Different levels of medical insurance have great differences in treatment.
There are differences in medical insurance payment and treatment. The differences between the first, second and third grades of Shenzhen medical insurance include general outpatient treatment, family welfare personal account, insufficient payment of personal account, and expenses incurred by large-scale outpatient equipment inspection and treatment.
I. General outpatient treatment
First-class insured
Personal accounts are used to pay the medical expenses within the scope of the general outpatient medical insurance catalogue of the insured. Community health center basic medical expenses personal account to pay 70%, the overall fund to pay 30% in accordance with the provisions.
Second/third insured
Belong to class A drugs and class B drugs, respectively, by the community outpatient fund according to the proportion of 80% and 60% payment;
90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment amount shall not exceed 120 yuan;
The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-grade and third-grade insured within a medical insurance year shall not exceed 1000 yuan.
2. Personal account for family use
For the first time, the accumulated amount of the personal account of the insured exceeds 5% of the average wage of employees in this city in the previous year, and the excess can be purchased in the designated pharmacies of over-the-counter drugs within the scope of the 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.
Secondary Insured/Tertiary Insured: None.
Third, the personal account is insufficient to pay.
First-class insured
If the first insured person has been insured for one year in a row, and the basic outpatient medical expenses and supplementary medical expenses paid by himself in the same medical insurance year exceed 5% of the average salary of employees on the job, the excess part shall be paid by the overall fund according to the regulations (80% for those over 70 years old).
Secondary Insured/Tertiary Insured: None.
Four. be hospitalized
First/second insured
The basic medical expenses and local supplementary medical expenses above the deductible line shall be paid 95% or 90% according to the regulations.
Third-class insured
You can go to the settlement hospital where the community health center is bound, or you can refer to the prescribed hospital through the settlement hospital. The reimbursement rates of basic medical expenses and local supplementary medical expenses above the hospitalization deductible line are: 85% in first-class hospitals, 80% in second-class hospitals, 75% in third-class hospitals and 70% in hospitals outside the city; Hospitalization medical expenses incurred due to emergency rescue in non-settlement hospitals due to business trip and business trip shall be paid according to 90% of the hospitalization payment standard of the hospital. In addition, the basic medical expenses and local supplementary medical expenses incurred by the first, second and third types of insured persons who fail to handle referral and filing in designated medical institutions outside the city and non-designated medical institutions outside the city are paid according to the standard of 90% and 70% respectively.
Grade conversion does not affect the accumulation of years.
When employees of an enterprise change the medical insurance grade, the insured years are calculated together, that is, the mutual conversion of different medical grades does not affect the calculation of accumulated payment years and continuous payment years. Shenzhen Human Resources and Social Security Bureau reminded that the new medical insurance measures stipulate that the basic medical insurance form selected by the insured units for employees shall not be changed during the medical insurance year. The medical insurance year refers to the period from July 1 day to June 30th of the following year, and the insured unit can change the medical insurance grade for its employees from July 1 day to 20th of each year.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.