Why do my social security card registration and outpatient service pay me in Longhua New District, Shenzhen?

First of all, Shenzhen medical insurance is divided into three grades, and the payment and treatment of the three grades are different. The specific differences are as follows:

Principle of seeking medical treatment

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

Second-class insured: the outpatient department seeks medical treatment in the binding community health center, the inpatient department seeks medical treatment in any designated medical institution in the city, and the outpatient department seeks medical treatment in a designated hospital institution for serious illness.

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

General outpatient treatment

Class I insured: 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.

Second Insured/Third Insured:

Belong to class A drugs and class B drugs, respectively, by the community outpatient fund according to the proportion of 80% and 60% payment;

90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment amount 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.

Family personal account * * *

A class of insured persons: the accumulated amount of personal accounts exceeds 5% of the average salary of employees in this city in the previous year, and the excess can be purchased in designated pharmacies of over-the-counter drugs within the scope of medical insurance catalogue; When visiting a designated medical institution, you can pay the basic medical expenses and local supplementary medical expenses paid by yourself and your spouse and immediate family members who participate in the basic medical insurance in this Municipality; It can cover the health check-up and vaccination expenses for me, my spouse and immediate family members to participate in the basic medical insurance in this city.

Secondary Insured/Tertiary Insured: None.

Personal account is not enough to pay.

First-class insured person: if the first-class insured person has been insured for one year in a row, and the basic outpatient medical expenses and local supplementary medical expenses paid by individuals in the same medical insurance year exceed 5% of the average salary of employees in this city last year, 70% of the excess will be paid by the basic medical insurance serious illness pooling fund or local supplementary medical insurance fund according to regulations (80% will be paid for those over 70 years old).

Secondary Insured/Tertiary Insured: None.

Outpatient large-scale equipment inspection and treatment costs

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.

Secondary Insured/Tertiary Insured: None.

Medical examination subsidy

First-class insurance: one-time 500 yuan at retirement, 20 yuan per person per month (40 yuan per person at the age of 70).

Secondary Insured/Tertiary Insured: None.

be hospitalized

First-class insured: 95% or 90% of the basic medical expenses incurred in hospitalization and local supplementary medical expenses above the direct payment line shall be paid according to the regulations.

Second Insured/Third 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-class insured/third-class insured: general outpatient expenses will not be reimbursed; In accordance with the provisions of the serious illness outpatient expenses and hospitalization expenses can be reimbursed according to the provisions.

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Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.