Which file does the basic medical insurance for Shenzhen employees belong to?

The basic medical insurance for employees in Shenzhen is divided into three levels: the first level of basic medical care, the second level of basic medical care and the third level of basic medical care, as follows:

1, there are different payment, treatment and adaptation groups in primary medical care, secondary medical care and tertiary medical care;

2. Pay the first basic medical care (unit 6%+ individual 2%)+ local supplementary medical care (unit 0.2%)+ maternity medical care (unit 0.5%), and the payment base is the employee's actual payment salary (minimum 3 13 1 yuan), with a total payment of 272 yuan; The second payment base of basic medical care (unit 0.5%+ individual 0.2%)+ local supplementary medical care (unit 0. 1%)+ maternity medical care (unit 0.2%) is the average monthly salary of employees in the previous year (now 52 18), and the accumulated payment is 52; The third basic medical care (unit 0.4%+ individual 0. 1%)+ local supplementary medical care (unit 0.05%), the payment base is the average monthly salary of employees in the previous year (now 52 18), and the total payment is 29 yuan;

3. For outpatient service, the third-level basic medical care and the second-level basic medical care cost 1000 yuan per year, but they can only be enjoyed if they are bound to a social health hospital. 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 first file of basic medical care does not mean that there is no welfare. It has the following three advantages: continuous insurance for the first level of basic medical care 13 1 yuan, 70% of the excess can be reimbursed, 30% of all social health hospitals can be reimbursed, and 80% of outpatient large-scale equipment inspection can be reimbursed. In terms of hospitalization, the first-class basic medical treatment and the second-class basic medical treatment are 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 to say, if the hospital to see a doctor is not a higher-level hospital, there is no way to be referred to this hospital. Of course, you can go directly to the hospital without a referral form, but the reimbursement rate will drop 10%. For example, under normal circumstances, hospitalization in a tertiary hospital will be reimbursed by 75%. If you don't have a referral form, only about 67.5% will be reimbursed. Therefore, the insured will try to participate in the second file of basic medical insurance.

How to choose the medical level? If there is a unit payment, the deep household insured can only choose the first file of basic medical insurance. If it is an individual payment, he can choose first or second gear. Non-deep households can choose any medical grade, of course, it is best not to choose the third gear; Children's medical insurance and college students' medical insurance participate in the second grade of basic medical insurance; 4. Whether it is a deep household or a non-deep household, as long as you choose the first file or the second file, it is mandatory to pay maternity insurance, and the third file does not include maternity insurance.

To sum up, under normal circumstances, the personal account of the insured person is used to pay the insured person's basic outpatient medical expenses, local supplementary medical expenses, and the expenses of purchasing drugs within the scope of the medical insurance catalogue at designated retail pharmacies with prescriptions issued by doctors in designated medical institutions in the city. The insufficient part of the personal account is paid by the individual.

Legal basis:

Article 2 of People's Republic of China (PRC) Insurance Law

The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.

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This Law is applicable to insurance activities in People's Republic of China (PRC).

Article 5

The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.