Medical insurance reimbursement has always been a hot issue that people pay attention to, and editor Tuhaobao will explain this issue in detail. The basic medical insurance in Shenzhen includes comprehensive medical insurance, hospitalization medical insurance, migrant workers' medical insurance, children's hospitalization and serious illness outpatient medical insurance. After the insured has gone through the insurance formalities and paid the medical insurance premium in full, he will enjoy the medical insurance benefits stipulated in the Measures of Shenzhen Municipality on Social Medical Insurance from the next month 1 day. The difference among comprehensive medical insurance, hospitalization medical insurance and migrant workers' medical insurance: 1. Comprehensive medical insurance: both deep households and non-deep households can participate. Pay more, Shenzhen hukou must participate in comprehensive medical insurance. You can buy medicines in pharmacies, see outpatient clinics, stay in hospitals, enjoy reimbursement for serious illness outpatient clinics, and enjoy maternity insurance. Foreign urban hukou can also buy comprehensive medical insurance, as long as the work unit is willing. & gt& gt& gt List of designated social security medical institutions in Shenzhen II. In-hospital medical insurance: Non-local urban hukou must participate in in-hospital medical insurance, and the payment is lower than comprehensive medical insurance. Can enjoy a small amount of outpatient reimbursement, maternity insurance benefits, foreign farmers and units are willing to participate in this hospitalization medical insurance, mainly for non-Shenzhen hukou payment. Hospitalization can reimburse most of the expenses, excluding maternity insurance. You can see the clinic, but you need to go to the bound community health center. & gt& gt& gt To put it simply, the list of Shenzhen Social Health Center says that the hospitalization reimbursement treatment of deep-seated comprehensive medical insurance and non-deep-seated inpatient medical insurance is the same, except that deep-seated comprehensive medical insurance has a personal account, which can be used to buy medicines at pharmacies, reimburse part of outpatient expenses, and also include maternity insurance, which can reimburse maternity expenses. Non-in-hospital medical insurance can only be reimbursed for hospitalization. No personal account, no outpatient reimbursement, no maternity insurance. 3. Migrant workers' medical insurance (commonly known as migrant workers' medical insurance, also known as cooperative medical insurance): This is for foreign farmers, and the hospitalization treatment is relatively low, with a small amount of outpatient subsidies and hospitalization reimbursement, but the reimbursement ratio and limit are not as high as the above two medical insurances, and there are not as many hospitals as above. Need to go to the bound social health clinic, excluding maternity insurance. Non-local farmers and units should at least provide medical insurance for workers. If the unit is willing, it can choose hospitalization medical insurance. At least all non-local urban hukou should be inpatient medical insurance. If the unit is willing, it can participate in comprehensive medical insurance. & gt& gt& gt List of Designated Medical Institutions for Migrant Workers in Shenzhen All the above three kinds of medical insurance hospitalization can be reimbursed, and the comprehensive reimbursement for hospitalization is the same as hospitalization, but the reimbursement for cooperative hospitalization is lower than the first two kinds, and there are no hospitals with more than the first two kinds, so you can only go to the designated social health hospital for medical treatment, not directly to the big hospital. The reimbursement rate of migrant workers' medical insurance is not as high as that of urban medical insurance. The reimbursement ratio of medical insurance for urban workers and urban residents is different. Generally speaking, medical insurance for employees is higher than that for residents, with an average of 80% for employees and 50% for residents. As for the specific proportion, it is related to the age of the insured and the level of the hospital. The older you are, the lower the hospital level and the higher the reimbursement rate. (The term "migrant workers" as mentioned in these Measures refers to non-urban household registration employees who are employed in this Municipality and are not registered in this Municipality. For more information, please click on >>& gt Interpretation of Shenzhen Social Medical Insurance Measures & gt17 Detailed explanation of new measures of Shenzhen Social Medical Insurance Measures >:>& gt Shenzhen Social Medical Insurance Cash Reimbursement Management Measures Medical Insurance Reimbursement Measures: Medical insurance reimbursement should be made at the local medical insurance management center or the medical insurance checkout window of designated medical institutions. For specific provisions, see the relevant parts of the Measures of Shenzhen Municipality on Social Medical Insurance (underlined part): Article 78 The insured shall pay the following medical expenses in cash first, and then apply to the municipal social insurance agency with relevant documents and materials, and the municipal social insurance agency shall review and reimburse according to the regulations: (1) The insured with comprehensive medical insurance and hospitalization medical insurance is in emergency treatment in other cities in China or has been approved to be referred to China. (2) The medical expenses incurred by the insured in the medical institution for filing in other cities in China for a long time or living in other cities in China after retirement; (3) Medical expenses incurred by the insured in outpatient dialysis of chronic renal failure, outpatient use of anti-rejection drugs after organ transplantation, outpatient chemotherapy of malignant tumor, interventional therapy, radiotherapy or radionuclide therapy in designated medical institutions; (four) medical expenses incurred by the insured for migrant workers' medical insurance in the emergency department of non-settlement hospitals due to going out or going on business trips; (five) with the consent of the hospital, the expenses incurred by the insured in the catalogue of medical treatment projects outside the hospital; (six) maternity medical expenses that meet the requirements in other cities in China. Article 80 Under any of the following circumstances, the medical expenses incurred by the insured in hospitalization or the medical expenses incurred by the insured in outpatient service of comprehensive medical insurance shall be paid in cash in advance, and the medical institutions for medical treatment may review and reimburse according to the relevant documents and materials: (1) The designated medical institutions for medical treatment have computer failure or are unable to keep accounts due to the damage of social security cards; (two) with the consent of the hospital, the prescription drugs within the scope of the basic medical insurance catalogue are purchased outside the hospital; Article 81 The insured shall submit the following materials for reimbursement within 12 months from the date of occurrence of medical expenses (hospitalization from the date of discharge): hospital referral certificate, copy of outpatient medical records or inpatient medical records stamped by the hospital, disease diagnosis certificate (outpatient service), discharge diagnosis certificate or discharge summary (hospitalization), detailed list of expenses, original receipt of expenses, certificate of employer, and so on. The specific materials to be provided for reimbursement of hospitalization expenses are as follows: (1) outpatient medical records (original inspection, copy receipt); (2) Hospital medical records stamped with the official seal of the hospital (including admission records, doctor's orders, operation records, discharge records and related inspection reports) (copies); (3) A valid invoice (check the original and receive a copy); (4) Detailed list of expenses (copy received); (5) disease diagnosis certificate (original); (6) unit certificate (on-the-job employee) (original); (7) My medical card (check the original and receive a copy); (8) My bankbook in this city (limited to the four major state-owned banks) (check the original and receive a copy). & gt& gt& gt If you go to the city for medical treatment, you can reimburse the insured in proportion. What is the situation, you can go to the municipal social insurance agency for review and reimbursement according to regulations? 1. Outpatient peritoneal dialysis, organ transplantation (anti-rejection therapy), chemotherapy, radiotherapy and radionuclide therapy (before accounting) were performed in designated medical institutions in our city due to chronic renal insufficiency (uremia stage); 2, to the non designated medical institutions for emergency rescue; 3. Retirees who receive monthly pensions from social insurance institutions in this Municipality have lived in other areas of China (excluding Hong Kong, Macao and Taiwan, the same below) for a long time, and selected three local medical insurance designated medical institutions as medical outpatient serious illness (category I) medical institutions at their places of residence, and have gone through the filing formalities in social insurance institutions in this Municipality; 4, long-term resident in China (excluding Hong Kong, Macao and Taiwan, the same below) other cities of the city registered insured, in the workplace to choose 3 local medical insurance designated medical institutions as their medical outpatient serious illness (category I) medical institutions, and has been in the city social insurance institutions for the record. & lt/FONT & gt； & lt/FONT & gt； How long will it take to pay medical insurance to reimburse hospitalization expenses? How to reimburse hospitalization expenses? How to calculate the reimbursement expenses? Generally speaking, the medical insurance paid by the unit can be reimbursed in the next month, while the medical insurance paid by the individual generally needs to be paid for more than half a year to enjoy the reimbursement treatment. When going through the hospitalization formalities, the medical insurance records and medical insurance cards should be handed over to the inpatient department of the hospital for the smooth use of the medical insurance pooling account. If it cannot be submitted at that time due to emergency, the medical insurance records and cards should be handed over to the hospital in time. Under normal circumstances, if there is a deductible line for medical insurance reimbursement, different inpatient deductible lines will be set according to different levels of hospitals. The higher the level, the higher the deductible. City level 1 and below hospitals 100 yuan, city level 2 hospital 200 yuan, city level 3 hospital 300 yuan, non-local hospital 400 yuan. If the deductible line is not reached, reimbursement will not be supported. In other words, you must be above the deductible to be reimbursed. The part above the deductible line shall be reimbursed according to the regulations. In addition, there may be some drugs that are not covered by medical insurance, so you need to pay some cash when you go through the hospitalization procedures. Medical insurance reimbursement is carried out in proportion, and the proportion of hospitalization reimbursement in different levels of hospitals is different. Generally floating around 70%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors. For example, it is clear that Class A drugs can enjoy full coverage, Class C drugs need to bear all the costs, and Class B drugs will report 80% and bear 20% of the costs. For example, hospitalization deductible 1000 yuan, 500 yuan's self-funded medicine, if someone's medical expenses total 5,000 yuan. 85% reimbursement, 15% conceit. Then the medical insurance can be reimbursed = (5000-1000-500) x 85% = 3500 x 85% = 2975 yuan, and the hospital can settle the account directly with the medical insurance bureau; In addition, individuals need to pay cash =1000+500+(5000-1000-500) x15% =1500+525 = 2025 yuan, and this part of the money is to be paid in cash. Reminder: It is very important to go to a designated medical institution for medical treatment before reimbursement. & gt& gt& gt The addresses and telephone numbers of Shenzhen Social Security Bureau and social security stations in various districts.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.