Zhongshan social insurance accident reimbursement rate

The basic medical insurance treatment in Zhongshan City includes the basic medical insurance treatment for hospitalization, the reimbursement treatment for outpatient medical expenses for specific diseases and the reimbursement treatment for maternity medical expenses; the supplementary medical insurance treatment includes the treatment for general outpatient treatment (paid by individual medical account), the coordinated treatment for outpatient treatment for special diseases and the supplementary medical treatment for inpatient treatment.

1. If a participant is hospitalized due to illness and incurs medical insurance expenses exceeding the hospitalization threshold standard, if he is hospitalized in a designated hospital of the first or second level (including community health service centers) within the city of Zhongshan, the co-ordinated fund pays 90% and the individual pays 10% out of his own pocket;

2. If he is hospitalized in a designated hospital of the third level within the city, if he is hospitalized for less than 10,000 Yuan (inclusive), the co-ordinated fund pays 80% and the individual pays 20% out of his own pocket. Individuals pay 20% out-of-pocket, and for the part of the medical insurance costs above 10,000 yuan, the coordinating fund pays 85%, and individuals pay 15% out-of-pocket;

3. For those who are hospitalized in designated hospitals outside of the city, the basic medical insurance fund pays 78% of the medical insurance costs below 10,000 yuan (including this amount), and individuals pay 22% out-of-pocket, and for the part of the medical insurance costs above 10,000 yuan, the basic medical insurance fund pays 83%, and individuals pay 17% out-of-pocket. 17%.

4. If a participant who has continuously paid supplementary medical insurance premiums for one year or more is hospitalized due to illness and enjoys the basic medical insurance treatment for inpatient hospitalization (including reimbursement of outpatient medical expenses for specific diseases), 90% of the medical insurance expenses paid by an individual within the social security year exceeding 4,000 yuan in total shall be paid by the Supplementary Medical Insurance Co-ordination Fund.

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