How to reimburse the proportion of comprehensive medical insurance in Shenzhen?

Insurance Bian Xiao helps you answer, and more questions can be answered online.

The medical insurance for employees of enterprises in Shenzhen is divided into three grades: basic medical care level 1, basic medical care level 2 and basic medical care level 3, with different payment, treatment and adaptation groups.

I. Payment

1. Primary medical care level 1 (unit 6%+ individual 2%)+

Local supplementary medical care (unit 0.2%), the payment base is the actual payment salary of employees (the minimum is 3632 yuan), and the total payment is 297.8 yuan;

2. The second basic medical care (unit 0.5%+ individual 0.2%)+ local supplementary medical care (unit 0. 1%), and the payment base is the average monthly salary of employees in the previous year (now 6054), with a total payment of 48.4;

3. The third basic medical care (unit 0.4%+ individual 0. 1%)+ local supplementary medical care (unit 0.05%), and the payment base is the average monthly salary of employees in the previous year (now 6054064), with a total payment of 33.3 yuan;

Two. deal with

1. In terms of outpatient service, tertiary basic medical care and secondary basic medical care cost 1000 yuan per year, but they can only be enjoyed if they are bound to social health hospitals. The first file of basic medical care can be seen in all hospitals, but it is all with money from personal accounts. When there is no money in personal accounts, they have to withdraw cash by themselves. To put it bluntly, you paid for all the money. You can report 1000 yuan per year for the second and third grades of basic medical care, which is the money from the overall fund, while the money from the first-level outpatient service of basic medical care is your own money, and only the money from the overall fund can be truly reimbursed. Of course, the basic medical level does not mean that there are no benefits. It has the following three advantages: First, the insured person 12 months or more, the outpatient expenses exceed 3,632 yuan in a medical year, and the excess part can be reimbursed by 70%; Second, 30% can be reimbursed in all outpatient clinics of social health hospitals; Third, outpatient large-scale equipment inspection can be reimbursed 80%.

2. In terms of hospitalization, the treatment of primary medical care and secondary basic medical care is the same, with a unified report of 90%. All designated hospitals in Shenzhen can directly handle hospitalization, and the reimbursement rate is 90%; According to different levels of hospitals, the proportion of reimbursement for tertiary hospitalization in basic medical care can be 85% in primary hospitals, 80% in secondary hospitals and 75% in tertiary hospitals. The tertiary insured must go to the bound social health hospital before hospitalization, and cannot be hospitalized directly in other hospitals. Only when a referral slip is issued in the bound hospital can they go to a higher-level hospital, that is, if the hospital to see a doctor is not a higher-level hospital, there is no way to refer them to this hospital. Of course, you can go directly to the hospital you want to stay in without a referral form, but the reimbursement rate will drop 10%. For example, under normal circumstances, hospitalization in tertiary hospitals is 75%. If you go without a referral form, you can only reimburse about 67.5%. Therefore, the insured will try to obtain the second level of basic medical insurance;

(If you don't know what grade of medical insurance you are paying, reply to "Social Security Inquiry" after paying attention, and inquire about the short article "How to inquire about medical grade quickly and simply" to teach you how to inquire)

For more social security issues in Shenzhen, you can pay attention to the official account of "Wu Qiubang" WeChat.