Third-grade reimbursement ratio of Shenzhen medical insurance

Legal analysis: The outpatient medical expenses incurred by Class II and III insured persons in the selected community health centers in this Municipality shall be handled according to the following provisions:

(a) belongs to the basic medical insurance drug list of class A drugs and class B drugs, respectively, by the community outpatient co-ordination fund according to the proportion of 80% and 60% to pay (II) belongs to the basic medical insurance drug list of single diagnosis and treatment items or medical materials, by the community outpatient co-ordination fund to pay 90%, but the maximum payment does not exceed 120 yuan.

The outpatient medical expenses incurred by the insured due to illness and referral to other medical institutions with the consent of the settlement hospital, or the emergency rescue outpatient medical expenses incurred in the non-settlement hospital due to business trip, shall be reimbursed by the community outpatient co-ordination fund according to 90% of the payment standard stipulated in the preceding paragraph. Outpatient medical expenses incurred in non-settlement hospitals will not be reimbursed.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) 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.