The difference in social security grades in Shenzhen lies in medical insurance. Grade one, grade two and grade three are different. Shenzhen's first-class medical insurance has the highest treatment, of course, the best treatment! So, what diseases can Shenzhen's first-class medical insurance reimburse? What is the scope of reimbursement?
Reimbursement scope
1. The personal account is used to pay for basic outpatient medical expenses, local supplementary medical expenses, and the purchase of drugs in the medical insurance catalogue at designated retail pharmacies.
2, continuous insurance for one year, in the same medical insurance year, individuals pay more than 5% of the average wage of employees in Shenzhen last year, and the excess part is paid by the basic medical insurance serious illness pooling fund or local supplementary medical insurance fund in accordance with the regulations, and 80% is paid over 70 years old.
3. If the accumulated amount of personal account exceeds 5% of the average salary of employees in Shenzhen last year, the excess can be used to pay the following expenses:
I purchase the expenses of non-prescription drugs within the scope of the basic medical insurance and local supplementary medical insurance drugs list in designated retail pharmacies.
The basic medical expenses and local supplementary medical expenses paid by myself, my spouse and immediate family members who have participated in the basic medical insurance in this Municipality when attending the designated medical institutions.
I, my spouse and my immediate family members who have participated in the basic medical insurance in this city, the cost of health examination, vaccination and other prescribed expenses.
note:
Insured persons who enjoy the treatment specified in the preceding paragraph do not enjoy the following treatment:
The basic medical expenses and local supplementary medical expenses incurred by the first-class insured in the designated community health centers in Shenzhen City are 70% paid by individual accounts, and 30% paid by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations, except for the following items:
1 oral treatment expenses;
2. Rehabilitation physiotherapy expenses;
3 large medical equipment inspection and treatment costs;
4 other items stipulated by the municipal government expenditure.
3. If the accumulated savings in personal accounts of Class I insured persons in basic medical insurance exceeds 5% of the average salary of employees in Shenzhen last year (current standard: 49 18 yuan/month), the excess can be used to pay the following expenses:
1 the cost of purchasing non-prescription drugs within the scope of basic medical insurance and local supplementary medical insurance drugs in designated retail pharmacies;
2. The basic medical expenses and local supplementary medical expenses paid by myself, my spouse and the immediate family members who have participated in the basic medical insurance in this Municipality at the designated medical institutions;
3 I and my spouse, immediate family members to participate in the city's basic medical insurance health examination and vaccination costs;
Other medical expenses stipulated by the state, Guangdong Province and this Municipality.
Reimbursement treatment of Shenzhen medical insurance first-class designated social health center
1. The basic medical expenses and local supplementary medical expenses incurred by Class I insured persons in designated community health centers in Shenzhen are 70% paid by personal accounts, and 30% paid by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations, except for the following items:
1 oral treatment expenses;
2. Rehabilitation physiotherapy expenses;
3 large medical equipment inspection and treatment costs;
4 other items stipulated by the municipal government expenditure.
2. Basic medical insurance The basic medical expenses and local supplementary medical expenses incurred by the first-class insured in Shenzhen designated medical institutions for large-scale medical equipment inspection and treatment shall be paid 80% by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations.
Treatment of serious illness in the first-level outpatient department of Shenzhen basic medical insurance
1. In any of the following circumstances, the insured person shall enjoy the treatment of serious illness in outpatient service:
1 chronic renal failure outpatient dialysis;
2. Anti-rejection drugs used in outpatient service after organ transplantation included in the scope of medical insurance payment;
3 outpatient chemotherapy, interventional therapy, radiotherapy or radionuclide treatment of malignant tumors;
4. Hemophilia specialist outpatient treatment;
5. Specialized outpatient treatment of aplastic anemia;
6. Specialized outpatient treatment of thalassemia;
7. Specialized outpatient treatment of intracranial benign tumors;
8 other circumstances approved by the municipal government.
Now it is a legal society, and many things closely related to life are inseparable from the law, so we should know some legal knowledge.