Shenzhen social security 3 years can reimburse how much

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Shenzhen social security has a limit

1, outpatient annual limit is 800 yuan, the excess is out-of-pocket expenses.

2, hospitalization limit: the maximum payment limit is 50,000 yuan, 100,000 yuan, 150,000 yuan and 200,000 yuan respectively for those who have been insured continuously for half a year but less than one year, for those who have been insured for one year but less than two years, for those who have been insured for two years but less than three years, and for those who have been insured for three years but less than six years, there is no maximum payment limit for those who have been insured continuously for more than six years. (b) For diagnostic and treatment items or medical materials in the basic medical insurance catalog, 90% of the price of a single item is less than 120 yuan, and 120 yuan of the price of a single item is more than 120 yuan, which will be paid by the community outpatient coordination fund;

(c) Outpatient medical expenses incurred by a participant who has been approved by the billing hospital to be referred to other designated medical institutions due to medical condition, or who has incurred emergency medical expenses in a hospital that does not have billing, will be paid by the community outpatient coordination fund. Emergency medical expenses incurred at a non-settlement hospital shall be reimbursed by the Community Outpatient Coordination Fund at the rate of 90% of the expenses paid in accordance with the provisions of the first and second paragraphs of this Article.

The total amount of outpatient medical expenses (including emergencies) paid by the Community Outpatient Coordination Fund to each inpatient medical insurance participant in a medical insurance year shall not exceed a maximum of RMB 800 yuan.

Article 44

If the inpatient drug expenses incurred by a participant fall within the scope of the drug list of the basic medical insurance, they shall be included in the accounting scope of the Basic Medical Insurance Major Disease Coordination Fund at the rate of 95% for retired persons and 90% for other persons.

The basic medical expenses incurred by the insured for hospitalization, including diagnostic and therapeutic items and general medical materials within the scope of the basic medical insurance catalog, shall be included in the accounting scope of the Basic Medical Insurance Fund for Major Diseases at the rate of 95% for retired persons and 90% for other persons.

When a participant is hospitalized and needs to do the basic medical insurance diagnostic and therapeutic items to use special medical materials, to install or replace artificial organs, or to use disposable medical materials with a unit price of more than 1,000 yuan, 90% of the price of the domestically produced universal type shall be included in the scope of the basic medical insurance major disease co-ordination fund; if there is no domestically produced universal type with a comparable price, 60% of the price of the imported universal type shall be included in the scope of the basic medical insurance major disease co-ordination fund. The basic medical insurance fund for major illnesses is included in the scope of the accounts.

The maximum bed fee for participants of comprehensive medical insurance and hospitalization medical insurance shall not exceed RMB 50 per day, and the maximum bed fee for participants of migrant workers' medical insurance shall not exceed RMB 35 per day.

Article 45

Different starting payment lines for hospitalization are set up according to the different levels of hospitals, with RMB 100 for hospitals of the first level or below in the city, RMB 200 for hospitals of the second level in the city, RMB 300 for hospitals of the third level in the city, and RMB 400 for hospitals not in the city.

The Basic Medical Insurance Fund will not pay for hospitalization medical expenses below the hospitalization threshold that fall within the scope of the accounts of the Basic Medical Insurance Fund.

If a participant is transferred to a different hospital for inpatient treatment, the hospitalization threshold shall be calculated separately.

Article 46

The maximum payment limit of the basic medical insurance co-ordination fund for each medical insurance year is linked to the number of years the insured person has continuously participated in the basic medical insurance. The maximum payment limit is 0.5 times, 1 times, 2 times, 3 times and 4 times of the average salary of the workers on duty in the previous year in the city respectively.

Article 47

Medical expenses incurred by a participant in comprehensive medical insurance or hospitalization medical insurance for hospitalization that are included in the basic medical insurance account, and which are above the hospitalization threshold and below the maximum payment limit of the integrated fund, shall be paid in full by the Basic Medical Insurance Fund for Major Diseases.

Migrant workers' health insurance participants hospitalized in the basic medical insurance accountable medical costs, in the hospitalization of the part of the starting line above the maximum payment limit of the integrated fund, by the basic medical insurance major disease fund according to the level of hospitalization hospitals to pay a different proportion of the proportion of hospitals within the city of the first-class hospitals, hospitals in the second-class hospitals, hospitals in the third-class hospitals, hospitals outside the city of the proportion of the payment of 95%, 90%, 80%, 70%, the remaining portion of the basic medical insurance major disease fund to pay the full amount, 80%, 70%, and the rest is paid by the insured.

Hospitalization expenses incurred by rural migrant workers' health insurance participants who are out of town or on business trips, or in non-settlement hospitals due to emergency rescue, shall be reimbursed at the rate of 90% of the expenses payable according to the standards stipulated in the preceding paragraph, and medical institutions with the necessary conditions may implement book-keeping.

Article 48

Retirees participating in comprehensive medical insurance are entitled to a one-time local supplementary medical insurance retirement subsidy of 500 yuan, and a monthly local supplementary medical insurance subsidy of 20 yuan, which shall be expensed by the Municipal Social Insurance Agency from the local supplementary medical insurance fund and transferred to their personal accounts, and may be used for their own health check-ups.

Article 49

The maximum payment limit of the local supplementary medical insurance fund for each medical insurance year is linked to the time of the participant's continuous participation in the local supplementary medical insurance, and the maximum payment limit is 50,000 yuan, 100,000 yuan and 150,000 yuan for those who have been continuously insured for half a year but less than one year, for those who have been insured for one year but less than two years, for those who have been insured for two years but less than three years, and for those who have been insured for three years but less than six years, respectively, 200,000 yuan, and there is no maximum payment limit for those who have been insured continuously for more than 6 years.

The number of years of participation in local supplementary medical insurance calculated before the implementation of these measures can be calculated continuously.

Shenzhen social medical insurance measures-Shenzhen Social Insurance Fund Administration