Scope and proportion of social security reimbursement in Dongguan

The scope and proportion of hospitalization reimbursement for social security in Dongguan are:

First, the proportion of reimbursement for medical treatment:

1, designated community health service institutions: 70%;

2. Non-selected designated community health service institutions: no payment.

Second, the proportion of referral reimbursement:

1, town/street designated community health service center: 70%;

2. Outpatient department of township/street designated hospitals or designated specialized hospitals: 50%;

3. Outpatient department of the third-level designated hospital in the city: 35%;

4. Other medical institutions: no payment.

Third, emergencies:

Go directly to the town/street designated community health service center outside the service hours of designated community health service institutions: 70%.

Reimbursement scope: hospitalization expenses incurred by insured persons in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by individuals.

Social insurance refers to a social and economic system that provides income or compensation for people who lose their ability to work, are temporarily unemployed or suffer losses due to health reasons. The main items of social insurance include endowment insurance, medical insurance, unemployment insurance, industrial injury insurance and maternity insurance. Social insurance is an important part of the social security system and occupies a core position in the whole social security system. In addition, social insurance is a contributory social security. The funds are mainly paid by employers and workers themselves, and the government finances give subsidies and bear the ultimate responsibility. However, workers can only enjoy the corresponding social insurance benefits if they fulfill their statutory payment obligations and meet the statutory conditions.

Legal basis:

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

Article 4 Employers and individuals in People's Republic of China (PRC) shall pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

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.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.