Social security differences among the first, second and third gears

First, the difference between the first, second and third grades of social security

1, payment level

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.

2. Outpatient service

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.

3. 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.

legal ground

People's Republic of China (PRC) social insurance law

Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.