The importance of medical insurance is self-evident. For ordinary people, being able to get large reimbursements for medical treatment depends entirely on the complete welfare policy of medical insurance. In Shenzhen, almost everyone participates in the purchase of medical insurance
The levels of medical insurance are also divided into three levels
That is, the first, second and third levels. Many friends do not know their specific differences. Today I will take you to learn more about them! Before answering your questions, we will first It should be made clear that social security includes five insurances: pension insurance, medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance.
Only medical insurance is divided into brackets
The other four insurances are not divided into brackets.
The difference between the first, second and third tiers of social insurance in Shenzhen___
The payment standards are different. If an employee participates in the first tier of medical insurance, the monthly payment shall be based on the employee's total monthly salary of 8.2 or 7.2. , of which the employer pays 6.2 or 5.2, and the individual pays 2. The payment base for the second level of medical insurance is the average monthly salary of Shenzhen employees in the previous year, and the payment ratio is 0.8 (basic medical insurance + local supplementary medical insurance), of which 0.6 is paid by the unit and 0.2 is paid by the individual. The payment base for the third level of medical insurance is the average monthly salary of Shenzhen employees in the previous year, and the payment ratio is 0.55 (basic medical insurance + local supplementary medical insurance), of which 0.45 is paid by the unit and 0.1 is paid by the individual. If you are in the third level of medical insurance, the monthly medical insurance payment is 51.12 yuan, of which the personal payment is 9.31 yuan.
Principles of medical treatment
First-tier insured persons: seek medical treatment at any designated medical institution in the city.
Second-tier insured persons: outpatient medical treatment at the bound social health center, inpatient medical treatment at any designated medical institution in the city, and outpatient treatment at prescribed medical institutions for serious illnesses.
Three levels of insured persons: outpatient treatment at the bound social health center, inpatient and outpatient serious illness treatment at prescribed medical institutions.
Reimbursement Principles
First-tier insured persons: Whether they are Shenzhen households or non-Shenzhen households, they can go to any designated medical institution in the city for outpatient treatment or hospitalization and swipe their card for reimbursement.
Second-level insured persons: Whether they are Shenzhen households or non-Shenzhen households, they must go to the bound social welfare outpatient clinic. If you are hospitalized, you can go to any designated medical institution in the city.
Three-tier insured persons: Whether they are outpatient or hospitalized, they must go to the bound medical institution. Want to inquire and apply for social security? Send social security in the Shenzhen Chacha public account dialog box to get the relevant entrance online_
General outpatient treatment___
First-tier insurance: The personal account is used to pay the insured’s medical expenses within the scope of the general outpatient medical insurance catalog. For the basic medical expenses of the social health center, 70% will be paid from the personal account and 30% will be paid from the overall fund according to regulations.
Second-tier insured persons/Third-tier insured persons: Those belonging to Category A drugs and Category B drugs will be paid by the community outpatient coordinating fund at the proportion of 80 and 60 respectively. Individual diagnosis and treatment belonging to the medical insurance catalog or For medical materials, RMB 90 will be paid by the community outpatient coordinating fund, but the maximum payment amount shall not exceed RMB 120. The outpatient medical expenses paid by the community outpatient coordinating fund to each second- and third-tier insured person in a medical insurance year shall not exceed RMB 1,000. Yuan.
Personal account family financial aid
First-tier insured persons: if the personal account accumulation exceeds 5% of the average salary of employees working in this city in the previous year, the excess can be taken to designated pharmacies By purchasing over-the-counter drugs within the scope of the medical insurance catalog, you can pay for yourself and your spouse and immediate family members who have participated in the city's basic medical insurance. Expenses for physical examinations and vaccinations for spouses and immediate family members who participate in the city's basic medical insurance.
Second-tier insured persons/Third-tier insured persons: None. Social security cards cannot be swiped when buying medicines at pharmacies.
Insufficient personal account payment
First-tier insured persons: First-tier insured persons have been insured for one consecutive year and pay out-of-pocket basic medical expenses and local expenses in the same medical insurance year. If the average salary of supermarket employees on the job is RMB 5 to supplement medical expenses, the excess will be paid RMB 70 from the overall fund in accordance with regulations (80 RMB will be paid to those over 70 years old).
Second-tier insured persons/Third-tier insured persons: None
The second-tier and third-tier medical insurance do not have personal accounts
So there is no account balance.
You cannot go to pharmacies to buy medicines. If you are in the first grade, your balance must meet the payment conditions before you can buy over-the-counter drugs in the medical insurance catalog at pharmacies
Outpatient large-scale equipment inspection
Expenses incurred for treatment and treatment___ First-tier insured persons: 80 will be paid from the overall fund in accordance with regulations. Second-tier insured persons/Third-tier insured persons: The maximum unit price for ordinary diagnosis and treatment items shall not exceed 120 yuan.
General outpatient blood transfusion costs for first-tier insured persons: 90 will be paid from the overall fund in accordance with regulations. Second-tier insured persons/Third-tier insured persons: 70 will be paid from the overall fund in accordance with regulations.
Outpatient critical illness benefits for first-tier insured persons/second-tier insured persons/third-tier insured persons: 60-90 RMB will be paid from the overall fund according to regulations according to the length of continuous insurance participation.
Hospitalization benefits for first-tier insured persons and second-tier insured persons: the basic medical expenses incurred during hospitalization and the portion above the threshold of local supplementary medical expenses shall be paid 95 or 90 according to regulations.
Third-level insured persons 1. Can be hospitalized in the settlement hospital of the bound social welfare center, or be transferred to the specified hospital through settlement hospital. The basic medical expenses and local supplementary medical expenses incurred will be paid in The partial reimbursement ratio above the hospitalization deductible is:
First-level hospital: 85
Second-level hospital: 80
Third-level hospital: 75 2. If If you are hospitalized in a specified hospital other than the settlement hospital without referral, you will be paid at 90% of the hospitalization payment standard of the hospital where you visited (i.e., the payment standard in Article 1 above).
Benefits for medical treatment outside the city
First-tier insured persons: ordinary outpatient expenses, serious illness outpatient expenses, and hospitalization expenses can be reimbursed according to regulations.
Second-tier insured persons/Third-tier insured persons: Ordinary outpatient expenses will not be reimbursed, but outpatient expenses and hospitalization expenses for serious illnesses that meet the regulations can be reimbursed according to regulations. The payment of medical insurance is relatively flexible. If the original payment is in the second or third level and meets certain conditions, the level can be modified.
If we want to modify the level of medical insurance
How should we do it? ?
Modification of Shenzhen Medical Insurance Level___ If the employee is a Shenzhen household employee, the employer must participate in the first level of medical insurance, and the level cannot be changed. If you are a non-Shenzhen household employee, the employer can choose one of the first, second, and third levels of medical insurance to participate. The same unit only has one opportunity per year to change the basic medical insurance level for its employees (usually July 1 By July 20) If you have already registered in Shenzhen, please inform the relevant person in charge of the company and modify it in the system. There is no need to wait for the time to uniformly modify the medical insurance grade. In addition, the change of medical insurance levels for flexible employment personnel is not subject to the once-a-year limit (individuals can only pay the first or second level of social security). The mutual conversion of different medical insurance levels will not affect the calculation of cumulative payment years and continuous payment years.