How much can Shenzhen Social Security Second Clinic reimburse?

Legal analysis: If it is a general outpatient service: 1, and it belongs to Class A and Class B drugs in the basic medical insurance drug list, it will be supported by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively. ; 2, belonging to the basic medical insurance directory of individual medical items or medical materials, by the community outpatient co-ordination fund to pay 90%, but the maximum payment amount does not exceed 120 yuan. 3. The outpatient medical expenses incurred by the insured due to illness, which need to be referred to other medical institutions with the consent of the settlement hospital, or the emergency rescue outpatient medical expenses incurred in non-settlement hospitals due to business trips, shall be reimbursed by the community outpatient co-ordination fund according to the provisions of the preceding paragraph. Other circumstances in the non-settlement hospital outpatient medical expenses community outpatient co-ordination fund will not be reimbursed. If it is a serious outpatient illness: if the insured person has been insured for 36 months continuously, he will enjoy the treatment of serious outpatient illness from the date of his application; Those who have been insured for less than 36 months in a row shall enjoy outpatient treatment for serious illness from the date of approval by the municipal social insurance institution. The basic medical expenses and local supplementary medical expenses incurred by the insured who enjoy the outpatient treatment of serious illness are paid by the basic medical insurance serious illness pooling fund and the local supplementary medical insurance fund respectively according to the following proportions: 60% if the continuous insurance period is less than 12 months; If the continuous participation time is over 12 months but less than 36 months, the payment ratio is 75%; For those who have been insured for 36 months continuously, the payment ratio is 90%. In case of outpatient blood transfusion, 70% of the general outpatient blood transfusion expenses incurred by the insured due to illness shall be paid by the basic medical insurance serious illness pooling fund.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope: (1) should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) Those who should be borne by public health: (4) Those who 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.