In the past, Shenzhen household registration insured can only choose to participate in employee medical insurance, whether it is personal payment or payment through the unit. At present, individual insurance has an option of residents' medical insurance, but residents' medical insurance is not included in the accumulated payment period of employee medical insurance; The payment base is Shenzhen? Last year, the monthly disposable income of Shenzhen urban residents (202 1 year, 5900 yuan/month) was 1.85% (including medical insurance for serious illness), the financial subsidies for children's medical insurance and students' medical insurance were 1.2%, and individuals paid 0.65%(38 yuan/month, about 0.65% per year).
Second, employee medical insurance is only divided into first and second grades.
The original third gear was merged into the second gear. The first payment rate is 2% for individual and 6.05% for unit (including the premium of serious illness insurance), and the second payment rate is 0.5% for individual and 0/.55% for unit/kloc-0. The lower limit of the payment base is this city? Last year, 60% of the average monthly salary of employees in full-caliber urban units (if it is implemented in 2023, the data of 202 1 will be used. I calculated that the full-scale salary of 202 1 is about 10952 yuan, and 60% is 657 1). The part paid by the first-level insured person will enter the medical treatment link.
The outpatient quota of third-grade and second-grade insured persons and residents' medical insurance insured persons has been increased.
Originally, the annual amount of social welfare was 1000 yuan, but now it is changed to? The maximum is not more than 65438+ 0.5% of the average annual salary of employees in this city last year. The annual salary of 202 1 is 155568 yuan, and 1.5% is almost 2333 yuan; Also bound to the hospital;
The first general outpatient service can be reimbursed.
This problem has been discussed in previous issues. General outpatient service can be reimbursed 55% to 85% according to different hospital levels. For your reference, Shenzhen medical insurance has undergone a major reform since February 65438. Some people are happy and some people are worried! The proportion of reimbursement for category I special diseases is related to the continuous payment period of employees' medical insurance, accounting for 60%-90%, 80% for category II special diseases and 60% for residents' medical care. For the types and identification details of special diseases, reply on the official account of WeChat: critical illness clinic;
Fifth, the hospitalization deductible line is improved.
Originally, the highest deductible line for hospitalization in Shenzhen was 300 yuan, and now it has been raised to tertiary hospital 900 yuan, secondary hospital 600 yuan and primary hospital 300 yuan. The proportion of hospitalization reimbursement has increased, and it is still 90% in tertiary hospitals and 1% to 4% in primary and secondary hospitals.
Six levels of local supplementary medical care are included in the serious illness insurance.
The basic medical reimbursement amount is related to the continuous payment period of medical insurance. The continuous payment period between employee medical insurance and resident medical insurance shall not exceed 3 months and shall not be interrupted. The maximum reimbursement for basic medical care is 930,000 yuan. If it exceeds the limit, and the self-funded expenses in a medical year are between 654.38+000-50,000 (now changed to 654.38+00-654.38+02), 70% can be reimbursed through critical illness insurance, and 80% can be reimbursed for the part of 50,000 yuan and above. The maximum amount of critical illness insurance is 6.5438+0 million;
7. Ordinary outpatient clinics in different places can be reimbursed.
Retirees, long-term residents in different places and permanent residents in different places can directly settle outpatient expenses in local networked hospitals after filing; The maximum amount of outpatient reimbursement cannot exceed the maximum amount of reimbursement in Shenzhen.
You can't get a pension in Shenzhen, but you can also enjoy medical treatment in Shenzhen.
Guangdong province's medical insurance transfer and connection measures stipulate that it is strictly forbidden to enjoy medical treatment and receive pensions together. In other words, if you meet the medical insurance conditions of the last insured place, even if you can't get a pension at the last insured place, you have the right to choose to keep the medical insurance of the last insured place. After reaching retirement age, you can stop paying and enjoy medical insurance benefits for free: First, the accumulated payment years of employees participating in medical insurance meet the requirements of the accumulated payment years of employees in the place where they enjoy retirement benefits (after 2030, the actual payment years of employees participating in medical insurance after retirement reach 10 year. If the above conditions cannot be met, you can choose to postpone payment on a monthly basis or make up the remaining years in one lump sum, or you can make up with the money from the medical account;