Tianjin social security new regulations pilot

Proportion of medical insurance reimbursement for hospitalized employees:

Hospitalization fee (hospitalization fee -800 or threshold fee 65,438+0,300 or 65,438+0,700) * (85% employed or 90% retired)

Except for self-funded drugs.

Part of the outpatient medical expenses for serious illness are reimbursed;

(1) 80% of employees' medical treatment is paid by the overall fund and 20% by individuals;

(2) For retirees seeking medical treatment, the overall fund pays 85%, and the individual pays 15%.

Large medical insurance:

(! ) 30,000 yuan to 654.38+10,000 yuan (inclusive) for medical expenses, 94% for large medical insurance premiums, and 6% for individuals;

(2) For medical expenses ranging from 6,543,800 yuan to 200,000 yuan (inclusive), 96% of the large medical insurance premium is paid, and 4% is paid by the individual;

(3) For medical expenses of more than 200,000 yuan, 98% is paid for large medical insurance premiums, and 2% is paid for individuals.

Proportion of hospitalization reimbursement for residents' medical insurance:

(a) students and children in a year hospitalization medical expenses below 6.5438+0.8 million yuan, in a hospital (community health service center) reimbursement ratio is 75%; The second-level hospital, starting from 400 yuan, has a reimbursement rate of 65%; A tertiary hospital, with a threshold of 500 yuan, has a reimbursement rate of 55%.

(two) the hospitalization expenses incurred by adult residents within one year shall be reimbursed according to the following standards:

Among them, the first-level hospital Qifubiaozhun is 300 yuan, the second-level hospital Qifubiaozhun is 400 yuan, and the third-level hospital Qifubiaozhun is 500 yuan. If urban and rural residents are hospitalized for more than two times in a settlement year, starting from the second hospitalization, the Qifubiaozhun fee will no longer be charged. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.

Tianjin held a conference on human resources and social security. This year, 480,000 new jobs were created in the city, and the registered unemployment rate in cities and towns was controlled within 3.8%. The government subsidy standard for residents' medical insurance is raised from 420 yuan to 520 yuan per person per year. This year, the proportion of reimbursement for hospitalization has increased by 5 percentage points, and the maximum payment limit for hospitalization has increased to 654.38+0.8 million yuan. Tianjin will also build a new mode of talent introduction with enterprises as the main body. We will launch the special support plan of "Thousands of Enterprises with Ten Thousand Talents" and support 65,438+10,000 enterprises to introduce and train 65,438+10,000 high-level talents in three to five years.

By the end of the year, the employment rate of college students will reach over 90%.

This year, Tianjin's employment work has made new moves, striving to achieve both group employment and enterprise employment. In the whole year, 480,000 new jobs were created, and the registered urban unemployment rate was controlled within 3.8%.

Tianjin will take entrepreneurship as the starting point to promote employment, implement the national entrepreneurship program and action plan, and encourage and support more workers to start their own businesses and become rich through hard work. At the same time, continue to carry out large-scale vocational training and build a lifelong vocational training system. In the whole year, 400 training packages for 80 occupations were newly developed, vocational skills training was carried out 1 10,000 person-times, and 200,000 skilled personnel were trained. In addition, continue to put college graduates in the first place in employment. For those who enter the graduation school year, carry out employment services into the campus and other activities; Implement real-name system management for unemployed graduates who leave school and follow up the service all the time; College graduates from poor families implement the responsibility system of guarantee and recommend employment within a time limit. By the end of the year, the employment rate of college students should reach over 90%.

The pension and medical insurance targets are 6.5 million and10.05 million respectively.

This year, Tianjin will continue to improve the social security system of coordinating urban and rural areas, focus on expanding the supervision and management of endowment insurance and medical insurance, reasonably consider all kinds of personnel, and improve their treatment level. In the whole year, the number of people participating in endowment insurance should reach 6.5 million, the number of people participating in medical insurance should reach/kloc-0.005 million, and the number of people participating in work-related injury insurance, unemployment insurance and maternity insurance should reach 3.45 million, 2.87 million and 7.6 million respectively.

Tianjin will continue to expand social insurance coverage. Focus on structural indicators such as the actual number of payers, the number of continuous payers, and the proportion of on-the-job retirees. Focus on labor dispatch organizations, small and medium-sized enterprises, private enterprises and migrant workers, flexible employees, people who stop paying fees, and rural residents, and promote everyone to enjoy basic social security.

Improve the normal adjustment mechanism of social security benefits. The standard of government subsidy for residents' medical insurance was raised from 420 yuan to 520 yuan per person per year, the proportion of hospitalization reimbursement was raised by 5 percentage points, the maximum payment limit for hospitalization was raised to 6.5438+0.8 million yuan, and the reimbursement grade of fully subsidized people with special difficulties was changed from low-grade to high-grade. Establish and implement the residents' serious illness insurance system, and form a "five in one" medical security system with full coverage of basic medical insurance and serious illness insurance, medical assistance, special assistance and accidental injury.

Ensure that the disposable income of urban households increases by 10%.

This year, Tianjin will continue to implement the 2 1 policy measures of the municipal party committee and the municipal government to increase people's income, focusing on enterprise employees and low-income groups, comprehensively increase the income of workers, and ensure that the disposable income of urban households increases by 10%. Tianjin brought disposable income of urban households into the assessment system of district and county governments. Moderately adjust the minimum wage standard and wage guidance line, and explore the industry minimum wage standard.

Some units have tried out the appointment system for civil servants.

This year, in accordance with the requirements of deepening the reform of the administrative system, we will comprehensively strengthen the construction of civil servants, deepen the reform of the personnel system of public institutions, select some units to carry out pilot projects on the appointment system of civil servants and the staff system of public institutions, accelerate the formation of an employment mechanism that can enter and exit, and constantly stimulate the vitality of cadres and workers. Closely combined with the classification reform of public institutions, we will implement the "Implementation Opinions on Further Deepening the Reform of Personnel System in Public Institutions" and improve the employment contracts and post settings that meet the characteristics of different units.

Since July 1 day, 2008, the collection, treatment and business handling of basic medical insurance in Development Zone have been unified with the whole city. According to the spirit of the document "Provisions on Basic Medical Insurance for Urban Workers in Tianjin" (J.R.F. [20065438+0] No.80) and the Opinions of the Development Zone Management Committee and the Municipal Labor and Social Security Bureau on Issues Related to Unifying the Basic Medical Insurance System between the Development Zone and the whole city (J.R.F. [2008] No.62), we hereby notify the relevant issues about the unification of the basic medical insurance system between our district and the whole city as follows:

First, about the payment ratio and the original insured individual payment subsidies.

(1) About payment proportion

Since July 1 day, 2008, the payment ratio of basic medical insurance in Development Zone has been adjusted as follows:

1. Personal contribution rate

Employees pay the basic medical insurance premium according to 2% of their average monthly salary in the previous year.

2. Proportion of unit payment

(1) The employer shall pay the basic medical insurance premium at 9% of the total individual contributions of employees;

(2) The employer shall pay the large medical insurance premium for outpatient (emergency) consultation according to 1% of the sum of the individual payment bases of employees.

(two) about the original insured individual payment subsidies.

1. Subsidy scope: those who have participated in the basic medical insurance in the development zone before June 30, 2008 and continue to pay the basic medical insurance premium after July 2008 1.

2. Subsidy standard: medical insurance premium paid at 2% of the average monthly salary of employees in the previous year.

3. Subsidy method: It is arranged by the development zone medical insurance overall balance fund, and the social insurance agency of the development zone will transfer it to the "development zone social insurance issuance card" of the corresponding insured person on a monthly basis.

4. Subsidy period: 5 years (i.e. until 2065438+June 30, 2003).

Two, about the large medical assistance and the original insured subsidies.

The financing standard of large medical assistance fee in development zone is implemented in the whole city. In 2008, employees paid annual fees 150 yuan and retirees paid annual fees 160 yuan.

After July 1 day, 2008, the newly insured employees should pay a large amount of medical assistance fees according to the unified standards of Tianjin.

(1) Large medical assistance in 2008

1. In-service personnel

For those who have participated in the basic medical insurance in the development zone before June 30, 2008 and continue to pay the basic medical insurance premium after July 2008 1, the large medical assistance fee 120 yuan that should be paid in 2008 will be arranged by the development zone medical insurance pooling balance fund, and individuals will no longer pay it.

2. Retirees

In 2008, the large medical assistance fee of the following two types of retirees 100 yuan will be arranged by the medical insurance balance fund of the development zone, and individuals will no longer pay it.

(1) Former insured retirees in the Development Zone before June 30, 2008;

(2) Persons who participated in the basic medical insurance of the Development Zone before June 30, 2008, and retired from July/KLOC-0 to February 3, 2008.

(2) Large medical assistance expenses after June 65438+1 October12009.

1.For those who retire before June 30, 2008, the large amount of medical assistance should be paid by the balance fund of medical insurance in Development Zone on a monthly basis according to the unified standard of Tianjin, and individuals will no longer pay.

2. Anyone who participated in the basic medical insurance in the Development Zone before June 30, 2008 and retired from July 1 day to June 30, 2006 shall pay a large amount of medical assistance fee from the date of retirement to February 3 1 day, 2006, according to the unified standards of Tianjin. After 20 1 4,65438+10/year in 2004, I shall pay the large amount of medical assistance.

Three, on the outpatient deductible and reimbursement ratio and the original insured subsidies.

(1) The outpatient and emergency medical expenses incurred by the insured in the Development Zone shall be unified throughout the city.

1. Qifubiaozhun and capping line of outpatient and emergency medical expenses

(1) On-the-job employee: 800 yuan-5,000 yuan.

(2) Retirees: 800 yuan under 60 years old-5,000 yuan; 60 -70 years old is 700 yuan -5000 yuan; 650 yuan over 70 years old -5000 yuan.

2. The proportion of outpatient and emergency medical expenses reimbursement

(1) On-the-job employees: 50% are under 45; 55% are over 45 years old.

(2) Retirees: 60% are under 70 years old; 70% are over 70 years old.

(two) subsidies to the original insured.

For the following three categories of personnel, the Development Zone Medical Insurance Balance Fund will make a one-time capital injection into the Development Zone Social Insurance Issuance Card 160 yuan.

1. Persons who have participated in the basic medical insurance in the Development Zone before June 30, 2008 and continue to pay the basic medical insurance premium after July 20081;

2. Before June 30, 2008, the original insured retirees in the Development Zone;

3. Persons who participated in the basic medical insurance of the Development Zone before June 30, 2008, and retired from July/KLOC-0 to February 3, 2008.

Fourthly, regarding hospitalization reimbursement.

The insured in the Development Zone shall implement the unified hospitalization reimbursement policy of the whole city. The compensation ratio is as follows:

(a) the proportion of reimbursement of medical expenses incurred by the insured in a first-class hospital was adjusted from 85% of the original employees and 90% of retirees to 90% of the employees and 95% of retirees.

(two) the proportion of reimbursement of hospitalization medical expenses in secondary and tertiary hospitals is still 85% for on-the-job employees and 90% for retirees.

The maximum payment limit for large medical assistance is adjusted from 200,000 yuan to 250,000 yuan, and 80% of large medical assistance is reimbursed.

Five, about the injection, use and management of personal account funds and the original insured medical insurance personal account storage.

After the basic medical insurance measures in the development zone are unified with the whole city, the transfer of personal account funds in the development zone shall be implemented according to the unified policy of the whole city. The use and management of individual accounts shall be unified throughout the city.

(1) Since July 1 2008, the basic medical insurance premium paid by the employer has been transferred to the personal account according to the unified regulations of the whole city. According to the following proportions:

1. Active employees

(1) Employees under the age of 45 are counted as 0.8% of the monthly per capita contribution salary of the employer;

(2) Employees who have reached the age of 45 shall be counted according to 65438+ 0.2% of the monthly per capita contribution salary of the employer.

2. Retirees

(1) Retirees under the age of 70 are transferred to personal account 40 yuan every month;

(2) Retirees who have reached the age of 70 are included in the personal account 50 yuan;

(3) Old workers who participated in revolutionary work before the founding of the People's Republic of China are included in the personal account of 60 yuan.

The standard of personal account transfer of basic medical insurance for retirees shall be adjusted in a timely manner according to the operation of the fund.

(2) Since July 1 2008, the basic medical insurance premium paid by individual employees has been included in individual accounts.

(three) the original insured medical insurance personal account all storage.

Before June 30, 2008, after the social insurance agency in the Development Zone has completed the examination and payment of all medical expenses in transit, the municipal social insurance agency will transfer all the deposits in the personal account of the original insured in the Development Zone to the personal account of social security card medical insurance before June 65438+ 10/0, 2009.

Other information of intransitive verbs

(1) Once the employee's social insurance relationship is transferred out of the Development Zone, no matter when it is transferred out, it will no longer enjoy the relevant treatment involved in this notice.

(2) The payment of basic medical insurance benefits for retirees in the Development Zone shall be socialized, and the enjoyment of medical benefits before retirement shall not be linked to enterprise payment.

(3) After the medical insurance system in the Development Zone is unified with the whole city, the insured persons use the social security cards uniformly issued by the whole city as medical treatment vouchers and payment vouchers, and manage and use them according to the unified system of the whole city. Before June 30, 2008, the social security card fees of the participants in the basic medical insurance need not be borne by individuals.

(4) Retirees who have participated in the basic medical insurance in the Development Zone before June 30, 2008, with the cumulative payment period of 25 years for men and 20 years for women, but the actual payment period is less than 5 years, can enjoy the basic medical insurance benefits after retirement after the system is unified in July 2008 1 day.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.