1. The personal account is used to pay for basic outpatient medical expenses, local supplementary medical expenses, and the purchase of drugs in the medical insurance catalogue at designated retail pharmacies.
2, continuous insurance for one year, in the same medical insurance year, individuals pay more than 5% of the average wage of employees in Shenzhen last year, and the excess part is paid by the basic medical insurance serious illness pooling fund or local supplementary medical insurance fund in accordance with the regulations, and 80% is paid over 70 years old.
3. If the accumulated amount of personal account exceeds 5% of the average salary of employees in Shenzhen last year, the excess can be used to pay the following expenses:
I purchase the expenses of non-prescription drugs within the scope of the basic medical insurance and local supplementary medical insurance drugs list in designated retail pharmacies.
The basic medical expenses and local supplementary medical expenses paid by myself, my spouse and immediate family members who have participated in the basic medical insurance in this Municipality when attending the designated medical institutions.
I, my spouse and my immediate family members who have participated in the basic medical insurance in this city, the cost of health examination, vaccination and other prescribed expenses.
note:
Insured persons who enjoy the treatment specified in the preceding paragraph do not enjoy the following treatment:
The basic medical expenses and local supplementary medical expenses incurred by the first-class insured in the designated community health centers in Shenzhen City are 70% paid by individual accounts, and 30% paid by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations, except for the following items:
(1) the cost of dental treatment;
② Rehabilitation physiotherapy expenses;
③ Expenses for examination and treatment of large medical equipment;
(4) Other engineering expenses stipulated by the municipal government.
3. If the accumulated savings in personal accounts of Class I insured persons in basic medical insurance exceeds 5% of the average salary of employees in Shenzhen last year (current standard: 49 18 yuan/month), the excess can be used to pay the following expenses:
(1) I purchase the expenses of non-prescription drugs within the scope of the basic medical insurance and local supplementary medical insurance drugs list in designated retail pharmacies;
(two) the basic medical expenses and local supplementary medical expenses paid by himself, his spouse and his immediate family members who have participated in the basic medical insurance in this Municipality when they visit the designated medical institutions;
(three) I and my spouse, immediate family members to participate in the city's basic medical insurance health examination and vaccination costs;
(four) other medical expenses stipulated by the state, Guangdong Province and this Municipality.
Reimbursement treatment of Shenzhen medical insurance first-class designated social health center
1. The basic medical expenses and local supplementary medical expenses incurred by Class I insured persons in designated community health centers in Shenzhen are 70% paid by personal accounts, and 30% paid by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations, except for the following items:
(1) the cost of dental treatment;
② Rehabilitation physiotherapy expenses;
③ Expenses for examination and treatment of large medical equipment;
(4) Other engineering expenses stipulated by the municipal government.
2. Basic medical insurance The basic medical expenses and local supplementary medical expenses incurred by the first-class insured in Shenzhen designated medical institutions for large-scale medical equipment inspection and treatment shall be paid 80% by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations.
Treatment of serious illness in the first-level outpatient department of Shenzhen basic medical insurance
1. In any of the following circumstances, the insured person shall enjoy the treatment of serious illness in outpatient service:
① Outpatient dialysis for chronic renal failure;
② Outpatient anti-rejection drugs included in the scope of medical insurance payment after organ transplantation;
③ Outpatient chemotherapy, interventional therapy, radiotherapy or radionuclide therapy for malignant tumor;
④ Hemophilia specialist outpatient treatment;
⑤ Specialized outpatient treatment of aplastic anemia;
⑥ Specialized outpatient treatment of thalassemia;
⑦ Specialized outpatient treatment of intracranial benign tumors;
Eight other circumstances approved by the municipal government.
Legal basis:
Notice of Shenzhen Medical Insurance Bureau on Printing and Distributing the Catalogue of Medical Service Price Items in Shenzhen
Second, the relevant requirements
Non-profit medical institutions to carry out the above-mentioned self-pricing medical service price items must keep the price relatively stable. Non-profit medical institutions shall not charge patients for medical service price items that have not been announced by the medical insurance department.
Non-profit medical institutions should incorporate medical service price items into their own charging system in a timely manner as required; When the patient pays the fee, the charging and settlement information will be uploaded to the medical insurance settlement system simultaneously to ensure the accuracy and integrity of the medical charging information; It is necessary to strengthen internal management, strictly abide by the regulations such as clearly marked price and daily fee list system, do a good job in price information disclosure and policy interpretation, and protect patients' right to know.