Tianjin medical insurance reimbursement ratio

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

First, outpatient service (outpatient service fee 800 yuan threshold fee) x50 %；;

2. Hospitalization expenses (hospitalization expenses are in 800 yuan or deductible line 1300 yuan or 1700 yuan) × (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 hospitalization medical expenses incurred by students and children within one year are less than 6.5438+0.8 million yuan, and 75% will be reimbursed in a 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.

Legal basis: The medical expenses incurred by the insured in the outpatient service of designated village clinics (designated rural community health service stations, the same below) shall be implemented in accordance with the relevant policies of outpatient reimbursement of first-class designated medical institutions. Among them, the general medical treatment fees charged by designated village clinics according to regulations include registration fees, medical treatment fees and injection fees (including intravenous infusion fees). If the outpatient payment is below the maximum limit, 80% will be reimbursed by the basic medical insurance fund, and the personal burden will be 20%. The specific measures shall be implemented in accordance with the current medical insurance regulations.