How to solve the social security problem of migrant workers

One: There are four forms of basic medical insurance in Shenzhen: comprehensive medical insurance, hospitalization medical insurance, migrant workers' medical insurance, children's hospitalization and serious illness outpatient medical insurance.

Two: [migrant workers' hospitalization medical insurance and medical insurance outpatient treatment]

The outpatient (including emergency) expenses incurred by the insured persons of hospitalization medical insurance and migrant workers' medical insurance in the selected community health centers shall be handled in accordance with the following provisions:

(a) Class A drugs and Class B drugs belonging to the basic medical insurance drug list shall be paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively;

(two) belong to the directory of medical items or medical materials, a single price below 120 yuan, paid by the community outpatient co-ordination fund 90%; If the single price exceeds 120 yuan, the community outpatient co-ordination fund will pay 120 yuan;

(III) The outpatient medical expenses incurred by the insured who need to be referred to other designated medical institutions with the approval of the settlement hospital due to illness, or the emergency medical expenses incurred in non-settlement hospitals, shall be reimbursed by the community outpatient co-ordination fund according to the provisions in the first and second paragraphs of this article.

The outpatient medical expenses (including emergency) paid by the community outpatient co-ordination fund within a medical insurance year shall not exceed the maximum of 800 yuan.

Three: [Hospitalization medical expenses accounting]

The maximum bed fee for comprehensive medical insurance and inpatient medical insurance is not more than 50 yuan/day, and the maximum bed fee for migrant workers' medical insurance is not more than 35 yuan/day.

Four: [Proportion of hospitalization payment for basic medical insurance]

The medical expenses incurred by the medical insurance insured for migrant workers who are hospitalized and included in the bookkeeping scope of the basic medical insurance shall be paid by the basic medical insurance serious illness pooling fund according to the hospital level in different proportions. The proportion of first-class hospitals, second-class hospitals, third-class hospitals and hospitals outside the city is 95%, 90%, 80% and 70% respectively, and the rest shall be paid by the insured.

Medical insurance for migrant workers insured for work or business trip, in non settlement hospital emergency hospitalization expenses, according to the provisions of the preceding paragraph, should be reimbursed for 90% of the expenses, conditional medical institutions can implement accounting.

Five: [principle of seeking medical treatment]

Migrant workers' medical insurance outpatient service should be in the selected community health center, or in other designated community health centers under the same settlement hospital as the selected community health center; Emergency rescue can go to the designated medical institutions in the city for medical treatment; Need hospitalization, should be treated in the settlement hospital of the selected community health center; After handling the referral procedures according to the regulations, you can also go to other medical institutions for medical treatment.

Six: [migrant workers' medical insurance referral principle]

If the insured who participates in the medical insurance for migrant workers needs to be referred because of their illness, the original settlement hospital will issue a referral certificate, which can be referred step by step or to a medical institution with a specialist at the same level in this city. The transfer hospital at each level shall issue a referral certificate to the hospital receiving the referral.

VII: [Reimbursement scope of municipal social security institutions]

The medical expenses incurred by the insured for medical treatment, in any of the following circumstances, shall be paid in cash first, and then an application shall be submitted to the municipal social insurance institution with relevant documents and materials, and the municipal social insurance institution shall review and reimburse according to the regulations:

Medical expenses incurred by the insured of migrant workers' medical insurance for emergency rescue in non-settlement hospitals due to going out to work or traveling;

VIII: [Scope of reimbursement to settlement hospital]

Under any of the following circumstances, the outpatient medical expenses incurred by the insured person of inpatient medical insurance and migrant workers' medical insurance for medical treatment shall be paid in cash first, and then an application shall be submitted to the settlement hospital or designated medical institution with relevant documents and materials, and the settlement hospital shall review and reimburse according to regulations:

(1) Outpatient expenses for referral to a non-settlement hospital with the approval of the settlement hospital due to illness;

(2) Outpatient emergency medical expenses incurred in non-settlement hospitals due to business trip or business trip;

(three) medical institutions designated for medical treatment due to the damage of social security card computer failure or unable to keep accounts.

Medical insurance for migrant workers insured by the settlement hospital approved referral to designated medical institutions for hospitalization expenses, in advance of cash, you can rely on the relevant documents and materials to the settlement hospital in accordance with the provisions of the audit and reimbursement.

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