Shenzhen social security comprehensive with the difference between the first two or three grades

Shenzhen enterprise workers' medical insurance is divided into three grades: . Basic medical first grade, basic medical second grade and basic medical third grade, its contributions, treatment and adapt to the population are different.

I. Contributions

1. Basic medical first class (unit 6% + individual 2%) + local supplementary medical (unit 0.2%), the contribution base is the employee's actual contribution to the salary (the minimum of 3,632 yuan), the total contribution of 297.8 yuan;

2. Basic medical second class (unit 0.5% + individual 0.2%) + local supplementary medical (unit 0.1%, the contribution base for the previous year's average monthly salary of on-the-job workers (now 6054), the total payment of 48.4;

3. Basic medical third class (unit 0.4% + individual 0.1%) + local supplementary medical (unit 0.05%), the contribution base for the previous year's average monthly salary of on-the-job workers (now 6054064), the total payment of 33.3 yuan;

Second, treatment

1, outpatient, basic medical third grade, basic medical second grade have 1,000 yuan per year outpatient costs, basic medical first grade in all hospitals can see the outpatient clinic, but are using their own personal account money.

Of course, the basic medical first class is not without its benefits, there are three advantages:

First, continuous participation in the basic medical first class for more than 12 months, and in a medical year outpatient out-of-pocket expenses more than 3,632 yuan, more than the part of the reimbursement can be 70%.

Secondly, 30% of outpatient visits to all social hospitals can be reimbursed, and thirdly, 80% of outpatient visits for large-scale equipment tests can be reimbursed, and this reimbursement is made with the money from the integrated fund, except for the money from your own account.

2, hospitalization, this medical first class, basic medical second class treatment is the same, a unified report 90%; basic medical third class hospitalization reimbursement rate according to the different levels of hospitals, in the first-class hospitals can be reimbursed 85%, second-class hospitals reimbursement of 80%, the third-class hospitals reimbursement of 75%, if there is no referral order to go over, it will only be reimbursed 67.5% or so, so participants try to fight for The second level of the basic medical insurance.

1, the principle of medical treatment

The first class of participants: the city of any certain point of medical institutions

The second class of participants: outpatient in the binding community health center, hospitalization in the city of any certain point of medical institutions, outpatient major medical institutions in the provisions of the medical treatment.

Third-tier participants: outpatient treatment at the bound community health center, inpatient treatment and outpatient treatment for major diseases at the prescribed medical institutions.

2. General outpatient treatment

First class enrollees: the person's personal account is used to pay for the medical expenses within the scope of the general outpatient medical insurance catalog of the enrollees. The basic medical expenses of the community health center, 70% paid by the individual account, 30% by the integrated fund in accordance with the provisions of the payment.

Second-grade participants/third-grade participants:

Those belonging to Class A drugs and Class B drugs are paid for by the community outpatient coordinated fund at the rate of 80% and 60%, respectively;

those belonging to the single diagnosis, treatment, or medical materials of the medical insurance catalog are paid for by the community outpatient coordinated fund at 90%, but the maximum amount of payment is not more than 120 yuan;

the community outpatient The total amount of outpatient medical expenses paid by the coordinated fund to each second- and third-stage participant shall not exceed RMB 1,000 in a medical insurance year. It can also pay for the basic medical expenses and local supplementary medical expenses for itself, its spouse and immediate family members who have joined the city's basic medical insurance, as well as the expenses for health checkups and preventive vaccinations.

Second-grade participant/third-grade participant: None

4. Individual account underpayment

First-grade participant: first-grade participant has continuously participated in the insurance for one year, and in the same medical insurance year, out-of-pocket basic outpatient medical expenses and local supplemental medical expenses of the supermarkets of the average salary of on-the-job workers of 5%, the excess part of the integrated fund will pay for the stipulated 70% (over the age of 70), 80%. Pay 80%).

Second-grade participants/third-grade participants: none

5. Costs incurred for outpatient large-scale equipment examination and treatment

First-grade participants: 80% of the cost will be paid by the integrated fund in accordance with the regulations

Second-grade participants/third-grade participants: up to a maximum of 120 yuan per unit price of general diagnostic and therapeutic items

6. Costs of blood transfusion for general outpatient clinics

The first-grade participants: 80% of the cost will be paid by the integrated fund in accordance with the regulations

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Participants in the first tier: 90% of the total amount will be paid by the integrated fund in accordance with regulations

Participants in the second tier/participants in the third tier: 70% of the total amount will be paid by the integrated fund in accordance with regulations

7. Outpatient treatment for serious illnesses

Participants in the first tier/participants in the second tier/participants in the third tier: 60-90% of the total amount will be paid by the integrated fund in accordance with regulations according to the length of time of continuous insurance participation

8. 8, medical examination subsidy

The first class participants: a lump sum of 500 yuan upon retirement, 20 yuan per person per month (70 years of age for 40 yuan per person per month)

The second class participants/third class participants: no

9, hospitalization treatment

The first class participants: hospitalization of the basic medical expenses and the local supplemental medical expenses above the starting line will be paid in accordance with the regulations 95% or 90%

Second-tier participants/third-tier participants:

1) If you can be hospitalized in the settlement hospitals of the bounded community health centers or referred to the prescribed hospitals by the settlement hospitals, the reimbursement ratio for the part of the basic medical expenses and local supplementary medical expenses incurred above the starting line of hospitalization will be as follows:

First-tier hospitals:85%

Second-tier hospitals : 80%

Tertiary hospitals: 75%

2) If you are hospitalized in a prescribed hospital other than the billing hospital without referral, you will be paid 90% of the inpatient payment rate of the attending hospital (i.e., the payment rate in Article 1 above)

Treatment of medical treatment outside of the city

First-tier insured persons: general outpatient expenses, outpatient expenses for major illnesses, and inpatient hospitalization expenses will all be Reimbursement according to regulations

Second-tier participants/third-tier participants: general outpatient expenses will not be reimbursed; outpatient expenses for major illnesses and hospitalization expenses that meet the regulations will be reimbursed according to regulations.

Source: Sohu.com "Shenzhen social security one, two or three gears of the difference, do not know you will lose big"