How to distinguish primary social security from secondary and tertiary social security?

According to China's social average index, social security payment units need to pay at least 40%, 1 file 60%, second file 80%, and third file most, and need to pay 100%. The higher the payment level, the higher the expected pension amount, mainly depending on your current economic situation.

The annual outpatient fee for the third-level and second-level basic medical care is 1000 yuan, but it can only be enjoyed in the bound community health hospital. All hospitals can see the outpatient service at the first level of basic medical care, but they all use the money from personal accounts. When there is no money in the personal account, you need to pay cash. 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.

There are three main advantages at the basic medical level. First, the first file of basic medical care has been insured continuously for more than 12 months, and if the out-of-pocket expenses of outpatient service exceed 3 1 and 3 1 yuan in a medical year, 70% of the excess can be reimbursed; Second, 30% can be reimbursed in all outpatient clinics of social health hospitals; Third, outpatient large-scale equipment inspection can be reimbursed.

I. Hospitalization

The first-level basic medical care and the second-level basic medical care are the same, and the unified report is 90%. For example, all designated hospitals in Shenzhen can directly handle hospitalization, and the reimbursement rate is 90%.

The proportion of reimbursement for tertiary hospitalization in basic medical care depends on the level of the hospital. In a first-class hospital, 85% can be reimbursed, and in a second-class hospital, 80% can be reimbursed. In a third-class hospital, the insured person must go to the bound social health hospital first, but not directly to other hospitals. He can only go to the next higher level hospital if he opens a referral form in the binding hospital.

What's the difference between the first, second and third social security files?

Second, the main differences between social insurance and commercial insurance

1, achieving different purposes.

Social insurance is the basic guarantee for social members when necessary, not for profit; Commercial insurance is the commercial operation of insurance companies, aiming at profit;

2. Different implementation methods

3. Social insurance is compulsory according to national legislation, commercial insurance follows the principle of "freedom of contract", and enterprises and individuals voluntarily take out insurance.

4. The subject and object of implementation are different.

Social insurance is raised, managed and distributed by special institutions set up by the state, targeting social members within the legal scope; Commercial insurance is managed by insurance companies, and the applicant can be anyone who meets the underwriting conditions;

5, different levels of protection

Social insurance provides the most basic protection for the insured, which is higher than the social poverty line and lower than 50% of the average social wage, with a low degree of protection; The level of protection provided by commercial insurance depends entirely on the agreement of both parties and the amount of premium paid by the insured. As long as the insured meets the insurance conditions and has a certain ability to pay, he can get a high level of protection.

Legal basis:

Article 64 of People's Republic of China (PRC) Social Insurance Law stipulates that social insurance funds include basic old-age insurance funds, basic medical insurance funds, industrial injury insurance funds, unemployment insurance funds and maternity insurance funds. All social insurance funds shall be accounted for according to the types of social insurance, and a unified national accounting system shall be implemented. The social insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it. The basic old-age insurance fund will gradually implement national overall planning, and other social insurance funds will gradually implement provincial overall planning. The specific time and steps shall be stipulated by the State Council.