How to reimburse outpatient medical insurance in Shenzhen

The deductible line is determined according to the level of the hospital. Below the city hospital 100 yuan, secondary hospital 200 yuan, tertiary hospital 300 yuan. If the insured person is referred to different hospitals for hospitalization, the deductible line shall be calculated respectively. Proportion of outpatient and inpatient medical insurance reimbursement in Shenzhen:

The personal account of the insured person of basic medical insurance is used to pay the insured person's outpatient basic medical expenses, local supplementary medical expenses, and the expenses of purchasing drugs within the scope of medical insurance catalogue at designated retail pharmacies with prescriptions issued by doctors of designated medical institutions in this Municipality. The insufficient part of the personal account is paid by the individual.

First, the basic medical insurance file has been insured for one year in a row. In the same medical insurance year, the personal out-of-pocket basic medical expenses and local supplementary medical expenses exceed this Municipality. Last year, 5% of the average wage of on-the-job workers, the excess is paid by the basic medical insurance serious illness pooling fund or the local supplementary medical insurance fund according to the regulations, and 80% is paid by the insured over 70 years old.

Two, the basic medical insurance personal accounts accumulated more than 5% of the average wage of workers in the city last year, the excess can be used to pay the following fees:

1. The cost of purchasing non-prescription drugs within the scope of the basic medical insurance and local supplementary medical insurance drugs list at designated retail pharmacies;

2. I, my spouse and my immediate family members who participate in the basic medical insurance in this Municipality pay the basic medical expenses and local supplementary medical expenses when visiting the designated medical institutions;

3, I and participate in the basic medical insurance in the city's spouse and immediate family members of the health examination, vaccination costs;

4 other medical expenses stipulated by the state, Guangdong Province and this Municipality.

Three, the basic medical insurance file insured in the city designated community health centers of basic medical expenses and local supplementary medical expenses, 70% paid by personal accounts, 30% by the basic medical insurance serious illness pooling fund, local supplementary medical insurance fund in accordance with the provisions of payment, but the following items are excluded:

1, dental treatment cost;

2. Rehabilitation physiotherapy expenses;

3, large medical equipment inspection and treatment costs;

4, other project costs stipulated by the municipal government.

Maximum reimbursement amount of medical insurance

In Shenzhen, in a medical insurance year, the cumulative interruption of insurance for more than three months is called the interruption of continuous payment period, also known as "zero year", which will affect the maximum amount and proportion of reimbursement.

The maximum amount of medical insurance reimbursement in Shenzhen is: the basic medical insurance pooling fund payment limit+the local supplementary medical insurance fund payment limit, which is linked to the payment period.

For example, your social security has only been paid for less than 6 months, so when you go to the hospital, the payment limit of the basic medical insurance pooling fund = (6753 yuan x 12 months) x 1=8 1036 yuan (6753 is 20 15 social security salary), then

Legal basis:

1. Social Insurance Law of People's Republic of China (PRC) (China)

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

2. People's Republic of China (PRC) (China) Social Insurance Law

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.