How much can Shenzhen medical insurance reimburse

Shenzhen medical insurance reimbursement rate is determined according to local policies and regulations, and the reimbursement rate may vary from region to region.

Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, the basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion of the medical insurance fund to pay for, generally ranging from 70% to 80%;

2, the individual out-of-pocket ratio: the individual out-of-pocket ratio refers to the proportion of the medical expenses that the individual needs to bear, generally ranging from 20% to 30%. The percentage of out-of-pocket expenses is the percentage of medical expenses that the individual has to bear.

Medical insurance reimbursement process:

1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their own treatment items belong to the scope of reimbursement of medical insurance;

2, collection of reimbursement materials: collection of the relevant records of treatment, drug receipts, medical cost lists and other related materials;

3, the social security department for the reimbursement: submit the relevant materials to the local social security department for reimbursement.

4. Waiting for the audit: the social security department will conduct the relevant audit and comparison to confirm the reimbursement rate and reimbursement amount; receiving reimbursement: after the audit is approved, you can receive the reimbursement amount of the medical insurance at the designated bank.

Reimbursement standard of chronic disease medical insurance:

1. The outpatient medical expenses incurred by patients with chronic diseases of category A in compliance with the regulations will be paid by the integrated fund at 85%. The outpatient hemodialysis cost, peritoneal dialysis cost and the cost of taking cyclosporine A after organ transplantation for patients with chronic renal failure in the stage of renal failure will be increased by ten percentage points on the basis of the above;

2. The starting line standard for chronic diseases of category B: 300 yuan. The outpatient medical expenses incurred by patients with Class B chronic diseases in accordance with the regulations shall be paid at 80% of the portion above the starting line standard, and the maximum payment limit for chronic diseases shall not be exceeded in a medical year or within the validity period;

3. Participants can be recognized with two Class B chronic diseases at the same time, and the management of the two diseases shall be based on the first recognized, and the starting line shall be calculated separately for each disease type. The management of the identification of chronic diseases and the maximum payment limit will be adjusted by the human resources and social security department in due course according to the income and expenditure situation of the integrated fund. The criteria, rules and procedures for the identification of chronic diseases will be formulated separately by the municipal human resources and social security administration.

In summary, the reimbursement rate of each regional health insurance are not the same, urban and rural residents living in a different place for a long time, urban and rural residents and urban and rural residents aged 60 years old and 55 years old, and urban and rural residents working in a different place, and students and children living with them, for the record of the registration of medical treatment in a different place, in the registration of the record of the hospitalization of hospitalization in a place of hospitalization start line standard for the first level of hospitals 400 yuan, the second level of 800 yuan, three levels The reimbursement rate is the same as that of the local designated hospital.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical services and facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons 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.