How much is the social security reimbursement for pregnant women in Shenzhen?

The medical insurance for employees of enterprises in Shenzhen is divided into three grades: basic medical care level 1, basic medical care level 2 and basic medical care level 3, with different payment, treatment and adaptation groups.

I. Payment

1. Basic medical care (unit 6%+ individual 2%)+ local supplementary medical care (unit 0.2%)+ maternity medical care (unit 0.5%), and the payment base is the actual payment salary of employees (minimum 3 13 1 yuan), with a total payment of 272 yuan;

2. The second payment base of basic medical care (unit 0.5%+ individual 0.2%)+ local supplementary medical care (unit 0. 1%)+ maternity medical care (unit 0.2%) is the average monthly salary of employees in the previous year (now 52 18), and the accumulated payment is 52;

3. The third basic medical care (unit 0.4%+ individual 0. 1%)+ local supplementary medical care (unit 0.05%), the payment base is the average monthly salary of employees in the previous year (now 52 18), and the total payment is 29 yuan;

Two. deal with

1. In terms of outpatient service, there is an annual outpatient fee of 1000 yuan for Grade III and II basic medical care, but it can only be enjoyed if it is bound to a community health hospital. Primary medical service All hospitals can see out-patients, but they all use money from personal accounts. When there is no money in personal accounts, they have to withdraw cash by themselves. To put it bluntly, you paid for all the money. You can report 1000 yuan per year for the second and third grades of basic medical care, which is the money from the overall fund, while the money from the first-level outpatient service of basic medical care is your own money, and only the money from the overall fund can be truly reimbursed. Of course, the first file of basic medical care does not mean that there is no welfare. It has the following three advantages: first, it has been insured continuously for more than 12 months, and the out-of-pocket expenses of outpatient service exceed 3 1 and 3 1 yuan in a medical year, and the excess part can be reimbursed by 70%; Second, it can be reimbursed in all social health hospitals; Third, the number of outpatients is large.

2. In terms of hospitalization,

The primary and secondary treatment of basic medical care is the same, with a unified report of 90%. All designated hospitals in Shenzhen can directly handle hospitalization, and the reimbursement rate is 90%;

According to different levels of hospitals, the proportion of reimbursement for tertiary hospitalization in basic medical care can be 85% in primary hospitals, 80% in secondary hospitals and 75% in tertiary hospitals. The tertiary insured must go to the bound social health hospital before hospitalization, and cannot be hospitalized directly in other hospitals. Only when a referral slip is issued in the bound hospital can they go to a higher-level hospital, that is, if the hospital to see a doctor is not a higher-level hospital, there is no way to refer them to this hospital. Of course, you can go directly to the hospital you want to stay in without a referral form, but the reimbursement rate will drop 10%. For example, under normal circumstances, hospitalization in tertiary hospitals is 75%. If you go without a referral form, you can only reimburse about 67.5%. Therefore, the insured will try to obtain the second level of basic medical insurance;

3. How to choose the medical grade?

1. If there is a unit payment, the deep household insured can only choose the first file of basic medical insurance. If it is an individual payment, he can choose first or second gear;

2. Non-deep households can choose any kind of medical grade, of course, it is best not to choose the third gear;

3. Children's medical insurance and college students' medical insurance participate in the second grade of basic medical insurance;

4. Whether it is a deep household or a non-deep household, as long as you choose the first file or the second file, it is mandatory to pay maternity insurance, and the third file does not include maternity insurance.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.