How to use tertiary medical insurance in Shenzhen in hospitals?

The medical insurance for employees of enterprises in Shenzhen is divided into three grades: basic medical care level 1, basic medical care level 2 and basic medical care level 3, with different payment, treatment and adaptation groups.

I. Payment

1. Basic medical care (unit 6%+ individual 2%)+ local supplementary medical care (unit 0.2%)+ maternity medical care (unit 0.5%), and the payment base is the actual payment salary of employees (minimum 3 13 1 yuan), with a total payment of 272 yuan;

2. The second payment base of basic medical care (unit 0.5%+ individual 0.2%)+ local supplementary medical care (unit 0. 1%)+ maternity medical care (unit 0.2%) is the average monthly salary of employees in the previous year (now 52 18), and the accumulated payment is 52;

3. The third basic medical care (unit 0.4%+ individual 0. 1%)+ local supplementary medical care (unit 0.05%), the payment base is the average monthly salary of employees in the previous year (now 52 18), and the total payment is 29 yuan;

Two. deal with

1. In terms of outpatient service, there is an annual outpatient fee of 1000 yuan for Grade III and II basic medical care, but it can only be enjoyed if it is bound to a community health hospital. Primary medical service All hospitals can see out-patients, but they all use money from personal accounts. When there is no money in personal accounts, they have to withdraw cash by themselves. To put it bluntly, you paid for all the money. You can report 1000 yuan per year for the second and third grades of basic medical care, which is the money from the overall fund, while the money from the first-level outpatient service of basic medical care is your own money, and only the money from the overall fund can be truly reimbursed. Of course, the first file of basic medical care does not mean that there is no welfare. It has the following three advantages: first, it has been insured continuously for more than 12 months, and the out-of-pocket expenses of outpatient service exceed 3 1 and 3 1 yuan in a medical year, and the excess part can be reimbursed by 70%; Second, it can be reimbursed in all social health hospitals; Third, the number of outpatients is large.

2. In terms of hospitalization, the first-level basic medical treatment and the second-level basic medical treatment are the same, with a unified report of 90%. All designated hospitals in Shenzhen can directly handle hospitalization, and the reimbursement rate is 90%.

Legal basis:

Measures of Shenzhen Municipality on Social Medical Insurance Article 2 This Municipality implements a multi-level and multi-form social medical insurance system. The government establishes basic medical insurance and local supplementary medical insurance. According to the payment and corresponding treatment, the basic medical insurance is divided into one, two and three forms.