It is related to 2023 Tianjin residents' medical insurance treatment, payment, reimbursement ... The latest policy is read!

Recently, the Municipal Education Commission of the Municipal Taxation Bureau of the Municipal Human Resources and Social Security Bureau of the Municipal Medical Insurance Bureau on issuing the "Propaganda Outline of the Basic Medical Insurance of Urban and Rural Residents in 2023", which is clear:

Payment standards: Flexible employees such as urban and rural employment residents and engaging in new employment forms, participating in basic medical insurance for urban and rural residents in the city in 2023, 980 yuan per person for high -end payment personnel, 350 yuan per person per year. Students and children pay at low -end personal payment standards, each person is 350 yuan per year to enjoy high -end payment reimbursement benefits.

Concentrated declaration payment period: In 2023, the concentrated application for medical insurance for the residents of this city is from September to December 2022, and adult residents and students and children who meet the conditions of the insurance. Insurance registration payment procedures.

Residents' Disease Insurance: In one year, insured persons are hospitalized and hospitalized (including special diseases). After the basic medical insurance reimbursement is reimbursed, the medical expenses of the personal burden of more than 300,000 yuan (inclusive) within the scope of the policy are The regulations are included in the scope of insurance insurance for residents' illness. Since 2023, the proportion of reimbursement in each cost of major illness insurance for urban and rural residents has increased by 5 percentage points, and medical expenses that have the medical expenses affordable for personal burden of medical insurance (urgent) diagnosis (urgent) diagnosis policy are included in the scope of residents' serious illness insurance. Employee's illness is implemented with reference.

All district medical insurance bureaus, human and social bureaus, tax bureaus, education bureau, relevant units:

In order to implement the "Notice of the Municipal Human Resources and Social Affairs Bureau of the Municipal Human Resources and Social Affairs Bureau of the Municipal Medical Insurance Bureau and the Municipal Human Resources and Social Security Bureau on the Basic Medical Guarantee Work of Urban and Rural Residents in 2022" (Jin Medical Insurance Bureau [2022] No. 61), do a good job of basic medical care of urban and rural residents in this city Safe in protection, and now print out the "Propaganda Outline of the Basic Medical Insurance in Urban and Rural Residents in 2023". Please do a good job of implementing work in combination with the actual work.

Attachment: "Propaganda Outline of the Basic Medical Insurance of Urban and Rural Residents in 2023"

Municipal Medical Insurance Bureau Municipal Human Resources and Social Affairs Bureau

Municipal Taxation Bureau Municipal Education Commission

September 23, 2022

(This piece is proactive)

Urban and rural residents in 2023

Basic Medical Insurance Propaganda Outline

1. Scope of insurance

(1) Flexible employees such as urban and rural employment and engaging in new employment forms

With the city's household registration or holding the "Tianjin Residence Permit", "Hong Kong and Macao Resident Residence Permit", "Taiwan Resident Residence Permit", "Foreign Residence Card for Foreigners of the People's Republic of China" and other valid certificates.

(2) Student children

1. Students in schools: students in the city, secondary vocational schools, ordinary primary and secondary schools, special education schools, etc.

2. Children of childcare institutions: children in kindergarten, childcare, and nursery;

3. Children and newborns who have not enrolled in school: the city's household registration or holding the "Tianjin Residence Permit", "Hong Kong and Macao Resident Residence Permit", "Taiwan Resident Residence Permit", "Foreigners of the People's Republic of China" Valid documents.

2. Payment standard

(1) Flexible employment personnel such as urban and rural employment residents and engaged in new employment forms, participate in the basic medical insurance (hereinafter referred to as residents' medical insurance) in the city of urban and rural residents in 2023. Persons who choose high -end payment per person per year Each person is 350 yuan per year.

(2) Students and children pay in accordance with the low -end personal payment standards, each person is 350 yuan per person to enjoy high -end payment reimbursement benefits.

(3) Supreme and orphans who have no fixed income of special difficulties, some preferential treatment objects, and retired cadres who have no fixed income. Participate in the personal payment part of the residents' medical insurance in 2023 at a percentage of 100%, and individuals do not need to pay fees.

(4) Family members of the minimum living security objects, minimum living security margins, and other severe disabled (referring to severe disabled people who have not enjoyed the city's special persons, the minimum living security objects, and minimum living security edge family members) (hereinafter collectively referred to as "Other severely disabled people"), enjoying difficult people such as national student loan colleges and universities, etc., participated in the medical insurance of residents in 2023, and funded at a rate of 90%. The remaining 10%cost was paid by individuals, which were 35 yuan per person per year. Other people with severe disabled choose to participate in the medical insurance for more than a higher payment grade, and the personal payment part will no longer enjoy a fixed funding policy.

3. Registration payment

(1) Concentrated application for payment period

In 2023, the concentrated application for medical insurance for residents from this city is from September to December 2022. Adult residents and students and children who meet the conditions of insurance participation will hold valid documents and related materials to the designated place for the registration and payment procedures for the 2023 resident medical insurance insurance.

(2) Category registration

1. Students and child care institutions in schools are based on their schools or child care institutions, and go to the District Social Security Center to apply for insurance registration. Students who apply for national student loans will still be registered with centralized insurance participation in school organizations. Each school should respond to special personnel in the school, do a good job of verification and information comparison, and do a good job of dynamic management of insurance participation in accordance with regulations.

2. Students and children who leave school or childcare institutions due to dropping out and dropout, and can go to the integrated service agency of the street (town) comprehensive service agency to apply for insurance registration. Among them, those under the age of eighteen continue to apply for insurance registration as students, and those who are eighteen years old shall be registered in accordance with adult residents.

3. From the date of birth, the newborn can go to the local street (town) comprehensive service agency to complete the insurance registration procedures within one year. Newborns who are in line with the scope of reform of the "newborn birth" in this city shall go through the relevant provisions and processes in accordance with the relevant provisions and procedures in accordance with the "newborn birth". 4. Rural residents, take the administrative village as the unit, go to the village street (town) comprehensive service agency to apply for insurance registration.

5. Flexible employees such as other unable to employment and engaging in new employment forms, hold their valid documents to the place where the household registration is located or frequently residential street (town) comprehensive service agencies to apply for insurance registration.

6. Persons who stay in the elderly welfare institutes, children's welfare institutes, social welfare institutes and other welfare institutions shall go to the District Social Security Sub -Center to apply for insurance registration.

7. The target of the city's medical assistance (minimum living security objects, special personnel, minimum living security marginal family members, etc.), some preferential care objects, other severe disabled persons, spouses without fixed income of retired cadres are citizenship, respectively The Municipal Retired Military Bureau, the Municipal Disabled Persons' Federation, and the Municipal Party Committee's veteran cadre management departments are responsible for providing relevant information to the Municipal Medical Insurance Center. The time limit of the above -mentioned personnel will be registered for concentrated and uniform insurance registration after identifying the identity of each competent department. The guarantee shall be fulfilled at the end of December, and the basic medical insurance treatment shall be enjoyed according to the natural annual year.

8. Due to the termination of the labor contract with the employer to terminate or terminate the labor insurance payment personnel (hereinafter referred to as: interrupt employee medical insurance personnel): within three months after the termination of the labor contract or receiving the unemployment deposit, it can be valid. Certificate to the place where the household registration is located or frequently residential street (town) comprehensive service agencies shall apply for insurance registration, and during the centralized application payment period, the tax department will continue to apply for the basic medical insurance insurance for urban and rural residents in the city in the next year.

(3) Declaration and payment

1. Schools, child care institutions, welfare institutions and other units, after applying for insurance registration in the District Social Security Center, apply to the tax department for the social insurance premium system (hereinafter referred to as the agency system), and then determine the payment level of the payment according to the residents' insurance information information. The amount of the payment of the payment is selected within the prescribed time limit.

2. Flexible employees such as rural residents, other unblocked residents and engaging in new employment forms to the street (town) comprehensive service agency to apply for insurance registration, and the street (town) comprehensive service agency will pass the agency system according to the information of the residents. Determine the payment grade, approve the amount of payment, and print the "Payment Notice of Social Insurance Charges of the Tianjin Taxation Bureau of the State Administration of Taxation" (hereinafter referred to as the "Payment Notice").

If the rural residents who apply for rural residents on behalf of the administrative village, the street (town) comprehensive service agency will apply for insurance registration for rural residents, according to the information of the residents' insured, through the agency of the system, determine the payment level, approve the amount of payment, and choose within the prescribed time limit. The bank's inquiry payment vouchers pay the payment method.

3. Difficulties such as the minimum living security objects, minimum living security marginal family members, and other heavy disabled persons, etc., after the municipal medical insurance center is uniformly registered for insurance participation, they can print the "Payment Notice" to the integrated service agency of the street (town). And choose to pay a one -time payment fee for the taxation department to agree to the commercial bank outlets, the tax service office, or through the mobile APP, the online tax bureau, and the POS credit card.

4. Enjoy the uniform generation of national school -aid colleges and universities from the school and go to the social security agency in the area under the jurisdiction. Pay the payment at one time.

5. Since 2023, new students at all levels of colleges and universities at all levels in the city have participated in residents 'medical insurance, canceled the medical premium mechanism for residents' medical premiums in the school year, and adopted the annual application to pay resident's medical insurance premiums.

6. In accordance with the "Implementation Measures for the Basic Pension Insurance of Urban and Rural Residents in Tianjin" (Jin Zhengfa [2014] No. 19), the elderly who received the urban and rural subsidies for living subsidies should voluntarily choose to participate in the medical insurance of the residents voluntarily. Then implement the medical insurance premiums that individuals should pay from their life subsidies.

7. Payment method: All the paymenters should choose to pay the tax department to agree to the commercial bank outlets, pay the tax service hall, or pay through the mobile app, the online tax bureau, and the POS credit card within one time within the prescribed time limit.

(1) Bank counter payment: Payments hold the "Bank Inquiry Payment Volume" or "Payment Notice" to the agreement to pay the counter at the agreement commercial bank outlet. Agreement Commercial Bank includes: Bank of China, Agricultural Bank, Industrial and Commercial Bank of China, Construction Bank, Tianjin Bank, Postal Savings Bank, Everbright Bank, Rural Commercial Bank, China Merchants Bank, CITIC Bank, Bank of Communications, Binhai Rural Commercial Bank, Bohai Bank, Industrial Bank, Industrial Bank , Pudong Development Bank, Minsheng Bank, Qilu Bank.

(2) Tianjin Tax Mobile APP payment: Paye can log in to the website of the State Administration of Taxation Tianjin Electronic Taxation Bureau, or use the "Payment Notice" to scan the QR code with the mobile phone, download the "Tianjin Tax" mobile phone app, and then via Tianjin through Tianjin Tax mobile app self -service payment.

(3) Payment of Electronic Taxation Bureau: Payments can log in to the website of the State Administration of Taxation, Tianjin Electronic Taxation Bureau website, and use natural person login to pay for them.

(4) WeChat and Alipay payment: Payments through WeChat and Alipay APP resident medical insurance payment modules, or to scan the two -dimensional codes of residents' medical insurance, self -service payment. (5) Payment of tax service departments: The payment person goes to the tax service office, swipe the card and scan the code through cash or use a smart POS machine.

(6) UnionPay payment: Payeers' self -service payment of resident medical insurance payment modules through the UnionPay APP.

(4) Information change

1. Change of insured information: If information involving names and citizen ID numbers such as citizenship cards, insured persons shall go to the city (district) social security agency or the local street (town) comprehensive service agency In charge of the taxation service department of the Taxation Bureau to handle information change.

2. Change of other information: If the person who has handled the payment and settlement involves changes in information such as the address, the local street (town), etc., you shall hold your valid document to the District Social Security Society Center where you will have valid documents shall go through the change procedures. If you apply for insurance registration in the street (town) comprehensive service agency, you shall submit to the district social security division center through the street (town) integrated service agency to go through the procedures for changing the relevant materials; Street (towns) comprehensive service agencies or district social security points centers go through the change procedures.

(5) Rebate treatment

Those who have handled the payment settlement and meet the relevant provisions of the surrender, and those who have not yet entered the resident medical insurance treatment period can be applied for the tax service hall of the tax bureau to the tax bureau or through the Tianjin Electronic Taxation Bureau, the Tianjin Tax Mobile App Social Security Personal prepaid refund function shall be handled for refund procedures, and relevant departments will be refunded according to the procedures.

Insured persons who have entered the period of residents' medical insurance treatment period do not go through the refund procedures. Students who have obtained a national student loan within one year of enrollment can apply for refund procedures within the year of obtaining a student loan. For those who refund the fees due to death, the time limit for the application is that before December 31st, the annual insurance year, it will not be accepted after the deadline.

Fourth, insurance payment and treatment enjoyment

(1) Those who participated in the insurance payment period during the centralized application of residents 'medical insurance for the centralized application of residents' medical insurance in accordance with regulations, the treatment period is from January 1 to December 31, 2023. Participants participating in the city's residents 'medical insurance can enjoy relevant treatment such as residents' serious illness insurance for free, and individuals do not need to pay for additional fees.

(2) For new entrusted students who have not participated in the year -on -school entrusted students who have not participated in the year of residents 'medical insurance, in the 2023 centralized application payment period, if the school and childcare institutions shall apply for the 2023 residents' medical insurance for medical insurance, On December 31st, the residents' medical insurance treatment was enjoyed, and from January 1st to December 31st the following year, they enjoyed the medical insurance treatment of 2023.

(3) If the newborn will apply for the insurance payment procedures within four months from the date of birth, it will enjoy the medical insurance treatment of the year from the date of birth; If the insurance payment procedures, enjoy the medical insurance benefits of the year from the next day. The newborn was born from September to December 2022, and who has completed the insurance payment procedures for 2023. From the date of birth to December 31, the medical insurance treatment of residents was enjoyed. Enjoy the medical insurance benefits of 2023 on the 31st.

(4) Those who fail to handle the registration and payment procedures of the 2023 residents 'medical insurance for medical insurance in the centralized application of the city's residents' medical insurance shall be completed at any time in 2023.

1. Continuous participants who have participated in basic medical insurance for 2 years or more (excluding supplementary payment) and the interrupted payment will re -participate in the city's residents' medical insurance within 3 months. For a month, set up a 6 -month treatment to enjoy the waiting period. The medical insurance expenses incurred during the waiting period will not be reimbursed;

2. Participants who have participated in the basic medical insurance for 2 years or more (excluding supplement) and the interrupted payment will be re -participated in the city's employee medical insurance within 3 months. In the waiting period for 6 months of treatment, the medical expenses incurred during the waiting period, the medical insurance of employees will not be reimbursed.

3. Insured persons who have not continued to participate in basic medical insurance for 2 years or more (excluding repayment) participating in the medical insurance of residents in the city, set up a 6 -month treatment to enjoy the waiting period. It

(5) Residents' major illness insurance treatment period The basic medical insurance for residents.

5. Treatment standards

(1) Basic medical insurance for residents

The insured person signed a contract with the family doctor of the grassroots medical institution. From the second month of the signing of the contract, the personal outpatient medical insurance quota increased by 200 yuan, and the payment percentage increased by five percentage points. Specific measures are implemented in accordance with the current policy of residents' medical insurance.

(2) Residents' serious illness insurance

During one year, insured persons are hospitalized and hospitalized (including special diseases from outpatient clinics). After reimbursement of basic medical insurance, medical expenses of personal burden of more than 300,000 yuan (inclusive) within the scope of the policy will be included in the residents' illness in accordance with regulations. Insurance payment scope. Since 2023, the proportion of reimbursement in each cost of major illness insurance for urban and rural residents has increased by 5 percentage points, and medical expenses that have the medical expenses affordable for personal burden of medical insurance (urgent) diagnosis (urgent) diagnosis policy are included in the scope of residents' serious illness insurance. Employee's illness is implemented with reference.

2023 Standards for Diseases of Residents

Payment line: According to 50%of the per capita disposable income of residents in the previous year. Medical rescue targets residents' illness insurance starting line reduces 50%on the basis of ordinary people, and the reimbursement ratio increases by 5 percentage points to cancel the top line. (3) Medical assistance

Since 2023, medical assistance objects have enjoyed medical assistance treatment in accordance with the following standards.

1. Outpatient rescue: Medical rescue targets occur in the medical insurance category, diagnosis and treatment items, medical service facilities standards, and emergency, rescue and other reimbursement scope of medical insurance for outpatient medical institutions. Basic medical insurance The personal burden part is given to outpatient assistance according to the prescribed proportion and limit. The rescue standard is: 50%of the individual self -payment within the scope of the policy, no payment standards, the maximum rescue limit is 1,000 yuan, and other rescue objects are 400 yuan.

2. Rescue (including specific diseases) rescue: medical rescue targets in the cities in this city's medical rescue medical institutions (including specific diseases with outpatient diseases) in this city, which occurred during the treatment of basic medical insurance drugs, diagnostic and treatment project directory, and medical service facilities directory during the treatment of medical assistance The cost, within the policy scope of basic medical insurance and major illness insurance reimbursement, will be given inpatient assistance according to the prescribed proportion. The rescue standard is: the special poverty and the subsistence allowance of the inpatient medical assistance of the subsistence allowances does not set up a line of payment, and the rescue ratio is 75%and 70%, respectively. 10%of the control income is determined, and the rescue ratio is 65%.

3. Medical assistance for major diseases: For medical insurance, such medical insurance, major illness insurance, and inpatient medical assistance, personal hospitalization medical expenses and other medical assistance objects are still heavy. It is 50%and the maximum rescue limit is 200,000 yuan.

6. Payment reimbursement

(1) Resident medical insurance and major illness insurance

Pay medical expenses incurred by insured persons, and the medical insurance of residents and major illness insurance are declared together.

1. Acceptance review: Pay medical expenses incurred by the insured by the administrative village, family and specialized households, and report to the community workstation or street (town) comprehensive service agency with relevant materials. After the street (town) comprehensive service agency was accepted, it was entered into the resident medical insurance payment system and uploaded it in a timely manner and transferred the application materials to the district medical insurance center (or resident medical insurance service center). If you fail to declare in time, you can refer to the relevant provisions of the employee's medical insurance paid reimbursement.

Insured persons with schools, child care and welfare institutions, and the cost of padding for medical care, shall be declared by me or the school to apply for relevant materials to the area (or resident medical insurance service center) in the area where they are located. The District Medical Insurance Branch Center (or resident medical insurance service center) shall timely enter the residential medical insurance payment system and complete the cost upload work.

When the students who left the school or the child who leaving school or childcare institutions due to the exile, the expiration of the academic period, and the post -employment period, they were reimbursed, the city's household registration was responsible for the complex service agency of the street (town) of the city; The District Medical Insurance Sub -Center is responsible for the reimbursement procedures in accordance with the reimbursement process.

2. Cost payment: In principle, medical insurance reimbursement medical expenses are implemented in principle. The bank of the Municipal Medical Insurance Center and the Municipal Medical Insurance Settlement Center regularly transfer the amount of payment to the active personal social security card account through the banks paid by the agency. Insured persons who have not received the social security card have not received the social security card, when applying for the application for medical expenses for the first time, they should go to the local street (town) comprehensive service institution or the district medical security score center to complete the settlement account.

(2) Resident maternity insurance

1. Registration: After pregnancy, the insured person should go to the residential place or household registration street (town) family planning management department to apply for maternity service registration in time; insured persons who have performed maternity registration shall go to a designated medical institution at the grass -roots level Registration. If you cannot handle it for some reason, you can go to the integrated service agency or district medical insurance center of the street (town).

2. Acceptance review and payment: Insured persons should report to the integrated service agency of the street (town) comprehensive service agency in this city due to special reasons for special reasons. Resident maternity insurance is paid in accordance with the prescribed standards. If the insured person is hospitalized during the hospitalization period, the cost of this hospitalization will be paid in accordance with the inpatient registration annual urban and rural residents' maternity insurance benefits.

In accordance with the requirements of the state and our city's treatment list system, we will clean up and standardize the maternity insurance system in a timely manner, properly do a good job of policy connection, and the maternity medical expenses of residents are included in the basic medical insurance. Specific measures shall be formulated.

Seven, medical treatment in different places

(1) Scope of personnel

In accordance with regulations, long -term residents who participated in the medical insurance of urban and rural residents and temporarily temporarily went out for medical treatment for inter -provincial residents could apply for direct settlement for cross -provincial medical treatment.

1. Long -term residents of inter -provincial and different places: mainly refers to participants who have worked in different places and live in different places, including retirees, long -term residents, and resident staff in other places. Essence

2. Cross -provincial temporary medical treatment personnel: mainly refer to the referral of medical treatment in different places. Due to work, tourism and other reasons, the emergency rescuers of different places and other inter -provincial temporary medical treatment members in accordance with the policy regulations.

(2) Medical for medical treatment in different places

Before cross -provincial medical treatment, the insured passed the “National Medical Insurance Service Platform”, “Jin Medical Insurance”, and “Jinxin Office” and other APP self -service opening of different places for medical treatment directly. Provincial medical treatment procedures. (3) Reimbursement treatment

Cross -provincial medical expenses directly settled in hospitals, general outpatient and outpatient medical expenses, in principle implement the scope of payment specified in the medical place and relevant regulations (basic medical insurance drugs, medical service items, medical consumables and other payment scope), implement participation participation) The relevant policies such as starting standards, payment ratios, maximum payment limit, and outpatient slow disease scope of basic medical insurance funds stipulated in the preservation ground are. Cross -provincial medical expenses for reimbursement of medical cushions and reimbursement are implemented to implement the scope of payment and relevant regulations of the city.

(4) Medical settlement

Cross -provincial medical personnel can enjoy a variety of guarantees such as residents 'basic medical insurance, residents' serious illness insurance, and urban and rural medical assistance, and implement "one -stop" services and "one -order" settlement. If it cannot be settled directly due to special circumstances, it is necessary to return to the entrance agencies of the insurance place with relevant materials to reimburse in accordance with the city's payment scope and relevant regulations. Students and children pay for medical expenses during the period of living (or returning to their homogeneous) with their parents, and are implemented with reference.

(5) Mente registration

Those who have a medical person in different places have specific diseases in outpatient clinics, and they will go to the city's medical institution for appraisal and go through the procedures for registration of the city's medical institutions in accordance with regulations. It can also be approved by the highest -level medical institutions selected in different places, and rely on the diagnosis certificate and related examination results to go to the city's medical insurance agency.

(6) Other circumstances

During a treatment period, if the insured patients are hospitalized for more than two times in the designated medical institution, they will no longer collect the payment standards from the second hospitalization treatment.

After the "Outline of the Propaganda of the Basic Medical Insurance of Urban and Rural Residents in 2023", if the policy adjustment is encountered, it is implemented in accordance with the latest valid policies.

Source: Tianjin Government Affairs Network

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Review: Wang Shaoyun

Editor: Li Pei

Material arrangement: Hu Yanzhu, Shi Jiaojiao

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