Tianjin New Medical Insurance Policy 2023

Recently, the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau issued a notice on doing a good job in the basic medical security for urban and rural residents in 2022. This notice shall come into force as of the date of issuance and shall be valid for 5 years. In 2023, the personal payment standard and treatment guarantee level of medical insurance in Tianjin will be improved:

Raise the individual payment standard: In 2023, the individual payment standard of medical insurance for residents in this city will be raised in 30 yuan, specifically, 980 yuan per year for high-level residents and 350 yuan per year for low-level residents. Students and children implement low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.

Consolidate and improve the level of treatment guarantee: from 2023, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic diseases and special diseases) will be raised to 250,000 yuan; The proportion of reimbursement for serious illness insurance for urban and rural residents increased by 5 percentage points; Incorporate the medical expenses borne by individuals within the scope of residents' medical insurance policy into the coverage of residents' serious illness insurance. Employee's serious illness insurance shall be implemented by reference.

First, raise the fund-raising standard reasonably.

(1) Raise the financial subsidy standard. In 2022, the financial subsidy standard for residents' medical insurance in this city will be 6 10 yuan per year for low-grade residents and 0100 yuan per year for high-grade residents; Those who hold a residence permit in Tianjin to participate in medical insurance for residents in this Municipality shall be given financial subsidies according to the same standards for residents in this Municipality. In 2023, the per capita financial subsidy standard for residents' medical insurance in this city will be adjusted according to national requirements.

(2) Improve the individual payment standard. In 2022, the individual payment standard of medical insurance for residents in this city shall be implemented in accordance with the Notice of the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau on Doing a Good Job in Basic Medical Insurance for Urban and Rural Residents in 20021(No.86 issued by Tianjin Medical Insurance Bureau). In 2023, the individual payment standard of medical insurance for residents in this city will be raised in 30 yuan, specifically, 980 yuan per year for high-level residents and 350 yuan per year for low-level residents. Students and children implement low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.

(3) Improve the financing and payment mechanism. Since 2023, the payment mechanism of college students has been adjusted, and all kinds of college freshmen in this city have declared and paid residents' medical insurance premiums on an annual basis; In accordance with the relevant provisions of this Municipality, the elderly in urban and rural areas who receive living allowances voluntarily choose the payment grade to participate in residents' medical insurance, and the system of withholding and remitting living allowances will no longer be implemented; College students who enjoy national student loans in this city shall be determined by the Municipal Education Commission to guide colleges and universities according to regulations, and the financial department shall arrange budget quotas to support residents' medical insurance.

Second, consolidate and improve the level of treatment guarantee.

(a) to consolidate and improve the basic medical insurance benefits. We will fully implement the policy of liberalizing reimbursement for outpatient (emergency) clinics in tertiary hospitals with residents' medical insurance, increase the proportion of reimbursement for outpatient (emergency) clinics in primary and secondary hospitals for high-end paying people, and reduce the increase in the proportion of medical consumables in inpatients and outpatients. Since 2023, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic diseases and special diseases) has been raised to 250,000 yuan. Continue to do a good job in ensuring medication for outpatients with hypertension and diabetes.

(2) Improve the guarantee function of serious illness insurance. From 2023, the reimbursement rate of major illness insurance for urban and rural residents will increase by 5 percentage points; Incorporate the medical expenses borne by individuals within the scope of residents' medical insurance policy into the coverage of residents' serious illness insurance. Employee's serious illness insurance shall be implemented by reference.

(3) Strengthen medical assistance. Some measures to comprehensively implement and improve the medical security and assistance system for serious and serious diseases. Since 2023, there will be no deductible for hospitalization medical assistance for poor people and low-income people, and the proportion of assistance will be 75% and 70% respectively. The minimum living allowance threshold for hospitalization assistance for marginal family members is determined according to 10% of the per capita disposable income of residents in this city published last year, and the assistance ratio is 65%. For the needy people whose personal expenses are still heavy after the triple system guarantee, we should do a good job in connecting temporary assistance with charitable assistance and accurately implement classified assistance.

Third, earnestly grasp the bottom line of people's livelihood security.

Continue to consolidate the achievements of medical security in poverty alleviation and do a good job in connecting with rural revitalization. Further optimize the information exchange and sharing mode between medical insurance and civil affairs departments, and gradually realize the automatic handling of insurance payment and treatment for difficult groups through the system. In accordance with the provisions of the classification for the poor, low-income groups and other difficult groups to participate in the medical insurance for residents. Continue to do a good job in outpatient service, hospitalization and medical assistance for serious diseases, carry out medical assistance according to applications, and improve the efficiency of the use of medical assistance funds.

Fourth,

Promote the unification of institutional norms

Resolutely implement the national and municipal medical insurance diagnosis and treatment catalogue management system, and promote the three-year special action of cleaning up and standardizing. Clean up and standardize the city's accident insurance system, do a good job in policy convergence, and relevant expenses are included in the reimbursement scope of the basic medical insurance system according to regulations. Since 2023, children with autism spectrum disorder's diseases, such as cerebral palsy, tuberculosis and severe mental disorders, can continue to enjoy reimbursement for critical illness insurance and medical assistance according to the current regulations of this Municipality. We will implement the active maternity insurance policy, revise and improve the regulations on maternity insurance for employees, clean up and standardize the maternity insurance system for urban and rural residents, guarantee the medical expenses and maternity allowance for three children, and adjust and improve the reimbursement policy for maternity medical expenses.

Five, strengthen the management of medical insurance payment

Implement the 202 1 version of the national medical insurance drug list, and fully complete the task of cleaning up the self-funded drug varieties. Solidly promote the "dual-channel" management of negotiated drugs, and strengthen the supply guarantee and landing monitoring of negotiated drugs. Improve the management methods of hospital preparations and dynamically adjust the catalogue of hospital preparations. Improve the management of consumables and medical services for traditional Chinese medicine in medical insurance. Deepen the reform of medical insurance payment methods, solidly promote the reform of grouping according to disease diagnosis and paying according to disease points, covering more than 70% of hospitalization medical expenses. Promote outpatient chronic diseases such as diabetes to pay per head. Improve the management of designated medical institutions and the "internet plus" medical service medical insurance payment management policy.

Six, strengthen the centralized procurement and price management of pharmaceutical consumables.

Continue to implement the centralized procurement and use of drugs organized by the state, and accelerate the implementation of the results of centralized procurement of drugs such as insulin organized by the state. Do a good job in the implementation of the seventh batch of centralized procurement of drugs organized by the state and the landing of the selected results of centralized procurement of spinal consumables organized by the state. Actively promote the Beijing-Tianjin-Hebei "3+N" pharmaceutical procurement alliance to centrally purchase drugs and consumables. We will do a good job in implementing the results of centralized procurement of drugs and high-value medical consumables, and implement supporting policies such as direct settlement of medical insurance, coordination of payment standards, and retention of balances. Implement the dynamic adjustment mechanism of medical service price and formulate the medical service price adjustment plan. Organize the compilation of medical price index, and implement the medical price and recruitment credit evaluation system.

Seven, strengthen the supervision and operation analysis of funds.

We will continue to carry out in-depth special rectification actions against fraud and insurance fraud, focus on investigating cases, severely investigate and deal with fraud and insurance fraud cases, resolutely expose typical cases, fully take comprehensive measures such as cost review, agreement handling and administrative punishment, increase the punishment for violations of laws and regulations, and further strengthen the high-pressure strike situation. Give full play to the multi-sector participation in the supervision linkage mechanism, actively carry out information sharing, collaborative law enforcement, implementation convergence and discipline convergence, promote the coordinated use of comprehensive supervision results, and implement joint punishment. Organize the final accounts and budget preparation of the medical insurance fund, strengthen the monitoring of the budget implementation of the medical insurance fund, and do a good job in analyzing the implementation progress. Establish an early warning mechanism for the normal operation of funds. Prepare a report on the risk assessment and early warning mechanism of medical insurance fund operation, strengthen the monitoring of fund operation, and improve the risk early warning, assessment and resolution mechanism through in-depth analysis of important indicators such as participation and fund revenue and expenditure scale, so as to effectively prevent and resolve fund operation risks.

Eight, comprehensively improve the ability of public management services

In accordance with national requirements, comprehensively strengthen the construction of handling service system. Carry out the construction of "standard year" for medical insurance handling, and fully implement the list of government services and operational norms. We will fully implement the interim measures for the transfer and continuation of basic medical insurance relations and continue to do a good job in the transfer and continuation of "inter-provincial generality". Solidly promote the construction of a service demonstration window. Continue to do a good job in the settlement and settlement of medical expenses of patients in COVID-19, vaccines and vaccination expenses in COVID-19. Promote "one thing to protect" and "one thing for newborns". Deepen the direct settlement of medical treatment in different places, continue to expand the scope of designated medical institutions for outpatient settlement in different places, and include some outpatient treatment expenses related to chronic diseases and special diseases into the scope of reimbursement for medical treatment in different places.

Nine, promote standardization and information construction

Improve the unified, efficient, convenient, safe and intelligent medical insurance information platform. We will further promote the standardized application of medical insurance, actively explore scenario applications, and form a linkage effect. Further expand the activation rate and application scenarios of medical insurance electronic certificates and electronic social security cards. Strictly implement information management, network security management and data security management measures to comprehensively strengthen data security protection. Do a good job in the promotion and application of "Tianjin medical insurance" and expand the function of convenient service carrier.

X. Do a good job in organization and implementation

The medical security, finance and taxation departments at all levels in this Municipality should further improve their political position, strengthen their responsibility and compact their work responsibilities. It is necessary to strengthen overall coordination among departments and coordinate the implementation and management of residents' medical insurance benefits. It is necessary to further increase policy propaganda, popularize the concept of mutual assistance and sharing of medical insurance, enhance people's awareness of insurance payment, and reasonably guide social expectations.