1, clinic. Qifubiaozhun is divided into 800 yuan, 700 yuan and 650 yuan according to the working and retired personnel. The reimbursement rate is 75% in a first-class hospital, 65% in a second-class hospital and 55% in a third-class hospital, with a minimum threshold of 5,500 yuan (inclusive). For the part exceeding 5,500 yuan, the unified reimbursement ratio is 55%.

2, specific disease outpatient service (such as chronic diseases). Qifubiaozhun is 1300 yuan, which is combined with the Qifubiaozhun for the first hospitalization or family bed. The reimbursement rate of less than 654.38+200,000 yuan is 85%, and the reimbursement rate of more than 654.38+200,000 yuan is 80%.

3. Hospitalization. Qifubiaozhun varies according to the level of medical institutions and whether it is the first hospitalization. The first-level hospital is 800 yuan, the second-level hospital 1 100 yuan, and the third-level hospital 1700 yuan. The reimbursement rate of less than 654.38+200,000 yuan is 85%, and the reimbursement rate of more than 654.38+200,000 yuan is 80%.

4. critical illness insurance. The reimbursement ratio varies according to the part that the compliance medical expenses (including outpatient emergency, outpatient special diseases and hospitalization) borne by individuals exceed the deductible line of serious illness insurance. The threshold is determined according to 50% of the per capita disposable income of residents in the previous year, and the annual maximum payment limit is 300,000 yuan. The minimum deductible is 654.38+ 10,000 yuan to 200,000 yuan, and the reimbursement ratio is 70%. For the part of 200,000 yuan to 300,000 yuan, the reimbursement ratio is 75%.

In 2024, the diagnostic capping line of medical insurance outpatient (emergency) in Tianjin was raised to 1 10,000 yuan, and the proportion of partial reimbursement was unified at 55%.

Proportion of medical insurance reimbursement:

1, outpatient and emergency medical expenses: the medical expenses of the employees in line with the basic medical insurance coverage in the year totaled more than 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual. Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3, the insured should be properly kept in the designated hospital outpatient medical documents, as a medical expense reimbursement certificate.

4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing.

To sum up, the employer shall register the basic medical insurance for its employees according to law. When an enterprise registers, it shall register the basic medical insurance simultaneously. Other employing units shall apply for registration of basic medical insurance within 30 days from the date of establishment. Flexible employees who participate in the basic medical insurance for employees shall register for the basic medical insurance by themselves. The basic medical insurance for urban and rural residents shall be classified and registered, and the specific measures shall be formulated by the municipal medical security administrative department jointly with relevant departments.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.