Shenzhen social security first class, second class, the difference between the three grades are as follows:
1, the principle of access to health care is different from the first class of insured people: the city of any certain point of care in the medical institutions. Second-class participants: outpatient treatment in the bound community health center, hospitalization in the city at any point in the medical institutions, outpatient treatment of major diseases in the prescribed medical institutions. Participants in the third class: 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 is different from the first class of participants: the person's personal account is used to pay for participants in the general outpatient medical insurance catalog range of medical expenses. The basic medical expenses of the social health center, 70% paid by the individual account, 30% paid by the integrated fund in accordance with the provisions. Second-stage participants/third-stage participants: for drugs belonging to Class A and Class B, 80% and 60% respectively are paid by the community outpatient co-ordination fund; for single diagnosis and treatment or medical materials belonging to the medical insurance catalog, 90% is paid by the community outpatient co-ordination fund, but the maximum amount of payment does not exceed 120 yuan; the outpatient medical expenses paid by the community outpatient co-ordination fund to each second- and third-stage participant in one medical insurance year totaling no more than 1,000 yuan.
3, individual account family **** relief different from the first tranche of participants: individual account accumulation amount exceeds 5% of the city's average salary of on-the-job workers in the previous year, more than the part of the designated pharmacy to buy non-prescription drugs in the scope of the medical insurance directory; can be for themselves and their spouses and immediate family members have participated in the city's basic medical insurance to pay for their own out-of-pocket basic medical expenses in designated health care institutions, local The insured person can pay for the basic medical expenses and local supplementary medical expenses paid by the insured person and his/her spouse and immediate family members who have participated in the basic medical insurance of the city; the insured person can pay for his/her own medical checkups and preventive vaccination expenses. Second-grade participants/third-grade participants: None
4, the individual account is insufficient to pay the different payment ratios of the first-grade participants: first-grade participants continuously enrolled in the insurance for one year, in the same medical insurance year, out-of-pocket outpatient basic medical expenses and local supplemental medical costs of the supermarkets on-the-job average wages of workers 5%, the excess part of the integrated fund by the provisions of the 70% (over 70 years of age to pay 80%). . Second-class participants/third-class participants: none
5, outpatient large equipment inspection and treatment of the costs incurred by different reimbursement rates first-class participants: 80% paid by the integrated fund in accordance with the provisions. Participants in the second/third tier: the maximum unit price of general diagnostic and treatment items will be paid at a maximum of 120 yuan.
6. General outpatient blood transfusion costs are paid differently for first-tier participants: 90% of the cost is paid by the integrated fund according to regulations. The second class of participants/third class of participants: 70% paid by the integrated fund according to the regulations.7. Outpatient treatment of major illnesses is different from the first class of participants/second class of participants/third class of participants: according to the length of continuous participation in the insurance by the integrated fund according to the provisions of the payment of 60%-90%.
Legal basis:
Social Insurance Law of the People's Republic of China
Article 2 of the State establishes a social insurance system of basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance and other social insurance systems to safeguard the right of citizens to obtain material assistance from the State and society in old age, sickness, industrial injury, unemployment and maternity in accordance with the law. society in the event of old age, sickness, industrial injury, unemployment or maternity, in accordance with the law.
Article 25 The State establishes and improves the basic medical insurance system for urban residents.
Basic medical insurance for urban residents combines individual contributions with government subsidies.
The government shall subsidize the part of the individual contributions required by those who are entitled to the minimum subsistence guarantee, persons with disabilities who have lost their ability to work, and elderly persons and minors over sixty years of age from low-income families.