Tianjin urban and rural residents in 2023 medical insurance payment standard

Latest news

Recently, the Tianjin Municipal Health Insurance Bureau, the Municipal Human Resources and Social Security Bureau, the Municipal Taxation Bureau, the Municipal Education Commission issued the "2023 Urban and Rural Residents' Basic Medical Insurance Publicity Syllabus", which involves the scope of the urban and rural residents of the basic medical insurance in the year of 2023, the standard of payment, reimbursement treatment and so on, which is closely related to each and every one of them.

Scope of insurance

(a) urban and rural residents who are not employed, engaged in new forms of employment and other flexible employment with the city's household registration or hold a "Tianjin Residence Permit", "Hong Kong and Macao Residents Residence Permit", "Taiwan Residents Residence Permit", "People's Republic of China *** and the country of foreigners permanent resident identity card" and other valid documents.

(B) students and children

1. school students: the city's higher education, secondary vocational schools, primary and secondary schools, special education schools and other full-time school students;

2. child care institutions: the city's kindergartens, nursery schools, nursery school children;

3. not enrolled in the nursery and newborns: the city's household registration or hold "Tianjin Residence Permit", "Hong Kong and Macao Residents Residence Permit", "Taiwan Residents Residence Permit", "Chinese People's *** and foreigners permanent residence ID card" and other valid documents. Hong Kong and Macao Residents Residence Permit", "Taiwan Residents Residence Permit", "People's Republic of China *** and foreigners permanent residence ID card" and other valid documents.

Contribution standards

(a) urban and rural residents who are not employed, engaged in new forms of employment and other flexible employment, to participate in the city's urban and rural residents in the year 2023 basic medical insurance (hereinafter referred to as the residents of the medical insurance), choose to pay the high level of contribution of 980 yuan per person per year, and those who choose to pay the low level of contribution of 350 yuan per person per year.

(b) Students and children pay 350 RMB per person per year in accordance with the low-tier individual contribution standard, and enjoy reimbursement for the high-tier contribution.

(c) Special hardship cases, some of the beneficiaries, spouses of retired cadres with no fixed income and orphans, to participate in the 2023 residents of the medical insurance individual contribution part of the proportion of 100% fully subsidized, individuals do not need to pay the cost.

(d) the city's minimum subsistence guarantee recipients, minimum subsistence guarantee marginal family members, other severely disabled (refers to the city's special hardship cases, minimum subsistence guarantee recipients, minimum subsistence guarantee marginal family members of the treatment of severely disabled) (hereinafter collectively referred to as "other severely disabled"), enjoying the national student loans For people with difficulties, such as students in higher education, participating in the 2023 Resident's Medical Insurance will be subsidized at a fixed rate of 90%, and the remaining 10% of the cost will be paid by the individual, which will be 35 yuan per person per year. Other persons with severe disabilities who choose to participate in residential health insurance at a higher level of contribution, the individual contribution part no longer enjoys the fixed subsidy participation policy.

III

Registration and payment

(a) Centralized declaration and payment period

2023 residents of the city health insurance centralized declaration and payment period for the period of September to December 2022, eligible for participation in the adult residents and students and children, with valid documents and related materials to the designated location for the 2023 residents of health insurance registration and payment procedures.

(2) Classified registration

1. School students and children in childcare institutions will register at their district social security sub-centers on the basis of their schools or childcare institutions. Students applying for state student loans are still registered centrally by their schools. Schools should be the school of special personnel, do a good job of identity verification, information matching work, according to the provisions of the dynamic management of insurance.

2. Students and children who have left school or child care institutions due to withdrawal, dropout and other reasons, can go to their respective streets (towns) integrated service organizations for registration. Among them, those under the age of 18 continue to register as students, and those who have reached the age of 18 register as adult residents.

3. Newborns can register at their local street (town) comprehensive service organization at any time within one year from the date of birth. Newborns who are eligible for the city's "newborn birth" one thing reform scope of application, should be in accordance with the "newborn birth" one thing of the relevant provisions and procedures for registration procedures.

4. Rural residents, the administrative village as a unit, to the village of the street (town) comprehensive service organization for registration.

5. Other unemployed residents and engaged in new forms of employment and other flexible employment, with their own valid documents to the domicile or habitual residence of the street (town) integrated service organizations for registration.

6. People living in old-age welfare homes, children's welfare homes, social welfare homes and other welfare institutions, welfare institutions as a unit, to the district social security sub-centers for registration.

7. The city's medical aid recipients (minimum subsistence guarantee recipients, special hardship case, minimum subsistence guarantee marginal family members, etc.), some of the beneficiaries, other persons with severe disabilities, spouses of retired cadres with no fixed income, etc., respectively, by the Municipal Bureau of Civil Affairs, the Municipal Bureau of Veterans, the Municipal Federation of the Disabled, the Municipal Party Committee of the old cadres management is responsible for the Municipal Health Insurance Center to provide relevant information by the Municipal Health Insurance Center for the unified The Municipal Medical Insurance Center will be responsible for the unified registration of the participants. The time limit for the above people to participate in the insurance, by the competent authorities to identify the identity of the centralized unified registration, the end of December to realize the insurance should be insured, and enjoy the basic medical insurance treatment according to the natural year.

8. Due to the termination or termination of the labor contract with the employer to interrupt the employee health insurance contributions (hereinafter referred to as: interruption of employee health insurance): in the termination, termination of the labor contract or unemployment benefits within three months of the expiration of the period, can hold their own valid documents to the domicile of the location or habitual residence of the streets (towns) integrated service institutions for registration, and can be in the centralized declaration of the period of payment of contributions to the tax department to continue to apply for the next year of urban and rural residents of the city. The city's urban and rural residents to apply for the next year to participate in the basic medical insurance premiums.

1. Schools, child care institutions, welfare institutions and other units, after registration in the district social security sub-centers, apply to the tax department for social insurance premium system (hereinafter referred to as the system), and then based on the residents of the insurance information, to determine the level of payment, approved the amount of contributions, within the prescribed time limit, choose to authorize (entrusted) to transfer the payment of contributions to the agreement or the bank end of the query to pay the fees. The payment is made in a lump sum by means of a voucher.

2. After the rural residents, other unemployed residents and flexibly employed persons engaged in new employment patterns go to the street (town) comprehensive service organization for registration, the street (town) comprehensive service organization will determine the contribution level, approve the amount of contribution, and print the "Notice of Payment of Social Insurance Premiums by Tianjin Municipal Tax Bureau of the State Administration of Taxation" (hereinafter referred to as "Notice of Payment of Social Insurance Premiums") on the basis of the information of the residents' participation in the insurance policy through the agency system. The first is the "Purchase of the goods", which is the first step in the process.)

In order to declare contributions on behalf of rural residents in the administrative village, the street (town) comprehensive service agency for rural residents to register for insurance, based on the residents to participate in the information, through the agency system, to determine the level of contributions, approved the amount of contributions, in the prescribed time limit, choose the bank to query the payment voucher payment method to pay the fees.

3. Minimum subsistence guarantee recipients, marginal family members of the minimum subsistence guarantee, other persons with severe disabilities and other persons in difficulty, unified by the Municipal Health Insurance Center for registration, the nearest to the street (town) integrated service institutions to print the "Payment Notice", and choose to the tax department agreement commercial bank outlets, tax service halls, or through the cell phone APP, the online tax bureau, the POS swipe card one-time payment. The fee will be paid in one go through the mobile phone APP, online tax bureau and POS card.

4. The students of the institutions enjoying national student loans are collected by the schools on behalf of the schools, and after registering with the social security agencies under their jurisdiction, the institutions at all levels will choose to authorize the (entrusted) transfer of the payment agreement to pay the fees or to pay the fees by querying the payment vouchers at the bank side to pay the fees in one go.

5. Starting from 2023, newly enrolled students at all levels and in all types of institutions in the city to participate in the residents' health insurance, abolish the mechanism of single payment of residents' health insurance premiums according to the academic year, and adopt the annual declaration of payment of residents' health insurance premiums.

6. In accordance with the "Tianjin Urban and Rural Residents' Basic Pension Insurance Implementation Measures" (Jin Zheng Fa [2014] No. 19), urban and rural elderly people who are receiving living allowances should voluntarily choose to participate in the residents' health insurance premiums from 2023 onwards, and no longer implement the practice of withholding from the living allowances the residents' health insurance premiums that should be paid by the individual.

7. Payment method: All contributors should choose to pay the fees at the commercial bank outlets of the tax department agreement, tax service halls, or pay the fees in one go through the cell phone APP, the online tax bureau, and the POS swipe card within the stipulated time limit.

(1) bank counter payment: the payer with the "bank end inquiry payment voucher" or "payment notice", to the agreement of commercial bank outlets counter payment. Agreement commercial banks include: Bank of China, Agricultural Bank of China, Industrial and Commercial Bank of China, Construction Bank of China, Bank of Tianjin, China Post Bank, Everbright Bank, Agricultural and Commercial Bank of China, China Merchants Bank, China CITIC Bank, Bank of Communications, Binhai Agricultural and Commercial Bank, Bohai Bank, Industrial Bank, Pudong Development Bank, Minsheng Bank, Qilu Bank.

(2) Tianjin tax mobile APP payment: the payer can log on to the website of Tianjin Electronic Taxation Bureau of the State Administration of Taxation, or through the Payment Notice, scan the QR code with your cell phone, download and register the "Tianjin Tax" mobile APP, and then pay the fee through the Tianjin Tax mobile APP.

(3) Electronic Taxation Bureau: The payer can log in to the website of Tianjin Electronic Taxation Bureau of the State Administration of Taxation, and pay the fee through the natural person's login.

(4) WeChat and Alipay Payment: Payers can pay by themselves through WeChat and Alipay APP's Resident Medical Insurance Payment Module or by scanning the QR code of Resident Medical Insurance Cloud Payment.

(5) Payment at the tax office: Payers go to the tax office and pay by cash or by using smart POS machines to swipe or scan the code.

(6) UnionPay Payment: The payer pays through the self-help payment module of the UnionPay APP for residents' medical insurance.

(D) information changes

1. Participation in information changes: involving changes in name, ID number and other information, participants should be in the city (district) social security agencies or their respective streets (towns) comprehensive service agencies for change procedures, to the competent tax bureau tax service hall for information changes.

2. Other changes in information: has been for the settlement of contributions related to the address of the person belonging to the street (town) and other changes in information, should hold my valid documents to the registration of social security district social security sub-centers for change procedures. In the street (town) integrated service institutions for registration, should be through the street (town) integrated service institutions to the district social security sub-centers to send the relevant materials for change procedures; did not pay the settlement of personnel, can be held with their own valid documents directly in the street (town) integrated service institutions or district social security sub-centers for change procedures.

(E) refund processing

has been for the settlement of contributions, in line with the relevant provisions of the refund, has not yet entered the residents of the medical insurance entitlement period of the insured person, with their own application to the competent tax bureau of the tax service hall or through the Tianjin e-Taxation Bureau, Tianjin Taxation Mobile APP social security premiums individual prepaid refund function for the refund formalities, and by the relevant departments in accordance with the procedures of the refund payment.

Participants who have already entered the period of enjoyment of the residents' medical insurance benefits will not be subject to refund procedures. Students who received a national student loan within one year of enrollment can apply for a refund in the year they received the student loan. For those who have died, the time limit for filing a refund is December 31 of the year of participation, and no application will be accepted after that date.

Participation and enjoyment of benefits

(a) All the provisions of the 2023 residents in the centralized declaration of contributions in 2023 to participate in the payment period, enjoyment of benefits for the period from January 1, 2023 to December 31st. Participants in the city's residents health insurance, residents can enjoy free major medical insurance and other related benefits, individuals do not have to pay additional fees.

(2) did not participate in the current year's residents of the medical insurance of the new enrollment into the nursery students and children, in the 2023 annual centralized declaration and payment period, the school, child care institutions as a unit for the 2023 year of the city's residents of the medical insurance premiums, September 1, that year, to enjoy the current year's residents of the medical insurance treatment on December 31, January 1, the next year, to enjoy the next year, to enjoy the 2023 year of the residents of the medical insurance treatment on December 31,.

(C) newborns from the date of birth of four months (including) for the current year's enrollment and payment procedures, from the date of birth to enjoy the current year's residents of medical insurance treatment; from the date of birth of four months after the current year's enrollment and payment procedures, from the next day after the payment to enjoy the current year's residents of medical insurance treatment. Newborns born between September and December 2022, and for the 2023 annual insurance payment procedures, from the date of birth to December 31 to enjoy the current year's residents of medical insurance treatment, the following year from January 1 to December 31 to enjoy the 2023 annual residents of medical insurance treatment.

(4) Those who have not registered and paid for the 2023 Resident Medical Insurance during the centralized declaration and payment period for the city's Resident Medical Insurance can apply for the current year's Resident Medical Insurance at any time during the 2023 period.

1. Participants who have continuously participated in basic medical insurance for 2 years or more (excluding retroactive payment) and rejoin the current year's residents' medical insurance within 3 months of the interruption of payment will be entitled to treatment from the day following the date of participation and payment, and for those who have participated for more than 3 months, a 6-month waiting period for entitlement to treatment will be set up, and medical expenses incurred during the waiting period will not be reimbursed by the residents' medical insurance. and above (excluding retroactive payment) and interruption of payment within three months to rejoin the city's employee health insurance participants, from the month of enrollment and payment to enjoy the benefits, more than three months, set a six-month waiting period to enjoy the benefits, the waiting period for the medical costs incurred during the period of reimbursement of the employee health insurance.

3. Not continuously participate in the basic medical insurance for 2 years and more (excluding retroactive payment) to participate in the city's residents of the medical insurance participants, set up a six-month waiting period to enjoy the treatment, waiting period during the medical expenses incurred, residents of the medical insurance will not be reimbursed;

(e) residents of the major medical insurance treatment period with the residents of the basic medical insurance.

Treatment Standards

(a) Resident Basic Medical Insurance

Participants contracted with the family doctor of their primary medical institutions, from the month following the contract, the individual outpatient medical insurance amount increased by 200 yuan, the payment ratio increased by five percentage points. Specific measures in accordance with the current policy implementation of the residents' health insurance.

(B) residents of major medical insurance

In a year, the insured person is sick and hospitalized (including outpatient special diseases), in the basic medical insurance reimbursement, the policy scope of the individual's burden of medical expenses above the starting line, 300,000 yuan (including) the following medical expenses, in accordance with the provisions of the residents of major medical insurance coverage. Starting from 2023, the reimbursement ratio of urban and rural residents' major disease insurance for each cost section will be increased by 5 percentage points, and the medical expenses borne by individuals within the policy scope of outpatient (emergency) consultation under residents' medical insurance will be included in the coverage of residents' major disease insurance. The employee's major illness reference implementation.

2023 annual residents of major medical treatment standards

Starting line: in accordance with the previous year's per capita disposable income of 50% of the residents to determine. Medical aid recipients of residents of major medical insurance starting line in the general population on the basis of a 50% reduction in reimbursement rates increased by 5 percentage points, the abolition of the ceiling line.

Since 2023, medical assistance recipients enjoy medical assistance in accordance with the following standards.

1. Outpatient assistance: medical assistance objects in the medical assistance designated medical institutions outpatient medical costs in line with the basic medical insurance drug list, diagnostic and treatment items, standards of medical services and facilities, as well as emergency, rescue and other reimbursement within the scope of the medical costs of the basic medical insurance reimbursement in accordance with the provisions of the individual's share of the burden, according to the prescribed ratio and limit to give outpatient assistance. Relief standard: the policy scope of the individual out-of-pocket part of the relief of 50%, do not set a starting standard, the maximum limit of relief for the special hardship case 1000 yuan, the other aid recipients 400 yuan.

2. Hospitalization (including outpatient specific diseases) assistance: medical assistance in the city medical assistance designated medical institutions hospitalization (including outpatient specific diseases) during the treatment of medical expenses incurred in accordance with the basic medical insurance drug list, diagnostic and therapeutic item list and medical service facilities directory of medical expenses in the basic medical insurance, major medical insurance reimbursement of the individual within the scope of the policy part of the burden, in accordance with the prescribed proportion of hospitalization assistance. Relief standards are: special hardship cases, low-income recipients of hospitalization medical assistance does not set a starting line, the proportion of assistance, respectively, 75%, 70%; low-income marginal family members hospitalization assistance starting line standard in accordance with the previous year's release of the city's per capita disposable income of 10% of the determination of the proportion of assistance is 65%.

3. Medical assistance for serious illnesses: the basic health insurance, major medical insurance and hospitalization medical assistance and other payment of individual hospitalization medical expenses are still a heavy burden on the medical assistance recipients, the implementation of medical assistance for serious illnesses, the starting standard of 10,000 yuan, the proportion of assistance for 50%, the maximum limit of 200,000 yuan of assistance.

Six

Advance reimbursement

(a) residents of the medical insurance and major medical insurance

Participants in the medical expenses incurred advances, residents of the medical insurance and major medical insurance together to declare.

1. Acceptance of the audit: administrative villages, families and households as a unit of the insured persons incurred advances in medical expenses, with the relevant materials to the community workstations or streets (towns) to declare the integrated service organizations. Street (town) integrated service agencies accept, enter the residents' health insurance payment system, timely upload and transfer the declaration materials to the district health insurance sub-centers (or residents' health insurance service centers). If you do not declare in time, you can refer to the relevant provisions of the employee health insurance advance reimbursement.

If a participant in a school, childcare or welfare institution incurs advance payment of medical expenses, the participant or the school should go to the regional health insurance sub-center (or the residents' health insurance service center) to make a declaration with the relevant materials. District health insurance sub-centers (or residents' health insurance service centers) should be entered into the residents' health insurance payment system in a timely manner, and complete the uploading of costs, the city health insurance center, the city clearinghouse should be completed in a timely manner, the transfer of money to pay for the work.

For reasons such as withdrawal, dropout, completion of studies without employment and other reasons to leave the school or child care institutions, students and children have to advance medical expenses reimbursement, the city domicile by the affiliated streets (towns) are responsible for the integrated services; non-city domicile by the affiliated district health insurance sub-centers are responsible for the unified process in accordance with the advance reimbursement reimbursement procedure for reimbursement procedures.

2. Expense payment: health insurance reimbursement of medical expenses in principle, the implementation of socialized distribution. Municipal health insurance center, the city health insurance settlement center through the agent of the payment of the bank will regularly review the amount of payment transferred to the activated personal social security card account. For the time being not receive social security card participants, in the first time for the advance payment of medical expenses declaration procedures, should be located in the street (town) comprehensive service agencies or district health insurance sub-center for settlement account opening procedures.

(B) residents of maternity insurance

1. Registration: the insured person is pregnant, should promptly go to the residence or domicile of the street (town) family planning management department for maternity services registration; has been registered for maternity participants should be to the grass-roots fixed-point medical institutions network for maternity insurance treatment registration. For some reason can not be networked, you can belong to the street (town) comprehensive service agencies or district health insurance sub-center.

2. Acceptance of the audit and payment: the insured person in the city for special reasons did not brush the card medical expenses incurred in accordance with the provisions of the individual advance payment of medical expenses, should be declared to their respective streets (towns) comprehensive service agencies, the health insurance agency audit, by the urban and rural residents maternity insurance in accordance with the prescribed standards. Participants hospitalization period across the insurance year, the hospitalization costs incurred in accordance with the hospitalization registration insurance year urban and rural residents maternity insurance treatment payment.

In accordance with the requirements of the state and the city's treatment list system, in due course to clean up and standardize the residents of the maternity insurance system, and properly do a good job of policy convergence, the residents of the maternity health care costs into the basic health care insurance. Specific measures to be formulated separately.

VII

management of foreign medical

(a) the scope of personnel

according to the provisions of the urban and rural residents to participate in the medical insurance of the cross-provincial long-term residents and cross-provincial temporary out of the medical personnel, you can apply for the cross-provincial direct settlement of medical treatment.

1. Long-term residents across provinces: mainly refers to participants who work and live in a different place for a long time, including retirees resettled in a different place, long-term residents in a different place, permanent staff in a different place and other people who work, live and live in a different place for a long time.