What the landlord said is more difficult to solve! Because the medical insurance policy designed by Tianjin municipal government is unique (relative to the policies of other local governments). Those who participate in medical insurance as individuals and pay medical insurance contributions (note that they are not urban workers) can only reimburse medical expenses for serious diseases (including serious diseases in hospitals and special diseases in outpatient clinics-also weighing diseases) in proportion. The specific explanation is as follows:

1. According to Article 8 of the Provisions on Basic Medical Insurance for Urban Employees in Tianjin, "Employees shall pay the basic medical insurance premium according to 2% of their average monthly salary in the previous year; The employer pays the basic medical insurance premium according to 9% of the sum of the individual contribution bases of employees. "

The payment ratio is 1 1%(2%+9%), and the payment amount is relatively high.

Article 17 stipulates that "social insurance agencies shall establish individual accounts for basic medical insurance for employees and retirees (hereinafter referred to as individual accounts)."

According to the provisions of article eighteenth, "personal accounts are composed of the following parts:

Basic medical insurance premiums paid by individual employees;

The basic medical insurance premium paid by the employer in accordance with the prescribed proportion;

3. Other funds;

4. Interest. "

Therefore, employees' personal medical insurance accounts have funds transferred out every month (social security management center transfers), that is, employees have funds in their social security cards.

According to the provisions of article twenty-ninth, "personal account payment scope includes the following items:

Medical expenses for outpatient (emergency) consultation in designated medical institutions;

(2) the cost of purchasing drugs in designated retail pharmacies;

Medical expenses below the three-level Qifubiaozhun;

(four) the medical expenses that should be borne by the individual are higher than the payment standard and lower than the maximum payment limit;

Medical expenses that should be borne by individuals above the maximum payment limit. "

In other words, employees can use the funds in their social security cards (that is, employees' personal medical insurance accounts) (mainly transferred from medical insurance contributions) to pay for outpatient (emergency) medical expenses or the cost of purchasing medicines at retail pharmacies, and so on.

2. "Basic situation of urban individual insurance in Tianjin"; The Interim Measures for Medical Insurance is a policy specifically for urban flexible employees (including individual industrial and commercial households and freelancers) to participate in basic medical insurance.

According to the provisions of Article 4, "6.3% of the average monthly salary of employees in this city for more than one year shall pay the basic medical insurance premium on a monthly basis. The payment time is before 15 every month. "

The payment ratio is low, only 6.3%, which is lower than the employee's insurance payment!

Article 5 stipulates that "the basic medical insurance premiums paid by individuals shall be co-ordinated by the society and incorporated into the unified management of the basic medical insurance fund."

The basic medical insurance premiums paid by individuals are all included in the social pooling account of medical insurance, and no personal account is set up (that is, no personal account is set up). Of course, there is no fund to be included in the personal account. The social security card in the hands of individuals does not have the function of paying outpatient medical expenses or drug purchase expenses in pharmacies with personal medical insurance accounts (it only has the function of basic pension accounts and the function of reimbursement and settlement of serious medical expenses).

According to the second paragraph of Article 2, "Individuals suffering from special diseases such as hospitalization and outpatient service are covered by the basic medical insurance pooling fund and the large medical expenses relief fund, and shall enjoy corresponding treatment in accordance with the provisions of these Measures."

Therefore, individuals who pay insurance contributions can only enjoy the reimbursement and settlement of serious illness (hospitalization) expenses and the treatment of special outpatient diseases.

3. The "Measures for the Administration of Special Diseases in Outpatient Department of Basic Medical Insurance for Urban Employees in Tianjin" stipulates the types of special diseases in outpatient department-in fact, diseases that are not suitable for long-term hospitalization (and cannot be cured), namely:

Article 2 The term "outpatient special diseases" as mentioned in these Measures refers to (hereinafter referred to as special diseases):

(1) Renal dialysis and anti-rejection therapy after renal transplantation;

Renal dialysis therapy refers to hemodialysis, peritoneal dialysis and colon dialysis to treat acute and chronic renal failure.

Anti-rejection therapy after renal transplantation refers to the necessary treatment to ensure the survival of kidney after renal transplantation.

(2) Radiotherapy, chemotherapy and analgesia for cancer;

The analgesic treatment of cancer refers to the analgesic measures taken to relieve the pain of patients with advanced cancer.

(3) diabetes;

(4) cor pulmonale;

(5) lupus erythematosus;

(6) hemiplegia;

Hemiplegia refers to the motor dysfunction of one limb caused by cerebrovascular diseases (cerebral hemorrhage, subarachnoid hemorrhage and cerebral infarction).

(7) mental illness.

Mental illness, especially schizophrenia, affective disorder and intention control disorder (such as arson). It needs the approval of the chief physician or deputy chief physician of the municipal psychiatric hospital or its recognized hospital (specialist).

Although my explanation may not please the landlord, this is the system. After all, the proportion and amount of personal insurance contributions are low! Of course, medical insurance benefits are also lower!

At present, medical insurance policies are issued by local municipal governments, and there is no unified policy in the province, let alone a unified national medical insurance policy!

There are two suggestions:

Find a unit first and "link" to pay social security. You can participate in employee social security (five insurances), that is, you can enjoy employee medical insurance benefits. However, the cost is relatively high (especially individuals have to bear the insurance contributions for work-related injuries, maternity and unemployment. That unit has to pay, as well as the premiums of employee pension insurance and medical insurance), which is not a small sum, ranging from 400-500 yuan per month (the standards vary from place to place).

Second, we still insist on individual insurance contributions (basic old-age insurance and medical insurance), and "hook" the actual expenses that should be borne by the unit insurance and remittance, or deposit or buy certain commercial insurance, or go directly to the outpatient clinic to see a doctor or buy medicine from a pharmacy to treat minor illnesses. Economically, it is not necessarily uneconomical, especially for young people, which is more beneficial!

The above opinions are for your reference!

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.