The difference between the first and second class reimbursement of employee medical insurance

The difference between the first and second class reimbursement of employee health insurance is as follows:

1, the contribution rate is different: the contribution rate of the first class of social security is relatively low, while the contribution rate of the second class of social security is higher;

2, the reimbursement rate is different: the hospitalization in the second class of social security can usually be reimbursed for 70 to 80 percent, while the reimbursement rate of the first class of social security may be lower;

3, the establishment of a personal account: The second level of social security needs to establish a personal account to pay for part of the medical expenses, while the first level of social security does not establish a personal account;

4, the starting line standard is different: in different levels of hospitals, the starting line standard of the second social security will be different, for example, the starting line for the first level of hospitals is less than one hundred yuan, the second level hospitals are two hundred dollars, and the third level of hospitals is three hundred dollars.

The benefits of employee health insurance:

1, strong protection. The basic medical insurance shares the risk of the unit or individual to bear all the medical costs, through the implementation of ****ancial insurance system, so that the basic medical care of the insured person to be effective and efficient protection. In the past, many units due to poor efficiency, the staff medical expenses for a long time without reimbursement, the implementation of health insurance, the government mandatory units for employees to pay the basic medical insurance premiums, will not occur because of the unit's difficulties in the staff medical expenses for a long time difficult to reimburse the phenomenon.

2. Wide range of choices. In the past, the era of public medical care, each of us can only have a designated hospital, employees no matter what disease must be in this hospital. After the implementation of health insurance, the insured can go to any one of the health insurance designated hospitals, but also to any one of the designated retail pharmacy card to purchase drugs.

3. Convenience. Outpatient medical fees and pharmacy fees can be settled directly with the IC card. If you are hospitalized, you only need to pay for the expenses that should be borne by the individual, and the remaining part will be settled by the hospital and the medical insurance center.

In summary, the difference between the first and second grades of employee health insurance mainly lies in the contribution ratio, reimbursement ratio, personal account establishment and the starting line standard. The contribution rate of the first class is lower, the reimbursement rate may be lower and no personal account is established; while the contribution rate of the second class is higher, the reimbursement rate for hospitalization is usually 70% to 80%, a personal account is required, and the standard of the starting line varies among hospitals of different levels.

Legal basis:

Shenzhen Measures for Social Medical Insurance

Article 54

The outpatient medical expenses incurred by second- and third-tier participants in basic medical insurance at selected community health centers in the city shall be handled in accordance with the following provisions:

(1) Medicines belonging to Category A and Category B of the drug list of the basic medical insurance shall be treated as outpatient expenses by the community health fund at 80% and 80% respectively. Outpatient Coordination Fund at the rate of 80% and 60% respectively;

(ii) for individual diagnostic and therapeutic items or medical materials belonging to the Basic Medical Insurance Catalog, 90% shall be paid by the Community Outpatient Coordination Fund, but the maximum amount to be paid shall not be more than 120 yuan.