Payment standard of medical insurance for college students in Tianjin

Policy Guide for Tianjin University Students to Participate in Residents' Basic Medical Insurance and Related Types of Insurance

Part I Insurance Registration and Payment

1. scope of students to which this policy guide applies.

Non-on-the-job college students studying in all kinds of ordinary colleges and universities (including higher vocational colleges) full-time schools in this city

2. Insurance payment time

Go through the insurance payment procedures from September 1 to February 3 1 every year, and it will not be accepted after the deadline.

3.20 16 What is the funding standard for residents' medical insurance?

Everyone goes to 830 yuan every year, of which the individual pays 100 yuan and the government subsidizes 730 yuan. Students and children with special difficulties who meet the relevant provisions of the state and this Municipality are recognized by their schools and enjoy full government subsidies, and individuals do not pay fees.

4. Who have special difficulties?

① Severe disabled persons. According to the Disabled Persons' Federation, the level of disability is one to two. The certificate is People's Republic of China (PRC) Disabled Person's Card.

(2) enjoy the subsistence allowances. Persons who enjoy the minimum living allowance as recognized by the civil affairs department. The certification certificate is "Tianjin Minimum Living Guarantee Certificate".

③ Special hardship relief workers. Confirmed by the civil affairs department, the certificate of the poor family members who enjoy the special hardship relief is the special hardship relief card for urban and rural residents in Tianjin.

(4) Minors from urban low-income families. Appraised by Jie Zhen Labor Service Center, the per capita income of the family is higher than the minimum living standard of urban and rural residents in this Municipality and lower than twice the minimum living standard of urban and rural residents in this Municipality. The identity certificate is a resident identity card and a low-income family certificate issued by the street town labor service center.

⑤ Help loan students. The identification certificate is the national student loan contract.

5. How to insure?

Take the school as the unit to participate in the insurance, and go through the insurance formalities in the social security sub-center of the district and county where it is located. City student medical insurance service center to assist in handling.

Students who get a national student loan within one year of enrollment can apply for a refund within the year when they get a student loan. If the fee is refunded due to death, the declaration time limit is before 65438+February 3 1 of the insured year, and it will not be accepted after the deadline.

Part II Medical Insurance Benefits

1, enjoy the treatment period

The treatment period is from 65438+ 10 to 65438+ in February of the following year, starting from September 1 in that year, starting from September 1 in that year to February 3 1 in the following year, and starting from June 65438+/kloc-0 in the following year.

2, treatment reimbursement standards

project

be hospitalized

Outpatient special diseases

General outpatient service

Reimbursement ratio

First-class hospitals (including pharmacies)

80%

65%

50%

Secondary hospital

70%

60%

No reimbursement

Tertiary hospital

60%

55%

No reimbursement

Qifubiaozhun

500 yuan (within one year, inpatient and outpatient specific diseases are treated separately, or two kinds of outpatient specific diseases occur, and the combined Qifubiaozhun is one each).

500 yuan

Maximum payment limit

65438+800,000 yuan

Three thousand yuan.

Special outpatient diseases include renal dialysis, anti-rejection therapy after renal transplantation, tumor radiotherapy and chemotherapy analgesia, diabetes, cor pulmonale, lupus erythematosus, hemiplegia, psychosis, anti-rejection therapy after liver transplantation, hemophilia, epilepsy, aplastic anemia and chronic thrombocytopenic purpura.

3. How to reimburse the medical expenses?

The first is online reimbursement. With the social security card or resident ID card (household registration book), you only need to pay the fees that the individual should pay, and the rest of the fees will be settled with the designated medical institutions by the social security center according to regulations.

The second is to advance medical expenses reimbursement. Where medical expenses are prepaid, the school is responsible for collecting the documents and related materials of prepaid medical expenses, transferring them to the student medical insurance service center or directly reporting and entering them in the local social security sub-center. The medical insurance agency will transfer the reimbursement to the social security card account. If the social security card has not been obtained, the settlement account shall be opened in the local medical insurance agency when the declaration formalities are handled for the first time. The materials needed to advance medical expenses are:

Details of outpatient (emergency) diagnosis documents

Rounded rectangle: 1. Special receipt for outpatient service of medical institutions in Tianjin (stamped with cash receipt seal, medical insurance seal or special seal for medical insurance, and full payment seal) 2. List of outpatient expenses of medical institutions in Tianjin (stamped with full payment seal) 3. Four prescriptions of medical institutions in Tianjin (stamped with full payment seal). Diagnosis certificate (stamped with the seal of diagnosis certificate, medical insurance or special medical insurance) 5. 6 copies of ID card or household registration book.

Detailed information of emergency observation documents

Rounded rectangle: 1. Diagnosis certificate (stamped with the seal of diagnosis certificate, medical insurance or special medical insurance seal, emergency seal) 2 copies. Special receipt for outpatient service of medical institutions in Tianjin (stamped with cash receipt stamp, full advance stamp and emergency stamp) 3. List of outpatient expenses of medical institutions in Tianjin (stamped with full advance seal) 4. Five prescriptions of medical institutions in Tianjin (stamped with full advance seal). 6 copies of ID card or household registration book. Copy of special receipt for hospitalization in Tianjin medical institution. Note: The diagnosis certificate should state "On * * * *, the patient was put on observation due to illness, and * years later".

Details of outpatient special disease documents

Rounded rectangle: 1. Special receipt for outpatient service of medical institutions in Tianjin (with cash receipt stamp, medical insurance or special seal for medical insurance and full advance stamp) 2. List of outpatient expenses of medical institutions in Tianjin (stamped with full advance stamp) 3. Four prescriptions of medical institutions in Tianjin (stamped with full advance payment seal). Five copies of the registration form for special diseases in outpatient department. 6 copies of ID card or household registration book. Diagnosis certificate (stamped with diagnosis certificate seal and medical insurance seal)

Details of hospitalization documents

Rounded rectangle: materials required for general hospitalization 1. Diagnosis certificate (stamped with the seal of diagnosis certificate, medical insurance or special seal for medical insurance) 2. Special receipt for hospitalization of medical institutions (with cash receipt stamp, medical insurance or special seal for medical insurance) 3. Home page of hospitalization medical records (medical records) and admission records. Discharge summary or discharge record (stamped with the seal of the medical record room). If the medical record of the hospital is a riding seal, all medical records must be reported. 4. Total hospitalization expenses (medical insurance or special seal for medical insurance). 5. Copy of ID card or household registration book. 6. Description of full advance (stamped with the official seal of the school)

Rounded rectangle: You still need 1 hospitalization when you return to your hometown. Local hospital grade certificate (with hospital seal) 2 copies. Certificate of returning to the place of origin (stamped with the school seal) 3. A copy of the original household registration book needs to be 1 transferred to other places in this city. Registration Form for Referral and Transfer (stamped with the official seal of the hospital and the social security sub-center) 2. Local hospital grade certificate (with hospital seal) 3. Description of full advance (with official seal of the school) 1. Two copies of medical records. Local hospital grade certificate (with hospital seal) 3. Diagnostic certificate (stamped with emergency seal) 4. Description of full advance payment (stamped with the official seal of the school)

4. How to register for hospitalization?

If you want to be hospitalized in a designated hospital, you must first register for hospitalization to ensure the normal enjoyment of medical insurance benefits. The specific procedures are as follows: hold the social security card or resident identity card (household registration book) and the hospitalization certificate of networked hospitals, and issue the Confirmation of Hospitalization Qualification of Tianjin Basic Medical Insurance on the hospital website on the day of hospitalization (within 5 days under special circumstances) to handle the hospitalization registration of the insured. If you are hospitalized in an unconnected hospital or unable to register in the hospital for some reason, you should go to the social security agency where the insurance payment is made to accept the registration post.

5. How to register special diseases in outpatient department?

Outpatients with special diseases are registered in the medical insurance department of the hospital with social security cards, examination results and approval forms issued by designated diagnostic doctors in designated hospitals.

6, remote medical expenses reimbursement

The reimbursement for medical treatment of the insured in different places is divided into four categories. First, the medical expenses incurred due to emergencies during the temporary outing; The second is the hospitalization expenses incurred by students and children with household registration in this city during their study abroad and students and children with non-household registration in this city during their origin; Third, the city's insured people who have lived in other places for a long time and have gone through the resettlement procedures in different places; Fourth, because of illness, I have to be transferred to other places for hospitalization. The medical expenses incurred in the above circumstances shall be paid in advance by myself, and shall be handled according to the relevant procedures for reimbursement of medical expenses after returning to Tianjin.

accident

1, enjoy the treatment period

The period of enjoying additional insurance benefits for accidental injury is from September of that year to August of the following year. The insured college students who leave school after graduation can continue to apply for additional insurance claims for accidental injuries during the period of enjoying residents' medical insurance benefits in the same year, and the commercial insurance company affiliated to the insured school will pay for them.

2. Treatment standard

1. Accidental medical treatment: 70% of the insured's medical expenses incurred below 6,000 yuan. The reimbursement rate of hospitalization medical expenses above 6000 yuan is 80%, and the maximum payment limit is 350000 yuan.

2. Accidental disability: If physical disability is caused by an accident, a one-time subsidy will be given. The specific criteria are: if the disability level is identified as level 4, the subsidy will be 20,000 yuan; If the disability level is Grade III, the subsidy is 25,000 yuan; Disability level is two, a subsidy of 30 thousand yuan; If the disability level is 1, the subsidy is 35,000 yuan.

3. Accidental death: In case of accidental death, a one-time subsidy of 50,000 yuan will be given.

3. Exemption from liability

What does not fall within the scope of reimbursement for accidental injury additional risks is:

(1) Conceal or cheat;

(2) Self-injury, self-injury or suicide;

(3) The legal beneficiary intentionally causes the death or disability of the insured;

(four) drunk driving, driving without a license, driving with an invalid driver's license, driving a motor vehicle without a valid driver's license, causing injuries;

(five) alcoholism, drug abuse or accidental injury caused by alcohol, drugs or controlled drugs.

(6) The insured has an accident due to abortion, childbirth, food poisoning, medical accident, acceptance or self-care, which leads to abortion without accidental injury;

(seven) accidental injury caused by violation of laws and regulations on public security management;

(eight) the liability for compensation is borne by a third person;

(9) The liability for compensation shall be borne by the industrial injury insurance fund;

(10) Medical expenses for accidental injuries occurred overseas.

(1 1) has been diagnosed as epilepsy, psychotic episode, pathological fracture or stroke due to physical injury caused by sudden illness.

4. Expense reimbursement

After students and children have accidental injuries, I will pay all medical expenses in advance, and schools and kindergartens will contact insurance companies to handle claims for them. The required materials include:

Application materials for additional insurance premium for accidental injury

General material

1, accident identification 2, outpatient medical records 3, hospitalization medical records and discharge summary

4. Accident certificate. Copy of bank passbook (card)

accident

Accidental disability

accidental death

Special material

1, original medical expense receipt and diagnosis certificate

2, medical expenses list or prescription

3. Inspection report

1, accident certificate issued by relevant departments.

2, disability appraisal report

1, certificate of accidental death issued by relevant departments.

2. funeral home cremation proved that

3. Medical certificate or forensic certificate of death of residents.

4. Identification certificate of beneficiary

5. The relationship between the beneficiary and the accident.

Service management

Contact information of the underwriting company of student accidental injury additional insurance:

Organization name

Reporting telephone number

Consulting contact person

consulting telephone

Sunshine life insurance co., ltd. Tianjin branch

955 10

Manager ma

5858087 1

People's Insurance Company of China Tianjin Branch

955 18

Manager sun

24386903

China continent property & casualty insurance co., ltd. Tianjin branch

95590

Manager Hao

58 12 1897

China Pacific property insurance co., ltd. Tianjin branch

95500

Manager Wei

278 18030

China life insurance co., ltd. Tianjin branch

955 19

Manager Cui

58693077

China United Insurance Co., Ltd. Tianjin Branch

95585

Manager Jia

28456228

Taikang life insurance co., ltd. Tianjin branch

95522

Manager feng

27827407

China Ping 'an Property Insurance Co., Ltd. Tianjin Branch

955 1 1

Liu Jingli

588 17574