimbursement limit resets each year and does not affect the balance in personal accounts, which are independent systems [4]. Group 3: Recommendations for Managing Personal Accounts - Individuals are advised not to panic and make unnecessary purchases due to rumors, as this can lead to waste [4]. - It is recommended to check personal account balances through official channels such as the National Medical Insurance Service Platform App or local medical insurance bureau [4]. - Staying informed about local policies regarding family sharing of personal accounts and reimbursement limits is crucial [4]. Group 4: Reasons Behind the Rumors - The emergence of medical insurance rumors is partly due to the public's anxiety about medical expenses, making them susceptible to believing claims of insufficient coverage [5]. - Rumor spreaders exploit the complexity of medical insurance statistics and payment terms, mixing different data to create misleading narratives [5].