What is the reimbursement ratio of Tianjin medical insurance card?

The reimbursement ratio of Tianjin medical insurance card is as follows:

1, reimbursement ratio of employee medical insurance hospitalization:

(1) 85% of hospitalization expenses are between 1300 yuan-30,000 yuan;

(2) The reimbursement rate between 30,000 yuan and 40,000 yuan is 90%;

(3) The reimbursement rate between 40,000 yuan and10,000 yuan is 95%;

(4 4) 10/00000 yuan to 300000 yuan reimbursement ratio is 85%;

2, the proportion of residents' medical insurance reimbursement:

(1) The reimbursement rate of first-class hospitals is 65%;

(2) 80% of the second-level hospitals are reimbursed for more than 6,000 yuan.

The basic medical insurance for employees is as follows:

The overall fund and individual account of employees' basic medical insurance shall be accounted for separately according to their respective payment scope, and shall not occupy each other.

1. Personal account, which is used to pay out-patient expenses, out-of-pocket expenses of hospitalization and shopping expenses of designated pharmacies.

2, the overall fund, used to pay for hospitalization and outpatient illness. The overall fund payment has a minimum payment standard and a maximum payment limit. Qifubiaozhun is controlled in principle at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled in principle at about 4 times of the average annual salary of local employees. Medical expenses below Qifubiaozhun shall be paid by personal account or borne by individuals. Medical expenses above Qifubiaozhun and below the maximum payment limit are mainly paid by the overall fund.

To sum up, the three most commonly used reimbursement methods for medical insurance are general drug purchase, outpatient service and hospitalization. Different categories have different reimbursement rates, methods and procedures.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.