Proportion of hospitalization reimbursement for second-class medical insurance in Shenzhen

The proportion of hospitalization reimbursement for Class II medical insurance in Shenzhen is as follows:

The proportion of hospitalization reimbursement for second-class medical insurance in Shenzhen is mainly hospitalization expenses, and the annual reimbursement amount for outpatient service is 1000 yuan. The reimbursement rate of hospitalization expenses is generally between 70% and 80%. When going through the hospitalization formalities, the patient needs to show his social security card and fill in the relevant information, and the hospital will directly deduct the reimbursable expenses when leaving the hospital for settlement. According to the Measures of Shenzhen Municipality on Social Medical Insurance, the second-class medical insurance participants should seek medical treatment in the selected social health centers, and those who need hospitalization or outpatient treatment for serious illness should seek medical treatment in the designated medical institutions in the city. In addition, if urban residents are hospitalized for more than two times in a settlement year, the minimum qifubiaozhun fee will no longer be charged from the second hospitalization. Transfer or hospitalization for more than two times, need to make up the Qifubiaozhun difference according to the provisions.

Interpretation of medical insurance policy;

1. Basic medical insurance system: introduce the composition, coverage and coverage of basic medical insurance in Shenzhen;

2. Reimbursement process: explain the specific process of hospitalization reimbursement, including the steps of reimbursement application, data submission and review;

3. Reimbursement standard: summarize the reimbursement ratio, capping line and deductible line of different grades of medical insurance;

4. Designated medical institutions: list the designated medical institutions in Shenzhen and their special provisions related to reimbursement;

5. reimbursement for medical treatment in different places: explain the reimbursement policies and procedures for medical treatment in non-designated medical institutions or in different places.

To sum up, the reimbursement rate of hospitalization medical expenses provided by Shenzhen Class II medical insurance for the insured is roughly 70%-80%, and the annual outpatient reimbursement amount is limited to 1 000 yuan. There are specific medical regulations and policies to make up for the difference between the Qifubiaozhun and reduce the risk of poverty caused by illness of urban residents.

Legal basis:

Measures of Shenzhen Municipality on Social Medical Insurance

Article 32

The insured persons of basic medical insurance enjoy medical insurance benefits according to the following provisions: (1) The insured persons of Class I of basic medical insurance are treated in designated medical institutions in this Municipality. (2) The secondary insured of basic medical insurance shall seek medical treatment in the selected community health center, and with the consent of the settlement hospital, they may seek medical treatment in other designated community health centers under the same settlement hospital as the selected community health center; Hospitalization and outpatient serious illness in the city designated medical institutions for medical treatment. (3) The third-level insured of basic medical insurance shall seek medical treatment in the selected community health center, and with the consent of the settlement hospital, they may seek medical treatment in other designated community health centers under the same settlement hospital as the selected community health center; Outpatient serious illness in the city designated medical institutions for medical treatment; Be hospitalized in the settlement hospital of the selected social rehabilitation center. (four) other medical conditions that meet the requirements of these measures.