Shenzhen third-grade social security reimbursement ceiling

First, the provisions of Du Kang Central Outpatient Medical Expense Reimbursement in the third file of Shenzhen Basic Medical Insurance.

1. The outpatient medical expenses incurred by the three-level insured of basic medical insurance in the selected community health center in Shenzhen shall be handled in accordance with the following provisions:

(1) Class A drugs and Class B drugs belonging to the basic medical insurance drug list are paid by the community outpatient co-ordination fund at the ratio of 80% and 60% respectively;

② If it belongs to a single diagnosis and treatment project or medical materials in the basic medical insurance catalogue, 90% will be paid by the community outpatient co-ordination fund, but the maximum payment amount will not exceed 120 yuan.

2. The insured due to work needs by the settlement hospital referral to other medical institutions outpatient medical expenses, or because of work needs in the non settlement hospital emergency rescue outpatient medical expenses, community outpatient co-ordination fund according to the provisions of the preceding paragraph payment standard reimbursement of 90%; Other circumstances in the non-settlement hospital outpatient medical expenses community outpatient co-ordination fund will not be reimbursed.

3. The total outpatient medical expenses paid by the community outpatient co-ordination fund to the third party of basic medical insurance within one medical insurance year shall not exceed 1 000 yuan.

Two, Shenzhen basic medical insurance third file hospitalization medical expenses reimbursement regulations

1. The basic medical expenses and local supplementary medical expenses incurred by the insured in hospitalization shall be paid by the insured under the condition that the deductible is not exceeded; The part exceeding the deductible shall be paid by the basic medical insurance fund and the local supplementary medical insurance fund in accordance with the regulations.

2. The deductible line is set according to the hospital level (the higher the level, the higher the deductible line of hospital medical insurance):

① Hospitals below the municipal level 100 yuan.

② 200 yuan, a secondary hospital.

③ 300 yuan, a tertiary hospital.

(4) 400 yuan, whose medical institutions outside the city have been referred or filed according to regulations.

(5) Failing to handle the referral or filing as required, 1 1,000 yuan.

Note: If the insured is referred to different hospitals for hospitalization, the deductible will be calculated separately.

The above-mentioned part of the basic medical expenses and local supplementary medical expenses incurred by the insured in hospitalization shall be paid according to the following provisions:

If the second-class insured of basic medical insurance fails to receive the pension insurance benefits for Shenzhen employees on a monthly basis, the payment ratio is 90%;

4. The insured person's hospitalization using special medical materials and disposable medical materials with a unit price exceeding 1000 yuan within the scope of the basic medical insurance diagnosis and treatment project, installing or replacing artificial organs, shall be paid by the basic medical insurance serious illness pooling fund according to the following provisions, but the maximum payment amount shall not exceed the public price announced by the municipal social insurance administrative department:

(1) domestic materials, pay 90% of the actual price;

② Imported materials shall be paid at 60% of the actual price.

Three, Shenzhen basic medical insurance for the third time hospitalization bed fee reimbursement regulations

The hospitalization bed fee of the insured person shall be paid by the basic medical insurance serious illness pooling fund according to the actual hospitalization bed fee, but it shall not exceed the following standards:

The third-level insured of the basic medical insurance, the highest payment amount is the first file of the government-guided price of the third-level bed fee for the class B general ward of non-profit medical institutions determined by the municipal price management department.

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