Shenzhen medical insurance scheme

Shenzhen medical insurance scheme is as follows:

1, Shenzhen city hospitalization reimbursement rate of about 80%, you can directly use the social security card settlement; outside the city of shenzhen hospital hospitalization reimbursement rate of 60%-75%, you need to advance before reimbursement;

2, outside the city of shenzhen non-shenzhen hospitalization, reimbursement rate of 60% of the two or three grades, the three grades of 45%-55%, you need to self-fund before reimbursement. Need to pay out-of-pocket before reimbursement;

3, social security payment suspension and then renewed will affect the health insurance, maternity, unemployment insurance treatment; units to pay for health insurance need to wait for the first of the next month, individuals need to wait for 3 months to pay to enjoy the health insurance treatment;

4, comprehensive health insurance or inpatient hospitalization health insurance after transferring to the hospital for the record reimbursement rate of up to 90%, without a record of a drop of 20%.

Types and characteristics of medical insurance:

1, basic medical insurance: to provide basic medical services and protection for employees and residents, divided into employees' health insurance and residents' health insurance;

2, major medical insurance: for patients with major diseases to provide compensation for the high cost of medical expenses;

3, medical assistance: for the difficult groups to provide assistance for the cost of medical care, to alleviate their

4. Commercial medical insurance: provided by commercial insurance companies and voluntarily purchased by individuals or organizations to provide more diversified medical insurance services;

5. Civil servants' medical subsidies: a system of subsidies for civil servants' medical expenses, enjoying a certain degree of preferential medical treatment.

In summary, Shenzhen's medical insurance system provides up to 80% reimbursement of hospitalization expenses for designated hospitals within the city, while the reimbursement rate for designated hospitals outside the city is slightly lower, and the reimbursement rate for non-designated hospitals is further reduced; interruption of social security payments may affect a number of insurance benefits, and the resumption of enjoyment of health care treatment has a certain waiting period; and through the comprehensive health insurance or hospitalization health insurance transfer filing, reimbursement can be significantly increased, but without filing will face a certain degree of medical treatment preferential treatment. The reimbursement rate can be significantly increased by filing with the Comprehensive Medical Insurance or Hospitalization Medical Insurance Transfer, but failure to file will risk a decrease in the reimbursement rate.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 23

Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employer and the employees in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.

Article 27

Individuals who have participated in the basic medical insurance for employees, and whose accumulated contributions have reached the number of years stipulated by the State by the time they reach the legal retirement age, shall no longer pay the basic medical insurance premiums after their retirement, and shall be entitled to the basic medical insurance benefits in accordance with the State's regulations; if they have not yet reached the number of years stipulated by the State, they may make contributions up to the number of years stipulated by the State.

Article 28

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and salvages, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.

Article 30

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund: (1) those that should be paid from the workers' compensation insurance fund; (2) those that should be borne by a third person; (3) those that should be borne by the public ****health; and (4) those that seek medical treatment outside China. If the medical expenses should be borne by a third person in accordance with the law, and the third person does not pay or the third person cannot be identified, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund pays first, it has the right to recover from the third party.