The Rights Structure of Personal Accounts of the Basic Medical Insurance for Employees

Author: Wang Tianyu



Abstract: Personal accounts of the basic medical insurance for employees under the mode of "combination of social pooling and individual accounts" have the ownership attribute, andsource of funds of "30% of the contributions made byindividuals and employers" is salary in nature.In the new round of employee medical insurance reform, "30% of the contribution made by employers is transferred into the pooling fund" as the second contribution made by employees, thereby realizing "equity replacement" of thepart ofemployers’ contributionin personal accounts, which means that the employee's ownership of this part of the contribution will be converted into the right to claim outpatient fees, while at the same time the ownership of the contribution made by the employee is retained. This reform fails to solve the basic problem of the employee’s right to claim reimbursement for hospitalization. As a component of social insurance, the employee medical insurance system follows the institutional legal principle of "the relationship of debts in public law". An insurance relationshipshould establish between the employeeas the insured anda social security agency as the insurer. The employee enjoys the right to claim insurance benefits by virtue of the payment of insurance premiums. Based on this, the implementation path for the complete conversion of the ownership of personal accounts into the right to claim is to use personal accounts as employee contribution accounts, abstract the actual contributions of employees as social contribution values, expressed as salary points, and gradually convert the existing idle money in personal accounts into salary points. The insured claim outpatient and hospitalization insurance benefits from social security agencies based on the salary points of their personal accounts, so that basic medical insurance returns to the mutual aid nature of mutual assistance.

Keywords:basic medical insurance for employees; personal account; ownership; claim; insurance relationship


Author:Wang Tianyu, an associate research fellow and deputy head of the Social Law Department of CASS Law Institute.


Source: 8 (2021) Law Science.