Tianjin medical insurance outpatient reimbursement limit

The reimbursement limit of medical insurance outpatient service for Tianjin employees has been raised to 9000 yuan/year.

Reimbursement rules include:

1, personnel category, deductible line, maximum amount and payment proportion;

2. The higher the hospital level, the lower the reimbursement rate. Qifubiaozhun is 5500 yuan, and the payment ratio is 55%;

3, more than 5500 yuan to 9000 yuan, the payment ratio is 55%.

The offline process of Tianjin medical insurance outpatient reimbursement is as follows:

1, the insured person applies for reimbursement to the medical insurance agency;

2, medical insurance agencies to review the application for reimbursement, after the approval of the stamp;

3. Pay reimbursement.

Tianjin medical insurance outpatient reimbursement needs the following materials:

1. My ID card, medical insurance card and medical certificate issued by the company (official seal of the company is required);

2. Discharge summary, invoice and medication list issued by the hospital;

3. Original and photocopy of my bank card or passbook;

4, emergency or observation into hospitalization, patients or their families need to sign and apply for large outpatient Medicaid, wait until the medical insurance agencies timely approval.

To sum up, retirees who meet the conditions of enjoying large-scale outpatient medical subsidies shall apply once a year by their units and be examined and approved once every two years. Want to know the specific details of Tianjin outpatient medical insurance reimbursement, it is recommended to consult the local medical insurance agency.

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 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.