Limit of outpatient reimbursement for first-class medical insurance in Shenzhen

The reimbursement limit for the first-class medical insurance outpatient service in Shenzhen is as follows:

1, the payment limit of basic medical insurance outpatient co-ordination fund is the balance of personal account. If the personal account balance is insufficient, the excess shall be paid by the individual;

2, serious illness insurance outpatient co-ordination fund payment limit for personal account balance, personal account balance is insufficient, the excess is paid by the basic medical insurance outpatient co-ordination fund;

3, the social security card "one card" outpatient fee payment limit for personal account balance and basic medical insurance outpatient co-ordination fund payment limit.

The conditions for medical insurance reimbursement include the following aspects:

1. Payment status: medical insurance participants need to pay medical insurance expenses in full and on time, otherwise the right to enjoy medical insurance reimbursement will be affected;

2. Reimbursement scope: the scope of medical insurance reimbursement includes medical expenses that meet the requirements of the medical insurance catalogue, such as the expenses of drugs, examination, treatment and surgery in the basic medical insurance catalogue. If the medical expenses are not in the medical insurance catalogue, it is generally impossible to enjoy medical insurance reimbursement;

3. Mode of medical treatment: medical insurance participants need to see a doctor in a prescribed medical institution, such as a cooperative hospital and referral according to regulations. If you go to a non-cooperative hospital, the scope of medical insurance reimbursement is limited;

4. Reimbursement proportion: The proportion of medical insurance reimbursement is different, and it is generally reimbursed according to the proportion stipulated in the medical insurance catalogue. Different medical items have different reimbursement rates, for example, the reimbursement rate of drugs may be higher than that of medical expenses;

5. Reimbursement limit: the medical insurance reimbursement limit refers to the upper limit of the medical insurance reimbursement amount that medical insurance participants can enjoy within the specified time. If the limit is exceeded, the excess shall be borne by you at your own expense.

To sum up, the medical insurance policies in different regions will be different, and the specific medical insurance reimbursement conditions shall be subject to local policies and regulations. If you need to know the specific medical insurance reimbursement conditions and procedures, it is recommended that you consult the local social insurance bureau or relevant departments.

Legal basis:

Article 29 of People's Republic of China (PRC) Social Insurance Law

The medical and military expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance carport insurance agency, medical institution and pharmaceutical business unit. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.