Can't Shenzhen tertiary medical insurance outpatient service be reimbursed if it exceeds 1000?

Yes, if you spend 1000 yuan a year on social security, you have to see a doctor at your own expense. The third-level insured with medical insurance card will enjoy zero bonus medical insurance, and there will be 1 0,000 yuan for outpatient reimbursement every medical year. If this 1 0,000 yuan is used up, you have to withdraw cash yourself. To put it bluntly, you paid for all this money; You can report 1000 yuan per year for the second and third grades of basic medical care, which is the money from the overall fund, while the money from the first-level outpatient service of basic medical care is your own money, and only the money from the overall fund can be truly reimbursed. Of course, the first file of basic medical care does not mean that there is no welfare. It has the following three advantages: first, it has been insured continuously for more than 12 months, and the out-of-pocket expenses of outpatient service exceed 3 1 and 3 1 yuan in a medical year, and the excess part can be reimbursed by 70%; Second, it can be reimbursed in all social health hospitals; Third, the number of outpatients is large.

The difference between the second and third-grade medical insurance lies in the different payment, treatment and adaptation groups.

The second class insured person goes to the bound social health center for medical treatment, is hospitalized in any designated medical institution in the city, and is seriously ill in the prescribed medical institution. The third-level insured person goes to the binding social health center for medical treatment, and the hospitalized and outpatient patients go to the prescribed medical institutions for medical treatment. General outpatient treatment is as follows:

1, which belongs to Class A drugs and Class B drugs, are paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively;

2, belonging to the medical insurance directory of individual diagnosis and treatment or medical materials, by the community outpatient co-ordination fund to pay 90%, but the maximum payment amount does not exceed 120 yuan;

3. The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-and third-level insured in a medical insurance year shall not exceed 1 000 yuan.

Personal account of medical insurance is a special account established according to the basic medical insurance policy, which is specially used to store the medical insurance premiums paid by the insured and the funds allocated by the employer according to a certain proportion, and record the medical consumption. The funds in the personal account are used to pay for the out-of-pocket part of medical treatment and medicine purchase. Social security card is an electronic information card that medical insurance agencies handle for the insured to seek medical treatment and purchase medicines, and is used to verify identity, record and store personal account funds and usage. With my social security card, the insured can seek medical treatment at any designated medical institution in this city or purchase medicines at designated retail pharmacies.

Legal basis:

Measures of Shenzhen Municipality on Social Medical Insurance

Article 40 In case of any of the following circumstances, the outpatient medical expenses incurred by the insured in the secondary and tertiary medical institutions of basic medical insurance shall be paid in advance by himself, and the relevant documents and materials shall be submitted to the settlement hospital or designated medical institutions for review and reimbursement:

(1) Outpatient medical expenses incurred by referral to a non-settlement hospital with the consent of the settlement hospital;

(two) outpatient medical expenses incurred in emergency rescue in non-settlement hospitals due to work or business trip;

(three) due to computer failure in designated medical institutions, the social security card is damaged or cannot be recorded during the replacement period.