Shenzhen medical insurance outpatient deductible line

The deductible line of Shenzhen medical insurance clinic is as follows:

1, hospitals below the first level 100 yuan;

2. 200 yuan, a secondary hospital;

3. 300 yuan, a tertiary hospital. When the insured is referred to different hospitals for hospitalization, the deductible will be calculated separately.

The scope and standard of medical insurance reimbursement:

1, reimbursement ratio: the reimbursement ratio of medical insurance may be different for different types of medical services and drugs;

2. Drug list: Medical insurance usually has a designated drug list, and only drugs in the list can be reimbursed;

3. Designated medical institutions: Medical insurance reimbursement usually needs to be treated in designated designated medical institutions;

4. Annual capping line: medical insurance has the highest reimbursement limit every year, which exceeds the personal responsibility;

5. Special disease policy: For some special diseases, medical insurance may have a special reimbursement policy;

6. reimbursement for medical treatment in different places: the reimbursement process and proportion of medical treatment in different places may be different from that in the local area.

To sum up, the outpatient deductible line of Shenzhen medical insurance varies according to the level of the hospital. The deductible line of hospitals below the first level 100 yuan, the second level hospital in 200 yuan, and the third level hospital in 300 yuan. When the insured is referred to different levels of hospitals for hospitalization, their respective deductible lines will be calculated independently.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Article 30

The following medical expenses are not included in the scope of payment of the basic medical insurance fund: (1) those that should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

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The establishment of the basic medical insurance fund for urban workers, the implementation of individual medical accounts (hereinafter referred to as individual accounts) and basic medical pooling funds (hereinafter referred to as pooling funds) payment system.