Proportion of hospitalization reimbursement in Shenzhen123rd file

Shenzhen123rd file hospitalization reimbursement ratio:

1. Hospitalization: 95% or 90% of expenses above the deductible can be reimbursed for hospitalization with Class I and II medical insurance. Third-level medical insurance insured, we can be hospitalized in the binding social health center settlement hospital, or referred to the prescribed hospital through the settlement hospital. The expenses incurred here that exceed the hospitalization deductible line can be reimbursed, and the reimbursement ratio is like this. 85% will be reimbursed for staying in a first-class hospital, 80% for staying in a second-class hospital and 75% for staying in a third-class hospital. If you are hospitalized directly in a hospital other than the settlement hospital without referral, you will be reimbursed according to 90% of the hospitalization payment standard of the hospital.

2. Treatment of medical treatment outside the city: If it is first-class medical insurance, the expenses of general outpatient service, serious illness outpatient service and hospitalization can be reimbursed according to regulations, and the expenses of general outpatient service, serious illness outpatient service and hospitalization can be reimbursed by first-class medical care. If you are a second-class or third-class medical insurance, then the general outpatient service outside the city cannot be reimbursed, and the outpatient and hospitalization expenses that meet the requirements can be reimbursed.

The difference between the first, second and third medical insurance in Shenzhen;

1, the first grade of medical insurance: individual 2%+ unit 6%+ local supplementary medical care 0.2% (unit pays) = 8.2%; The unit payment base is the actual payment salary of employees (the minimum is 6972 yuan), and the total payment is 57 1.7 yuan; Deep households pay for the first file, and the current minimum payment base is 4648 yuan; For non-deep-seated flexible employees, the minimum payment base of the same unit is 6972 yuan; According to the current policy, the first-class medical insurance is 5% in personal account before the age of 45, 5.6% in retirement after the age of 45 and 8.05% in retirement.

2. The second stage of medical insurance: individual 0.2%+ unit 0.5%+0.65438+ local supplementary medical care 0% (unit pays) = 0.8%; The payment base is the average monthly salary of employees in the previous year, and now it is 1 1620, with a total payment of 92.96 yuan; There is no personal account for the second-class medical insurance.

3. The third grade of medical insurance: individual 0. 1%+ unit 0.4%+ local supplementary medical care 0.05% (unit pays) = 0.55%; The payment base is the average monthly salary of employees in the previous year, which is now 1 1620, and the total payment is 63.95438+0 yuan; There is no personal account for tertiary medical insurance.

The insured person of basic medical insurance enjoys medical insurance benefits according to the following provisions:

1. The first-class insured of basic medical insurance goes to the selected community health center and the community health of the same settlement hospital for medical treatment; Hospitalization and outpatient illness in the city designated medical institutions for medical treatment;

2, the basic medical insurance second insured in the selected community health center outpatient medical treatment, with the consent of the settlement hospital, can be in the same settlement hospital with the selected community health center under the other designated community health center outpatient medical treatment; Hospitalization and outpatient illness in the city designated medical institutions for medical treatment;

3, the basic medical insurance third insured in the selected community health center outpatient medical treatment, with the consent of the settlement hospital, can be in the same settlement hospital as the selected community health center in another designated community health center outpatient medical treatment; Outpatient serious illness in the city designated medical institutions for medical treatment; Be hospitalized in the settlement hospital of the selected social rehabilitation center.

To sum up: If you are the second-and third-level insured of the basic medical insurance, you must go to the social health center in time or you will not see the clinic!

Legal basis:

Measures of Shenzhen Municipality on Social Medical Insurance

Article 7

The employing unit shall participate in the first basic medical insurance for its registered employees in this city, and choose one of the first, second and third basic medical insurance for its non-registered employees in this city.