How much is the threshold fee for outpatient medical insurance for retirees over 65 years old in Tianjin?

Tianjin outpatient reimbursement threshold for retirees over 65 years old is 800 yuan, 700 yuan for those over 70 years old and 600 yuan for those over 80 years old.

I. Outpatient reimbursement rate: 75% for primary hospitals, 65% for secondary hospitals, 55% for tertiary hospitals, 65% for pharmacies, all with a starting line of 800 yuan; hospitalization reimbursement rate: 85% for primary hospitals, secondary hospitals, and tertiary hospitals with a starting line of -120,000 yuan, and 80% for 12-45,000 yuan.

2, the legal basis: "Chinese people's *** and the State Social Insurance Law"

1, Article 26 The basic medical insurance for employees, the new type of rural cooperative medical care and the basic medical insurance for urban residents of the standard of treatment in accordance with the provisions of the State.

2. Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.

I. Tianjin urban and rural residents' medical insurance treatment

1. Changes in contributions. In the past, the residents' medical insurance is divided into high-grade, medium-grade and low-grade; in 2022, it will be divided into high-grade and low-grade, and there will be no more medium-grade, high-grade payment of 950 yuan, and low-grade payment of 320 yuan; students and children will pay according to the low-grade payment, and enjoy the high-grade treatment.

2, starting line changes. The current general outpatient starting line of 500 yuan, reimbursement rate of 50%, capped at 4,000 yuan, starting next year, the general outpatient starting line of 600 yuan, reimbursement rate according to the hospital level.

3, reimbursement rate changes.

General outpatient: in the past are reported 50%, the future of high-grade contributors in the second level hospitals can report 55%.

Inpatient treatment: 2022 low-grade and high-grade contributions in a disease hospital visits reimbursement rate rose 5% respectively, especially high-grade contributions in the three hospitals can report 75%.

Special outpatient treatment: In 2022, the reimbursement rate for special outpatient treatment in hospitals for various diseases will increase by 20% respectively, which is a very big change. In the past, high-grade contributions were reported 55 percent at tertiary institutions, but next year they will be able to report 75 percent.

Two, inventory of Tianjin residents health insurance current other protection

1, maternity expenses. Tianjin residents health insurance for maternity costs, based on the pregnancy week to set, divided into very fine. For the cost of delivery, the distinction is made between natural delivery, induced delivery, abortion, etc., and a fixed amount of subsidy is implemented. In some cities, the residents' medical insurance for childbirth is reimbursed according to the proportion, such as 75% of the cost of delivery, with reference to the hospitalization of disease.

2. Medical treatment in other places. According to the Notice of the Municipal Bureau of Human Resources and Social Security on the Issuance of Measures for the Administration of Tianjin Basic Medical Insurance Participants for Medical Treatment in Other Places, for those who are resettled in other places, permanent residents in other places, permanent residents in other places, as well as those who have been referred to the hospital, they can apply for medical treatment in other places. If you go through the relevant filing procedures and go for treatment abroad, the out-of-pocket percentage is raised by 5 percent.

If one fails to go through the required transfer procedures and goes to a secondary or tertiary designated institution in a different place for treatment, the out-of-pocket percentage is raised by 10%. If it is a non-designated institution in a different place, the medical insurance will not pay for it.

Note: There is no provision to raise the starting line for medical treatment in other places, and Tianjin's health insurance is still relatively lenient for medical treatment in other places.

3, special outpatient diseases: currently including 13 categories, renal dialysis treatment, kidney transplantation anti-rejection treatment, cancer radiotherapy, anti-rejection after liver transplantation, hemophilia, diabetes, pulmonary heart disease, lupus erythematosus, hemiplegia, mental illness, epilepsy, aplastic anemia, chronic thrombocytopenic purpura, the patient can hold the social security card, the "Tianjin Basic Medical Insurance Outpatient Special Disease Registration (Change) Approval Form" and the disease insurance outpatient special disease registration (change) approval form, patients can hold social security card, "Tianjin Basic Medical Insurance Outpatient Special Disease Registration (Change) Approval Form". (Change) Approval Form of Tianjin Basic Medical Insurance Outpatient Special Diseases and the diagnosis certificate of the disease, and apply for the application on the mobile app of "JinMediBao". After successful registration, you can buy drugs directly in the designated institutions, do not need to be hospitalized to enjoy similar hospitalization, but the reimbursement has a limit.