20 19 outpatient qifubiaozhun of basic medical insurance for urban workers and urban and rural residents in Tianjin

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In Tianjin, social security medical insurance reimbursement is divided into two parts: outpatient reimbursement and hospitalization reimbursement.

I. Outpatient service fee (800 yuan threshold fee for outpatient service) x50%.

2. Hospitalization (hospitalization fee is in 800 yuan or threshold fee 1.300 yuan or 1.700 yuan) x (85% on-the-job 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:

(1) 30,000 yuan to110,000 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.

Hospitalization medical insurance treatment standard:

The proportion of students and children's hospitalization expenses below 6.5438+0.8 million yuan within one year is 75% in the first-class hospital (community health service center); 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%.

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.

Standard for reimbursement of large medical expenses in outpatient and emergency departments:

In a year, the threshold for outpatient and emergency medical expenses incurred by urban and rural residents in first-class hospitals and community medical institutions is 600 yuan, with the maximum payment limit of 3,000 yuan and the reimbursement ratio of 50%.