What is the difference between the first, second and third grades of Shenzhen social security?

The importance of medical insurance is self-evident.

For ordinary people,

You can get a large reimbursement for seeing a doctor.

It all depends on the perfect medical insurance welfare policy.

In Shenzhen, the purchase of medical insurance is almost universal participation.

The level of medical insurance is also divided into three levels.

That is, first gear, second gear and third gear.

Many small partners don't know their specific differences.

Today, I will take you to know about it!

Before answering your question, let's be clear.

Social security includes endowment insurance and medical insurance.

Industrial injury insurance, unemployment insurance, maternity insurance

These five risks, among which

Only medical insurance is graded.

The other four risks are not classified.

The difference between the first, second and third grades of social security in Shenzhen

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Different payment standards

Employees who participate in the first medical insurance shall pay 8.2% or 7.2% of the total monthly salary of employees on a monthly basis, including 6.2% or 5.2% by the employer and 2% by the individual.

The second payment base of medical insurance is the average monthly salary of employees in Shenzhen last year, and the payment ratio is 0.8% (basic medical insurance+local supplementary medical insurance), of which the unit payment is 0.6% and the individual payment is 0.2%.

The payment base of the third grade medical insurance is the average monthly salary of employees in Shenzhen last year, and the payment ratio is 0.55% (basic medical insurance+local supplementary medical insurance), of which the unit payment is 0.45% and the individual payment is 0. 1%. In case of third-grade medical insurance, the monthly medical insurance payment is 5 1. 12 yuan, of which the individual payment is 9.3 1 yuan.

Principle of seeking medical treatment

First-class insured: any designated medical institution in this city for medical treatment.

Second-class insured: outpatient service is treated in the bound social health center, hospitalization is treated in any medical institution in the city, and serious illness in outpatient service is treated in the prescribed medical institution.

Third-level insured persons: outpatients seek medical treatment in the bound social rehabilitation center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.

Compensation principle

First-class insured persons: whether they are deep households or non-deep households, they can go to any designated medical institution in the city for outpatient and hospitalization reimbursement.

Second-class insured persons: whether they are deep households or non-deep households, they must go to the bound social health clinic for treatment. If you are hospitalized, you can go to any designated medical institution in the city.

Third-level insured: whether it is outpatient or inpatient, you must go to a bound medical institution.

Want to inquire about social security?

Check in Shenzhen. WeChat official account dialog box

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General outpatient treatment

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A type of insurance: personal account is used to pay the medical expenses within the scope of the insured's general outpatient medical insurance catalogue. Community health center basic medical expenses personal account to pay 70%, the overall fund to pay 30% in accordance with the provisions.

Class II insured/Class III insured: drugs belonging to Class A and Class B shall be paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively.

90% of the personal medical treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment shall not exceed 120 yuan.

The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-and third-level insured in a medical insurance year shall not exceed 1000 yuan.

Personal account family welfare

A class of insured persons: the accumulated amount in personal accounts exceeds 5% of the average salary of employees in this Municipality last year, and the over-the-counter drugs within the scope of medical insurance catalogue can be purchased from designated pharmacies, which can pay the basic medical expenses and local supplementary medical expenses paid by themselves and their spouses and immediate family members who participate in the basic medical insurance in this Municipality, and can also pay their health examination and vaccination expenses.

Secondary Insured/Tertiary Insured: None. You can't swipe your social security card when you go to the drugstore to buy medicine.

Personal account is not enough to pay.

First-class insured person: First-class insured person has been insured continuously for one year, and the average salary of supermarket employees is 5% of the basic outpatient medical expenses and supplementary medical expenses paid by himself in the same medical insurance year, and 70% of the excess is paid by the overall fund according to regulations (80% for those over 70 years old).

Secondary Insured/Tertiary Insured: None.

There is no personal account for secondary and tertiary medical insurance.

So there is no account balance.

You can't go to the drugstore to buy medicine.

The first gear also needs the balance to meet the payment conditions.

You can buy it at the drugstore.

Non-prescription drugs within the scope of medical insurance catalogue

Inspection of large-scale equipment in outpatient department

And the cost of treatment.

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First-class insured: 80% shall be paid by the overall fund as required.

Second-level insured/third-level insured: the highest unit price of general medical treatment items shall not exceed 120 yuan.

Blood transfusion cost in general outpatient department

First-class insured: 90% shall be paid by the overall fund as required.

Second-level insured/third-level insured: 70% shall be paid by the overall fund as required.

Treatment of serious illness in outpatient department

First-class insured/second-class insured/third-class insured: 60%-90% will be paid by the overall fund according to the continuous insurance years.

be hospitalized

First-class insured and second-class insured: 95% or 90% of the basic medical expenses and local supplementary medical expenses above the deductible line shall be paid according to the regulations.

Third-class insured

1, you can be hospitalized in the settlement hospital of the binding social health center, or you can be referred to the prescribed hospital by the settlement hospital. The reimbursement ratio of basic medical expenses and local supplementary medical expenses above the hospitalization deductible line is:

Level I hospital: 85%

Level II hospital: 80%

Tertiary hospitals: 75%

2. If you go to a hospital other than the settlement hospital without referral, you will be paid 90% of the hospitalization payment standard of this hospital (that is, the payment standard in the above 1).

Seek medical treatment outside the city

First-class insured: general outpatient expenses, serious illness outpatient expenses and hospitalization expenses can be reimbursed according to regulations.

Second-level insured/third-level insured: general outpatient expenses will not be reimbursed, and outpatient expenses and hospitalization expenses for serious illness that meet the requirements can be reimbursed according to the regulations.

Medical insurance payment is more flexible.

If the original payment is second or third gear.

Meet certain conditions

You can modify the grade.

If we want to change the level of medical insurance,

What should I do?

Revision of medical insurance grade in Shenzhen

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If it is a deep household employee, the employer must participate in the first-grade medical insurance for it, and the grade cannot be changed.

If it is a non-registered employee, the employer can choose one of the first, second and third grades of medical insurance, and the same company has only one opportunity to change the basic medical insurance grade for its employees every year (usually from July/KLOC-0 to July 20).

If you have entered the household, notify the relevant person in charge of the company and modify the system, without waiting for time to uniformly modify the medical insurance grade. In addition, the change of medical insurance grade for flexible employees is not limited to one file a year (individuals can only pay one or two files of social security).

The conversion of different medical insurance grades does not affect the calculation of accumulated payment years and continuous payment years.