2023 Tianjin employee medical insurance reimbursement ratio is how much

2023 Tianjin employee health insurance reimbursement ratio is as follows:

1, starting line and ceiling line: according to the regulations, the starting line standard for active employees is 800 yuan, the starting line for retirees less than 70 years of age is 700 yuan, the starting line for retirees older than 70 years of age is 650 yuan, and the maximum payment limit is 9,000 yuan in both cases;

2, reimbursement ratio: the starting line standard to 5500 RMB, the reimbursement rate for primary medical institutions is 75%, 65% for secondary medical institutions; 55% for tertiary medical institutions. The reimbursement rate for the portion that exceeds 5,500 yuan and is below the maximum payment limit is a flat 55 percent.

Medicare reimbursement includes the following:

1, medical expenses during resuscitation;

2, medical expenses during hospitalization;

3, surgical materials and auxiliary appliances;

4, bed charges: according to the standard of the local medical insurance. If due to acute - traumatic brain injury, complex visceral injury coma need to stay in ICU (intensive care unit) except, but out of danger should be immediately transferred to the general ward;

5, rehabilitation and physical therapy fees: according to the local medical insurance standards. In principle, not more than 3 kinds of rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;

6, drug replacement and rehabilitation function guidance training: according to the local medical insurance standards combined with the needs of the condition approved;

7, ambulance fees: according to the local health department and the price department of the approved standards;

8, other costs: in accordance with the provisions of the uncompensated costs will not be compensated;

9. Renewal of medical expenses: the insured can pay in advance for the future determinable and necessary renewal of medical expenses for the injured in order to close the case in advance. Must be in the discharge certificate or diagnostic certificate of the competent doctor has a clear record of the need to continue treatment or half a year, a year after the removal of internal fixation or regular review or record the follow-up treatment costs, while the compensation provided by the insurance payment vouchers on the record has been paid for the follow-up costs can be audited to renew the medical fee. The review of renewal fees will be based on the needs of the medical condition and will not be reimbursed for expenses that are clearly beyond the needs of the medical condition.

In summary, there are two kinds of reimbursement process: one is that the insured person carries the medical insurance card when he is hospitalized for treatment, in this case, he can directly show his medical insurance card to make payment at the medical insurance settlement window of the hospital, and the system will automatically identify what belongs to the medical insurance catalog, and directly complete the settlement; the other is that he forgets to bring his medical insurance card (emergency or off-site) for treatment, and when he is discharged from the hospital for settlement, he can directly show his card to the hospital for payment. The other is forgetting your health insurance card (for emergency or off-site treatment), you need to prepare a list of medical expenses, original invoices, discharge certificates, hospital diagnostic certificates, and then go to the relevant local health insurance agency to apply for reimbursement after organizing the information, and the reimbursement funds will be transferred to your personal account after passing the audit.

Legal basis:

Article 27 of the Social Insurance Law of the People's Republic of China

Individuals who participate in the basic medical insurance for employees and have made contributions for a total of up to a specified number of years by the state when they reach the legal retirement age are no longer required to pay the basic medical insurance premiums and are entitled to the basic medical insurance benefits in accordance with the state regulations; those who have not made contributions for a specified number of years are allowed to make contributions for up to a specified number of years. Contribute to the state prescribed years.