In 2023 Tianjin urban and rural residents' medical insurance adjustment!Involved in payment, reimbursement ...

Recently, the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal Human Resources and Social Security Bureau, and the Municipal Taxation Bureau issued a notice on the basic medical security work of urban and rural residents in 2022. This notice will be implemented from the date of issuance and is valid for 5 years. In 2023, Tianjin Medical Insurance Personal Payment Standard and Treatment of Personal Insurance have increased average:

Improve personal payment standards: In 2023, the personal payment standards for residents in this city increased by 30 yuan, which was 980 yuan per person per year and 350 yuan per person per year. Students and children are implemented in accordance with low -end personal payment standards and enjoy high -end payment reimbursement benefits.

Consolidation and improvement treatment level: starting in 2023, the maximum payment limit of residents' medical insurance (excluding outpatient clinics) is increased to 250,000 yuan; ) The medical expenses that individuals burden within the scope of diagnosis policies are included in the scope of the insurance insurance guarantee of residents. Employee Insurance Insurance is implemented with reference.

1. Reasonable improvement of fundraising standards

(1) Improve fiscal subsidy standards. In 2022, the financial subsidy standard of residents in this city is 610 yuan per person per year and 1100 yuan per person per year; those who hold the Tianjin residence permit to participate in the city's residents' medical insurance will provide financial subsidies in accordance with the same standards of the residents of the city. In 2023, the per capita financial subsidy standards of residents' medical insurance are adjusted in accordance with national requirements.

(2) Improve personal payment standards. In 2022, the personal payment standards for the city's residents' medical insurance in accordance with 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 on the Municipal Taxation Bureau of the Municipal Human Resources and Social Affairs Bureau on the Municipal Human Resources and Social Affairs Bureau of the Municipal Human Resources and Social Affairs Bureau on the Basic Medical Guarantee Work of Urban and Rural Residents in 2021" (Jin Medical Insurance Bureau [2021] No. 86) Essence In 2023, the personal payment standards of residents in this city increased by 30 yuan, specifically 980 yuan per person per year and 350 yuan per person per year. Students and children are implemented in accordance with low -end personal payment standards and enjoy high -end payment reimbursement benefits.

(3) Improve the funding payment mechanism. Since 2023, the student payment mechanism of colleges and universities is adjusted, and new enrollment students at all levels of colleges and universities at all levels in the city shall declare and pay residents' medical insurance premiums in accordance with the annual declaration of residents; , No longer implement the deduction system from the living subsidy fee; college students who enjoy national student loans in this city shall be guided by the Municipal Education Commission to identify higher colleges and universities in accordance with regulations, and will arrange budget quotas to participate in residents' medical insurance.

2. Consolidate and improve the level of treatment guarantee

(1) Consolidate and improve basic medical insurance benefits. Comprehensively implement the reimbursement policy for residents' medical insurance (emergency) diagnosis and diagnosis and increase the proportion of diagnosis and reimbursement in the first and second -level hospitals of high -end payment personnel, and reduce the proportion of personal additional payment proportion of hospitalization and outpatient medical consumables. Since 2023, the maximum payment limit of residents' medical insurance (excluding outpatient clinics) has increased to 250,000 yuan. Continue to do a good job in the guarantee of hypertension and diabetic clinics.

(2) Improve the function of major illness insurance. Since 2023, the proportion of reimbursement in each cost of major illness insurance for urban and rural residents has increased by 5 percentage points; medical expenses that have the scope of personal burden on the scope of medical insurance (urgent) diagnosis policies in residents are included in the scope of residents' serious illness insurance. Employee Insurance Insurance is implemented with reference.

(3) Strengthen the guarantee of medical assistance. Several measures to comprehensively implement and improve the medical insurance and rescue system for major diseases. Since 2023, the interested personnel and subsistence allowances are not set up for rescue for hospitalization medical assistance. The rescue ratio is 75%and 70%; The rescue line payment standard is determined by 10%of the per capita disposable income of residents released in the last year, with a rescue ratio of 65%. For people with heavy personal expenses after the triple system guarantee, the connection with temporary assistance, charity assistance, etc., and accurately implement layered classification assistance.

Third, effectively hold the bottom line of the people's livelihood guarantee

Continue to consolidate the results of poverty alleviation for medical security, and do a good job of connecting with rural revitalization. Further optimize the information interaction and sharing method of medical insurance and civil affairs departments, and gradually realize the automatic processing of the insurance payment and treatment of difficult groups in difficulties. In accordance with regulations, groups of difficulties and subsistence allowances to participate in residents' medical insurance. Continue to do medical assistance in outpatient clinics, hospitalization and severe diseases, and carry out medical assistance in accordance with the application of medical assistance to improve the effectiveness of medical assistance funds.

Fourth, promote the unified institutional norms

Resolutely implement the management system for the state and the city's medical insurance treatment list, and promote the special actions of three -year cleanup specifications. Clean up and standardize the city's accident insurance and other systems, and do a good job of policy connection. The relevant expenses are included in the scope of the reimbursement of the basic medical insurance system in accordance with regulations. Since 2023, diseases such as children's loneliness spectrum and cerebral paralysis, tuberculosis, severe mental disorders and other diseases can continue to enjoy reimbursement benefits such as major illness insurance and medical assistance in accordance with the current regulations. Implement the active maternity insurance policy, revise and improve the regulations on maternity insurance for employees, clean up and standardize the urban and rural residents' maternity insurance system, do a good job in the protection of three -child medical expenses and maternity allowances, and adjust and improve the reimbursement policy for maternity medical expenses.

5. Strengthen medical insurance payment management

Implement the 2021 version of the National Medical Insurance Drug Catalog, and complete the task of cleaning the drug varieties by themselves. Promote the management of "dual channels" of negotiating drugs in a solid promotion, and strengthen the protection of negotiating drug supply and landing monitoring. Improve the management measures of hospital preparations and dynamically adjust the in -hospital preparation directory. Improve medical insurance medical consumables and medical service project management. Deepen the reform of medical insurance payment methods, solidly promote the reform of related groups according to the diagnosis of diseases and payment of diseases according to the type of disease, and cover more than 70%of inpatient medical expenses. Promote slow special diseases such as diabetes and other clinics. Improve the management policy of fixed -point pharmaceutical institutions and "Internet+" medical service medical insurance payment management policies. 6. Strengthen the purchasing and price management of centralized bands of drug consumables

Continue to implement the procurement and use of national organizational drugs, and accelerate the implementation of the results of the national organic insulin and other drugs. Do a good job of the seventh batch of centralized procurement and implementation of drugs and the results of national organizational spine consumables. Actively promote the collection of drugs and consumables of Beijing -Tianjin -Hebei "3+N" pharmaceutical procurement alliance. Do a good job in the implementation of the results of medicines and high -value medical consumables, and implement supporting policies such as direct settlement of medical insurance, collaborative payment standards, and balance of retention. Implement the dynamic adjustment mechanism of medical services, and formulate medical service price adjustment plans. Organize the preparation of the pharmaceutical price index to implement the medical price and recruitment credit evaluation system.

7. Strengthen fund supervision and operation analysis

Continue to carry out special rectification actions to combat fraud and fraud insurance, focus on investigating cases, seriously investigate and deal with cases of fraudulent insurance, and resolutely expose typical cases, fully adopt comprehensive measures such as fees review, agreement handling, administrative punishment and other comprehensive measures. Punishment intensity and further strengthen the trend of high pressure. Give full play to the regulatory linkage mechanisms participated in multiple departments, actively carry out information sharing, collaborative law enforcement, execution connection, and discipline connection, promote the coordinated use of comprehensive supervision results, and implement joint punishment. Organize the final accounts and budget preparation of the medical insurance fund, strengthen the supervision of the budget implementation of the medical insurance fund, and do a good job of implementing the progress of implementation. Establish a normalized fund operation early warning mechanism. Prepare the report of the risk assessment and early warning mechanism of the medical insurance fund, strengthen the monitoring of the operation of the fund, and analyze the in -depth analysis of important indicators such as the insurance participation situation and the scale of the fund revenue and expenditure. Essence

8. Comprehensively improve public management service capabilities

In accordance with national requirements, the construction of the service system is comprehensively strengthened. Carry out the construction of the "Normal Year" of the Medical Insurance Office, and comprehensively implement the list of government service services and operation specifications. Comprehensively implement the temporary measures for the transfer of basic medical insurance relations, and continue to do a good job of "cross -provincial generalization". Promote the construction of service demonstration windows for the service. Continue to do medical expenses, new crown vaccines and vaccination costs for new crown pneumonia. Promote the co -organizing "one thing to participate in the insurance" and "the birth of the newborn". Deepen the direct settlement of medical treatment in different places, continue to expand the scope of fixed -point pharmaceutical institutions in outpatient clinics, and incorporate some outpatient clinics -related treatment costs into the scope of the reimbursement of the network of medical network.

Nine, promote standardization and information construction

Improve uniform, efficient, convenient, safe, and intelligent medical insurance information platform. In -depth promotion of the application of medical insurance standardization work, actively explore the application of scenarios, and form a linkage effect. Further expansion of medical insurance electronic vouchers, electronic social security card intensity and application scenarios. Strict implementation of information management, network security management and data security management measures, and comprehensively strengthen data security protection. Do a good job in the promotion and application of "Tianjin Medical Insurance" and expand the function of convenient service carrier.

10. Do a good job of organizing organization

The medical security, finance and tax departments at all levels in this city shall further improve their political standing, strengthen responsibility, and compact work responsibilities. It is necessary to strengthen overall coordination between departments and cooperate with the implementation and management services of residents' medical insurance treatment. It is necessary to further increase policy propaganda, popularize the concepts of mutual assistance to mutual assistance, share responsibilities, co -construction and sharing, enhance the awareness of the masses' insurance payment, and reasonably guide social expectations.

Comprehensive: Tianjin Daily, Tianjin Government Affairs Network, Tianjin Broadcasting

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Review: Wang Shaoyun

Editor: Li Pei

Material arrangement: Hu Yanzhu, Shi Jiaojiao

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