Proportion of outpatient medical insurance reimbursement in Shenzhen

First, the hospitalization reimbursement deductible standard is1; Hospitals below the first level 100 yuan; 200 yuan, a secondary hospital; 300 yuan, a tertiary hospital.

Two, a file of insured hospitalization basic medical expenses and local supplementary medical expenses deductible above, according to the following provisions.

(1) If the insured person has received employee pension insurance benefits on a monthly basis in this city and paid the basic medical insurance premium at 1 1.5%, the payment ratio is 95%; (2) If the primary insured pays the basic medical insurance premium at 8%, the payment ratio is 90%;

Three, the unit price of more than 1000 yuan of special medical materials and disposable medical materials, installation or replacement of artificial organs.

(1) 90% of the actual price of domestic materials:

(2) The imported materials shall be paid at 60% of the actual price.

Fourth, the bed fee

The maximum payment limit of the first file of basic medical insurance is the first file of government-guided bed fee for general ward-level rooms and double rooms of non-profit medical institutions determined by the municipal price management department:

Verb (abbreviation for verb) Other benefits

In this city, the insured person who receives the employee pension insurance or pension on a monthly basis and continues to enjoy the first-class treatment of basic medical insurance will receive the medical examination subsidy of 500 yuan from the local supplementary medical insurance fund the following month and pay the medical examination subsidy on a monthly basis according to the following standards, which will be included in the personal account:

1, under 70 years old, 20 yuan every month;

2, more than 70 years old, 40 yuan every month.

(two) the basic medical insurance fund and the local supplementary medical insurance fund set the payment limit. The part of the basic medical expenses paid by the basic medical insurance fund in accordance with the provisions of these Measures that exceeds its payment limit shall be paid by the local supplementary medical insurance fund within its payment limit. The basic medical expenses and local medical expenses incurred by the insured in the designated medical institutions in this Municipality, which exceed the payment limit of the local supplementary medical insurance fund, shall be paid by the local supplementary medical insurance fund by 50%.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.