Yes, you need to pay for medical treatment after the 1,000 yuan in the social security year is used up. However, if you swipe the medical insurance card, you will enjoy zero bonus on medical expenses. Participants in the third tier of medical insurance will have If the outpatient reimbursement fee of 1,000 yuan is used up, you have to get cash yourself. To put it bluntly, these are all the money you pay; for the second and third levels of basic medical care, you can claim 1,000 yuan per year. This money is from the unified fund, while the money for outpatient visits in the first level of basic medical care is your own money. Only the money from the overall pool fund is reimbursed in the true sense. Of course, the first level of basic medical care does not mean that there are no benefits. It has the following three advantages. First, if you have been continuously insured for more than 12 months, and the out-patient out-of-pocket expenses exceed 3,131 yuan in a medical year, the excess amount will be 70 can be reimbursed. Secondly, 30 can be reimbursed for outpatient visits in all social welfare hospitals. Thirdly, 80 can be reimbursed for large-scale equipment inspections in outpatient clinics. This reimbursement is all from the unified fund. Otherwise, all other expenses are reimbursed. The money in your own account;
The difference between the second and third tiers of medical insurance is that their payment, benefits and applicable groups are different.
The second-tier insured persons will receive outpatient medical treatment at the bound social health center, inpatient medical treatment at any designated medical institution in the city, and outpatient serious illness medical treatment at prescribed medical institutions. Insured persons in the third category receive outpatient medical treatment at the bound social health center, and inpatient and outpatient serious illness medical treatment at prescribed medical institutions. General outpatient benefits are as follows:
1. Drugs belonging to Category A and Category B will be paid by the community outpatient coordinating fund in the proportion of 80 and 60 respectively;
2. Those belonging to the medical insurance catalog For single diagnosis and treatment or medical materials, RMB 90 will be paid from the community outpatient overall fund, but the maximum payment amount shall not exceed 120 yuan;
3. The community outpatient overall fund will pay each second-tier and third-tier insured person The total outpatient medical expenses in a medical insurance year shall not exceed 1,000 yuan.
The medical insurance personal account is established in accordance with the basic medical insurance policy and is specially used to store the medical insurance premiums paid by the insured and the funds transferred in a certain proportion from the employer's payment, and to record medical consumption. Dedicated account. The funds in the personal account are used to pay for out-of-pocket expenses for medical treatment and drug purchases. The social security card is an electronic information card issued by the medical insurance agency for insured persons to seek medical treatment and purchase medicines. It is used to verify identity, record and store personal account funds and usage status. With their social security cards, insured persons can seek medical treatment at any designated medical institution or purchase medicines at designated retail pharmacies in this city.
Legal basis:
"Shenzhen Municipal Social Medical Insurance Measures"
Article 40, the second-tier and third-tier insured persons of basic medical insurance need medical treatment. If the outpatient medical expenses of the patient fall under the following circumstances, the person shall pay first and then go to the settlement hospital or designated medical institution to apply for review and reimbursement with relevant documents and information:
(1) Transfer to a non-settlement hospital with the consent of the settlement hospital Outpatient medical expenses incurred in the hospital;
(2) Outpatient medical expenses incurred for emergency rescue in non-accounting hospitals due to work or business trips;
(3) Designated medical institutions for medical treatment A computer failure occurs, the social security card is damaged, or the account cannot be recorded during the reissue period.