Increased efficiency in the use of health-care funds and reduction of the cash burden on participants. Previously, the shanghai city medical insurance board issued a circular on further expansion of the use of the funds available in the personal accounts of employees, specifying that, as of 1 september 2026, the “segregated self-supporting” costs incurred by the employees' health-care participants in their local health-care establishments or retail pharmacies can be directly offset by the annual savings in the personal accounts, and that insufficient amounts may be covered by the co-financing funds。
The so-called classification of self-sufficiency refers to a portion of the cost of medicines, diagnostic programmes and medical consumables that require an individual's prior contribution within the scope of health insurance reimbursement. Individual self-supporting costs are those which are covered by health insurance reimbursement and which, in addition to being classified as self-supporting, are to be borne proportionately by the individual。
For example, for a “behaviour” of $100, an individual is under 10 per cent (10 per cent * 10 per cent = 10 dollars), which is classified as a self-supporting cost; for example, for a group of 11 national collections of medicines, the price selected for collection (the health insurance payment standard) is 5 dollars, and for a non-selective “priced high” price is 30 dollars. If the participant chooses “high-priced drugs”, reimbursement under the health insurance provisions is within the range of $5, and the excess difference of $25 is also classified as self-financing。
Following this extension, the insured person (including the member of the family solidarity group) incurred a separate, self-supporting expense at a fixed medical institution or at a fixed retail pharmacies, giving priority to the use of the previous year's balance of his or her personal account to offset it; if his or her previous account is insufficient, the difference may be paid from the tied family support fund, without having to pay out all the cash。
The order in which the funds remaining in the personal accounts are offset against the personal self-sufficiency portion, including the emergency medical self-sustainment portion, the in-patient payout line and the out-patient co-payment portion of the health insurance claim, and the full self-financing category if the balance remains in the calendar year accounts。
For example, a “behaviour” is set at $100, with an individual paying 10 per cent (10 per cent *10 per cent = 10 per cent = 10 per cent = 10 per cent = cost per person per person per person per person per month) and a working employee at the level iii hospital level (30 per cent — 70 per cent — — 30 per cent = 27 per cent — 27 per person per person per person per person; the remaining $63 is reimbursed by health insurance. If a participant's personal account has only 30 yuan of the previous year's balance (including the family support fund), then the amount of 27 will be used to offset the individual's self-sufficiency, and 3 of the fully self-supporting group of 10 will be offset by a cash payment of 7 yuan。
The funds in the accounts of the employees ' health insurers for the previous years can be paid directly for the classified self-supporting expenses; if the accounts are insufficient, the tied family support funds may be used. Although there are no personal accounts, health-care subscribers can pay the related expenses through the establishment of a network of family support funds. Persons participating in the community medical assistance programme are paid for by the family solidarity fund。
Insured workers are able to form a network through the `accompanying with application' app, the `family solidarity in the individual accounts of health insurance' section, and choose the `system payment' modality to facilitate the use of co-benefit funds by family members。
According to the shanghai city health insurance board, the new deal will effectively raise funds from personal accounts and further reduce the pressure on the population to pay for their own health care, which will continue to be optimized in the future。
