How much is the hospitalization reimbursement of Shenzhen tertiary medical insurance?

Details of hospitalization reimbursement for tertiary medical insurance:

1. Basic medical insurance: the reimbursement rate of basic medical insurance ranges from 50% to 90%, and the specific reimbursement rate is calculated according to different items of medical expenses and hospital grades. During hospitalization, medical insurance can reimburse hospitalization expenses, operation expenses, medicine expenses, examination expenses and so on. Basic medical insurance also has a maximum reimbursement limit, the specific amount varies from region to region, generally around 6,543,800 yuan;

2. Critical illness insurance: Critical illness insurance refers to large medical expenses beyond the reimbursement scope of basic medical insurance, such as cancer and heart disease. The reimbursement rate of serious illness insurance ranges from 80% to 90%, and the maximum reimbursement limit is 300,000 yuan. It should be noted that major illness insurance needs to be applied in advance to enjoy reimbursement. Please consult the local medical insurance center for specific procedures and application conditions.

3. Commercial insurance: Commercial insurance refers to additional medical insurance purchased by individuals, and the general reimbursement ratio and amount vary with insurance companies and insurance schemes. It should be noted that the scope of application and reimbursement standard of commercial insurance may be different from basic medical insurance and critical illness insurance, and the insurance company should be consulted for details.

General process of hospitalization reimbursement for tertiary medical insurance in Shenzhen;

1. Hospitalization receipts and medical records: patients need to ask the hospital for hospitalization receipts, medical records and other relevant supporting materials after discharge;

2. Reimbursement application: patients need to submit hospitalization receipts, medical records and medical insurance cards to the local community health service center to apply for medical insurance reimbursement;

3. Reimbursement review: the community health service center reviews the application materials to verify whether the applicant's identity and hospitalization meet the reimbursement requirements;

4. Reimbursement processing: after the approval, the community health service center will reimburse the part that meets the reimbursement conditions, and the reimbursement amount will be directly credited to the applicant's bank account.

To sum up, the reimbursement ratio and reimbursement amount of different levels of medical insurance are different. You can consult the local medical insurance department or community health service center for the specific ratio and amount. At the same time, it is necessary to provide authentic and effective certification materials when applying, and strictly abide by the application process and requirements.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.