First-class outpatient reimbursement: 70% for individual account and 30% for overall fund according to regulations; First-class hospitalization reimbursement: 95% or 90% is paid for the part above the deductible.
The object of reimbursement for medical treatment in different places in Shenzhen medical insurance
1. The hospitalization expenses of four types of medical personnel in Shenzhen, such as resettlement and retirement, long-term residence in different places, permanent work in different places and referral in different places, can be directly reimbursed in different places.
Scope of reimbursement for medical treatment in Shenzhen medical insurance in different places
(1) reimbursement of hospitalization expenses
With the normal identity of the city's basic medical insurance one, two (children), three insured, off-site hospitalization basic medical expenses, local supplementary medical expenses, including self-treatment, referral, permanent residence in the mainland and other types of hospitalization.
(2) reimbursement of outpatient medical expenses
1. General reimbursement for outpatient service: first-class insured of basic medical insurance, insured with balance in personal account.
2. Out-of-year outpatient service exceeds the limit: the first-class insured of basic medical insurance has been insured for 12 months before seeing a doctor, which is in line with one of the situations of applying for permanent residence in the mainland or referral outside the city.
3. Reimbursement for special outpatient inspection: The insured person of Class I of basic medical insurance meets one of the situations of applying for permanent residence in the Mainland or referral outside the city.
4. Reimbursement for serious illness outpatient service: applying for registration of serious illness outpatient service in Shenzhen-Shenzhen, which meets the conditions of filing in the mainland or referral outside the city for the first, second (children) and third-level insured persons of basic medical insurance.
Materials required for reimbursement of medical treatment in Shenzhen medical insurance in different places
(1) reimbursement of outpatient medical expenses
Necessary materials
1, the social security card of the insured. If an agent is entrusted, the agent's ID card (original inspection and copy of receipt) shall also be provided.
2, the original charge receipt stamped with the official seal of the hospital (printed by the finance department or the tax department) (original.
3, stamped with the official seal of the hospital cost list (original).
4. Bank passbook or bank card of the insured (provided by the insured who has not applied for financial social security card, Shenzhen-Shenzhen account opening worker-bank, construction-bank, agriculture-bank, China-bank and recruitment-bank) (original inspection, copy received).
(2) reimbursement of general medical hospitalization expenses
Necessary materials
1, the social security card of the insured. If an agent is entrusted, the agent's ID card (original inspection and copy of receipt) shall also be provided.
2, the original charge receipt stamped with the official seal of the hospital (printed by the finance department or the tax department) (original).
3, stamped with the official seal of the hospital cost list (original).
4. Discharge record or discharge summary with official seal (original).
5. The insured's bankbook or bank card (provided by the insured who has opened an account in Shenzhen, ICBC, CCB, ABC, BOC and China Merchants Bank without a financial social security card).
legal ground
Article 4 of People's Republic of China (PRC) Social Insurance Law
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.
Article 29 of People's Republic of China (PRC) Social Insurance Law
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
"Shenzhen social medical insurance measures" sixtieth
The basic medical expenses and local supplementary medical expenses incurred by the personnel in the medical institutions for the record shall be reimbursed by the municipal social insurance institution upon the application of the insured, according to the standard of medical charges not higher than this Municipality.
Article 2 of the Measures of Shenzhen Municipality on Social Medical Insurance
The city implements a multi-level and multi-form social medical insurance system.
The government establishes basic medical insurance and local supplementary medical insurance.
According to the payment and corresponding treatment, the basic medical insurance is divided into one, two and three forms.
Article 49 of the Measures of Shenzhen Municipality on Social Medical Insurance
Basic medical insurance The basic medical expenses and local supplementary medical expenses incurred by the first-class insured in the designated community health centers in this Municipality shall be paid by the individual account 70% and by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund 30%, except for the following items:
The cost of dental treatment;
(2) Rehabilitation physiotherapy expenses;
(three) the cost of inspection and treatment of large medical equipment;
(four) other project expenses stipulated by the municipal government.