One-stop settlement:
The insured person is hospitalized in designated medical institutions inside and outside Shenzhen, and the medical expenses used are within the scope of "Shenzhen Huimin Insurance". When leaving the hospital, one-stop social security card settlement can be realized without applying for claims;
Sporadic reimbursement:
For medical expenses that do not meet the "one-stop" settlement and meet the insurance liability of "Shenzhen Huimin Insurance", "Shenzhen Huimin Insurance" will make sporadic claims. The applicant submits the required certificates and materials online through the official WeChat account of Shenzhen Huimin Insurance to apply for sporadic claims. After the audit and settlement, the fees paid by Shenzhen Huimin Insurance will be directly transferred to the bank account designated by the applicant.
Reimbursement amount of Shenzhen Huimin Insurance in 2023:
Different security responsibilities have different reimbursement amounts.
Responsibility 1: The expenses in the medical insurance catalogue are guaranteed. The annual deductible is10.6 million, the reimbursement rate is 80%, and the annual maximum compensation amount is10.2 million.
Responsibility 2: Protection of self-funded compliance drugs and inspection fees for hospitalization. The annual deductible line is10.6 million, the reimbursement rate is 70%, and the maximum compensation amount is10.2 million;
Responsibility 3: outpatient compliance drug expense insurance, with an annual deductible of 40,000 yuan and a reimbursement rate of 50%, with a maximum of 500,000 yuan.
Responsibility 4: The self-funded drug expenses for rare diseases are guaranteed. The annual deductible is 1 0.6 million, the reimbursement rate for insured for more than 3 years is 70%, the reimbursement rate for insured for more than 2 years is 60%, and the reimbursement rate for insured for less than1year is 50%, and the annual maximum compensation amount is 500,000.
Responsibility 5: Guarantee the cost of medical machinery pass in Hong Kong and Macao, with a deductible of 40,000, a compensation ratio of 50% and a maximum reimbursement of 500,000.
To sum up, the reimbursement of Shenzhen Huimin insurance should be based on the way you choose.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
_ The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.