What's the difference between primary, secondary and tertiary medical insurance in Shenzhen?

① The payment standards are different.

② Hospitalization reimbursement treatment.

③ General outpatient treatment is different.

(4) Different participation conditions.

⑤ Different participation standards.

⑥ Personal accounts are different.

⑦ The principle of seeking medical treatment is different.

1, the payment standard is different.

The first file: the monthly payment is 8.2% or 7.2% of the total monthly salary of employees, of which individuals only need to pay 2% and the unit pays 6.2% or 5.2%;

The second file: based on the average monthly salary of employees in Shenzhen last year, the payment ratio is 0.8%, of which the unit pays 0.6% and the individual pays 0.2%;

The third stage: based on the average salary of employees in Shenzhen last year, the contribution ratio is 0.55%, of which the unit contribution is 0.45% and the individual contribution is 0. 1%.

2. Hospitalization reimbursement treatment.

Grade I and II: 95% or 90% of medical expenses incurred in designated hospitals can be reimbursed. The reimbursement rate of the third-level insured in different hospitals is different, with 85% for medical treatment in the first-level hospital, 80% for the second-level hospital and 75% for the third-level hospital.

3. General outpatient treatment is different.

The insured who participates in the first file has a personal medical insurance account, and the balance of the account can be used to pay medical expenses. 70% of the expenses incurred by Dukang Center shall be paid by the individual account and 30% by the overall fund.

If you participate in the second and third gears, there is no individual payment for medical insurance. Class A and B drugs can be reimbursed by 80% and 60% as a whole in outpatient department. 90% of the medical materials in the single diagnosis and treatment or medical insurance catalogue can be reimbursed, and the maximum reimbursement amount does not exceed 120 yuan. The annual payment limit of outpatient medical expenses is 1000 yuan.

4. Different insurance conditions

In Shenzhen, medical insurance is divided into level 1, level 2 and level 3 according to payment and corresponding treatment, and each form of medical insurance corresponds to different insured people:

If the employee is a deep household, the unit should participate in the first medical insurance for him;

If you are not a deep household, you can participate in any one of the first, second and third gears.

5. Participation criteria are different.

For those who participated in the first medical insurance, the total wages of employees last month were at most three times the average wages of employees in Shenzhen last year (currently 34,860 yuan) and at least 60% of the average wages of employees in Shenzhen last year (currently 6,972 yuan). The employer pays 6.65% and the individual pays 2%.

Those who participate in the second-grade medical insurance will be paid monthly according to the standard of 0.8% of the average monthly salary of employees in Shenzhen last year (basic medical insurance+local supplementary medical insurance), of which the employer will pay 1.05% and the individual will pay 0.2%.

Those who participate in the third-grade medical insurance will be paid monthly according to the standard of 0.55% of the average monthly salary of employees in Shenzhen last year (basic medical insurance+local supplementary medical insurance), of which the employer will pay 0.9% and the individual will pay 0. 1%.

6. Personal accounts are different

After the first-class medical insurance is insured, a personal account is established, and the money paid in the account can be used in outpatient service. Second, third-grade medical insurance does not have a personal account, and the outpatient service is co-ordinated.

(1) Insured:

Personal accounts accumulated more than 5% of the average wage of employees in this city last year (i.e. 139436 yuan× 5% = 6971.8 yuan), and the excess part can be purchased from designated pharmacies within the scope of medical insurance catalogue;

When visiting a designated medical institution, you can pay the basic medical expenses and local supplementary medical expenses paid by yourself and your spouse and immediate family members who participate in the basic medical insurance in this Municipality; It can cover the health check-up and vaccination expenses for me, my spouse and immediate family members to participate in the basic medical insurance in this city.

At the same time, if the primary insured person has been insured for one year in a row, and the basic outpatient medical expenses and supplementary medical expenses paid in the same medical insurance year exceed 5% of the average salary of employees on the job, 70% of the excess will be paid by the overall fund according to regulations (80% will be paid for those over 70 years old).

② Level 2 Insured/Level 3 Insured: None. You can't swipe your social security card when you go to the drugstore to buy medicine.

7. The principle of seeking medical treatment is different.

First-class insured: any designated medical institution in this city for medical treatment.

Second-class insured persons: outpatients seek medical treatment in the binding community health center, inpatient departments seek medical treatment in any designated medical institutions in the city, and outpatients seek medical treatment in designated medical institutions for serious illness.

Third-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.

Legal basis:

Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and the employer and employees shall jointly pay the basic medical insurance premium according to the provisions of the state.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.