What is the threshold fee for outpatient service?

1. What is the threshold fee for social security clinics?

The Qifubiaozhun for urban and rural residents' medical insurance hospitalization was uniformly adjusted to 500 yuan. The reimbursement rate has increased by 5 percentage points on the basis of last year, and the reimbursement rates for students and children are 80%, 70% and 60% respectively according to the first, second and third-class hospitals; According to the different payment grades and hospital levels, the reimbursement rates of adult residents are: high-grade 80%, middle-grade 75%, low-grade 70%, high-grade 70%, middle-grade 65%, low-grade 60%, high-grade 60%, low-grade 55% and low-grade 50% in tertiary hospitals. Regardless of students, children and adult residents, the maximum payment limit is raised to 6.5438+0.8 million yuan. The threshold fee for medical insurance for urban and rural residents is also 500 yuan. Hospitalization and treatment of portal vein diseases within one year, or two or more portal vein diseases, are combined into a one-time minimum payment, and the maximum payment limit is 6.5438+0.8 million yuan. The reimbursement rate of students and children is different from that of adult residents. Students and children are reimbursed according to the proportion of 65% in first-class hospitals, 60% in second-class hospitals and 55% in third-class hospitals. Adult residents also pay according to different levels and hospital levels, with 65%, 60% and 55% for first-class hospitals, 60%, 55% and 50% for second-class hospitals and 55%, 50% and 45% for third-class hospitals.

2. What is the proportion of medical insurance reimbursement in Tianjin in 2022?

Social security medical reimbursement is divided into two parts.

I: outpatient service (outpatient service fee -800% threshold fee) *50%

2. Hospitalization fee (hospitalization fee -800 or threshold fee 65,438+0,300 or 65,438+0,700) * (85% employed 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.

Tianjin will raise the financing standard of urban and rural medical insurance and improve the corresponding reimbursement treatment. At present, the distribution of new year's goods has begun. By the end of February, citizens can go to the local labor security service center for consultation and payment.