1. Proportion of hospitalization reimbursement for Class II social security in Shenzhen:
1, the second kind of medical insurance is inpatient medical insurance.
2, outpatient service can be reimbursed every year 1000 yuan.
3. If you are hospitalized, you can basically reimburse 70% to 80%. Before going through the hospitalization formalities, you can show your social security and fill it out. When you leave the hospital, you will directly deduct the expenses that can be reimbursed.
Two, Shenzhen children's medical insurance reimbursement list
The scope of reimbursement for children's medical insurance in Shenzhen is as follows:
(a) outpatient reimbursement
1, drugs and drugs belonging to the basic medical insurance drug list are paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively.
2, belonging to the basic medical insurance directory of individual medical items or medical materials, by the community outpatient co-ordination fund to pay 90%, but the maximum payment limit does not exceed 120 yuan.
3. The outpatient medical expenses incurred by the insured who need to be referred to other designated medical institutions with the approval of the settlement hospital due to illness shall be reimbursed by the community outpatient co-ordination fund according to the provisions in items (1) and (2) above.
4. The outpatient medical expenses paid by the community outpatient co-ordination fund to each insured person in the second-level children's medical insurance within one medical insurance year shall not exceed 1 000 yuan at the maximum.
5, the insured children need outpatient blood transfusion costs due to illness, by the basic medical insurance fund to pay 70%.
(2) serious illness outpatient reimbursement
Insured children can enjoy outpatient treatment for serious illness, with the highest reimbursement rate reaching 90%.
The proportion of outpatient serious illness treatment is linked to the number of years of continuous insurance. The continuous participation time is less than 12 months, less than 36 months and more than 36 months, and the proportion of medical insurance fund payment is 60%, 75% and 90% respectively.
Under any of the following circumstances, you can enjoy outpatient treatment for serious illness.
1, chronic renal failure outpatient dialysis;
2, into the scope of medical insurance payment of organ transplant outpatient anti-rejection drugs;
3, malignant tumor outpatient chemotherapy, interventional therapy, radiotherapy or radionuclide therapy;
4, hemophilia specialist outpatient treatment;
5, aplastic anemia specialist outpatient treatment;
6, thalassemia specialist outpatient treatment;
7, intracranial benign tumor specialist outpatient treatment.
8, schizophrenia outpatient specialist treatment
9. Outpatient specialist treatment of schizoaffective disorder
10, outpatient specialized treatment of persistent delusional disorder (paranoid psychosis)
1 1, outpatient specialized treatment of bipolar disorder
12, outpatient special treatment of mental disorders caused by epilepsy
13, outpatient specialized treatment of mental retardation with mental disorders
14, AIDS outpatient specialized treatment and other circumstances approved by the municipal government.
(3) hospitalization reimbursement
The medical insurance fund pays 90% of the basic medical expenses and local supplementary medical expenses incurred by the insured children and college students in this city's hospitals.
If the insured fails to handle the referral and filing according to the regulations, the basic medical expenses and local supplementary medical expenses incurred in the hospitalization of designated medical institutions outside the city and non-designated medical institutions outside the city shall be paid according to the provisions of 90% and 70% of the payment standards respectively.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Measures of Shenzhen Municipality on Social Medical Insurance
Thirty-second basic medical insurance insured medical treatment in accordance with the following provisions, enjoy medical insurance benefits:
(a) the basic medical insurance insured in the city designated medical institutions for medical treatment.
(2) The secondary insured of basic medical insurance shall seek medical treatment in the selected community health center, and with the consent of the settlement hospital, they may seek medical treatment in other designated community health centers under the same settlement hospital as the selected community health center; Hospitalization and outpatient serious illness in the city designated medical institutions for medical treatment.
(3) The third-level insured of basic medical insurance shall seek medical treatment in the selected community health center, and with the consent of the settlement hospital, they may seek medical treatment in other designated community health centers under the same settlement hospital as the selected community health center; Outpatient serious illness in the city designated medical institutions for medical treatment; Be hospitalized in the settlement hospital of the selected social rehabilitation center.
(four) other medical conditions that meet the requirements of these measures.
Article 53 For the general outpatient blood transfusion expenses incurred by the insured due to illness, 90% of the primary insured of basic medical insurance shall be paid by the basic medical insurance serious illness pooling fund, and 70% of the secondary and tertiary insured of basic medical insurance shall be paid by the basic medical insurance serious illness pooling fund.
Fifty-fourth basic medical insurance second and third file insured in the city selected community health service center outpatient medical expenses according to the following provisions:
(a) Class A drugs and Class B drugs belonging to the basic medical insurance drug list shall be paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively;
(two) individual medical items or medical materials belonging to the basic medical insurance catalogue shall be paid by the community outpatient co-ordination fund for 90%, but the maximum payment amount shall 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; Other circumstances in the non-settlement hospital outpatient medical expenses community outpatient co-ordination fund will not be reimbursed.
The outpatient medical expenses paid by the community outpatient co-ordination fund to each second-and third-level insured person of basic medical insurance within a medical insurance year shall not exceed 1000 yuan at the highest.