Hospitalization Reimbursement Ratio for Non-Shenzhen Households

I. Starting line standard for hospitalization reimbursement

1. Hospitals below Grade 1: RMB 100

2. Grade 2 hospitals: RMB 200

3. Grade 3 hospitals: RMB 300

2. Part of the basic medical expenses and local supplemental medical expenses incurred by the first-grade participants for hospitalization that are above the starting line shall be paid according to the following provisions

①. participants have been in the city to receive monthly employee pension insurance benefits and pay 11.5% of the basic medical insurance premiums, the payment rate of 95%;

② basic medical insurance for the second tranche of participants who are not in the city to receive monthly employee pension insurance benefits, the payment rate of 90%;

three, special medical materials and unit price of more than 1,000 yuan of disposable medical materials, installation or replacement of artificial organs

① belonging to the domestic materials, according to the actual price of 90% payment;

② belonging to the imported materials, according to the actual price of 60% payment.

Four, bed charges

Basic medical insurance second-class maximum payment amount for the city price management department to determine the non-profit medical institutions in the general ward A room double room bed charges of the government guide price of the first class;

Five, other concessions

Basic medical insurance fund and the local supplementary medical insurance fund to set a limit of payment. The basic medical insurance fund in accordance with the provisions of the basic medical expenses paid over its payment limit, the local supplementary medical insurance fund within its payment limit.

The part of the basic medical expenses and local supplementary medical expenses incurred by the insured person hospitalized in the designated medical institutions in the city that exceeds the payment limit of the local supplementary medical insurance fund shall be paid by the local supplementary medical insurance fund by 50%.

VI, out of town

①have been referred to, for the record: no higher than the city's medical fees to be reimbursed, belonging to the individual account to pay the outpatient medical expenses, deducted from the individual account

② not referral, for the record

Shenzhen city outside the designated medical institutions: 90%; Shenzhen city outside the designated medical institutions: 70%

Shenzhen social security card includes health insurance, of course, provided that the unit to you to participate in health insurance, health insurance card is what we usually say social security card. As we participate in different forms of health insurance, the use of social security to see the doctor is not the same. Most of the non-deep households participate in migrant workers' medical insurance or hospitalization insurance, deep households are required to participate in comprehensive medical insurance, there are some non-deep households to participate in comprehensive medical insurance.

Migrant workers' health insurance (also called: cooperative medical care, laborers' medical care), in the bound social health center to see the outpatient general illnesses can be swiped, some of the costs are not in the scope of social security can not be swiped, to their own cash.

Hospitalization insurance, in the bound social welfare center to see the outpatient can also swipe the card, the use of the same method as described above. Migrant workers' health insurance or hospitalization insurance, outpatient swipe card, not deduct the money in the social security card (no personal account), but with the outpatient fund.

Comprehensive medical insurance to see outpatient general illness, is to swipe the card, with the money on their own account (comprehensive health insurance is a personal account), if the money in the health insurance personal account is exhausted, you can only own cash. Except for outpatient major illnesses, you can only use social security to keep track of your account and pay little or no money out of your own pocket. These major illnesses are regulated, now Shenzhen regulations 17 kinds of major outpatient diseases can use social security to see, and to see in the social security designated hospitals to see. So it's better to get sick less often, good health is the greatest wealth.

Then again, hospitalization, hospitalization can use social security, the reimbursement rate of several kinds of health insurance is somewhat different, but the difference is not very big. Hospitalization, some of the money is not spent on their own personal accounts, as long as in the hospitalization of the starting line above the maximum payment limit of the integrated fund below the part of the basic medical insurance major illnesses by the integrated fund to pay the full amount. The hospital will keep the account first, and then the hospital will settle with the social security bureau.

Legal basis

Shenzhen Measures for Social Medical Insurance

Article 47 Individual account of a participant of the first class of basic medical insurance shall be used to pay for the participant's outpatient basic medical expenses, local supplementary medical expenses, and expenses for drugs within the scope of the medical insurance catalogue purchased at designated retail pharmacies on the basis of a prescription issued by a doctor of a designated medical institution within the city of Shenzhen. The individual account is used to pay for the outpatient basic medical expenses, local supplementary medical expenses, and the expenses for purchasing medicines within the medical insurance catalog at designated retail pharmacies with a prescription issued by a doctor at a designated medical institution in the city.

If a participant of the first class of basic medical insurance has been continuously insured for one year, and the outpatient basic medical expenses and local supplementary medical expenses paid by the individual in the same medical insurance year exceed 5% of the average salary of the on-the-job workers in the previous year in the city, the part of the excess shall be paid by the basic medical insurance fund for major illnesses or the local supplementary medical insurance fund in accordance with the regulations, and 80% shall be paid by the participant who has reached the age of 70 years. 80%.

Participants enjoying the treatment provided for in the preceding paragraph are not entitled to the treatment provided for in Article 49.

Participants enjoying the treatments stipulated in Articles 50, 51, 52 and 53 of these Measures shall not enjoy the treatments stipulated in the second paragraph of this Article.