When you see a doctor, you can swipe your comprehensive medical insurance card. When the balance of your personal account is , you can't overdraw, you can only pay cash. For patients with heavy outpatient burden, comprehensive medical insurance also has a special discount. When the outpatient expenses reach a high level, they can get a 3% discount.

The advantages of comprehensive medical insurance (the following advantages are not available in inpatient medical insurance and migrant workers' medical insurance):

1. All designated medical insurance hospitals in Shenzhen can swipe the medical insurance card to register for medical treatment (it is 12~14 yuan cheaper than the registration fee without swiping the medical insurance card, because when swiping the medical insurance card to register, the Social Security Bureau directly pays the hospital a subsidy of 12~14 yuan).

2. With a comprehensive medical insurance card, you can get a 3% discount on the medicine fee and examination fee (the purpose of this discount is to advocate "finding a community health for minor illnesses and a hospital for serious illnesses". If you go to a big hospital for minor colds, no one cares about the small community health, which wastes the medical resources of the community health and leads to more crowded big hospitals).

3. Ensure serious illness in outpatient department and reduce the risk of "poverty due to illness". For example, if you spend 1, yuan a year on outpatient treatment, comprehensive medical insurance will help you to reimburse more than 6%, nearly 7% (the calculation method is more complicated, I put it at the bottom).

——— When using comprehensive medical insurance for hospitalization, you should pay a few hundred yuan deductible at your own expense, and the rest of the treatment expenses can generally be reimbursed 9%, and the hospitalization medical insurance is also 9%, and the proportion of migrant workers' medical insurance is 5~7%. You will see that the hospitalization of the three types of medical insurance can enjoy a large proportion of insurance, and only the outpatient service, comprehensive medical insurance is the most favorable in the outpatient service, and its preferential proportion depends on the actual cost of the insured.

———————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————— You shouldn't waste medical insurance money to write a CT application form for you.

To prevent "over-treatment", for example, if you can cure the disease after taking medicine for three days, you shouldn't waste medical insurance money to write medicine for 3 days.

The essence of medical insurance is to "concentrate all the insured's money to protect those who need it most". Everyone spends money on minor illness treatment, which makes the medical insurance fund unable to make ends meet and fails to treat the seriously ill patients who need the money most, which is not in line with the original intention of medical insurance.

comprehensive medical insurance, with personal account (comprehensive medical insurance is the only one with personal account among the three types of medical insurance in Shenzhen).

The Social Security Bureau has a special term "health check-up" for "self-proposed check-up", and the accumulated balance of personal account must exceed the baseline of the current year before it can be used for health check-up. For example, on July 1st this year, this baseline was 4,595 yuan. Assuming that the personal account balance of the landlord's medical insurance card is 4,7 yuan today, 15 yuan of it can be used for the landlord's "health check-up"; If the personal account balance is 4,6 yuan, then 5 yuan can be used for "health check-up"; If the personal account is less than 4595 yuan, you can't use the medical insurance health check-up, you can only have a medical check-up at your own expense.

Simply put, the usage of personal account is not at the discretion of the insured, and the Social Security Bureau has certain restrictions on it. The part exceeding 4,595 yuan can be used by the insured for his own health check-up, his own vaccination and for his family (family members refer to children, spouses and parents who have bought medical insurance in Shenzhen).

A small number of high-income people, because of their high income, pay a lot of medical insurance, and the accumulated personal account balance is also very high, ranging from 1, to tens of thousands. They are in a hurry to spend more on their own medical treatment. No problem, physical examination is available, and it is also available to see their families.

Most middle-income people don't pay much for medical insurance, and the accumulated personal account balance has just reached the average monthly income of last year (the average monthly income in Shenzhen in 211 was 4,595 yuan), so they can't use it for physical examination and medical treatment for their families (in fact, it is also a price to pay for medical treatment for their families by swiping a bank card, and there is no discount or discount for family access).

If you are below the line of 4,595 yuan, you can only see a doctor according to your actual condition. The doctor can prescribe whatever examination you should do and treat you as you should. In a word, it can meet the basic medical needs of the insured!

For those who exceed the basic medical needs, such as going to the stomatology department and finding tooth decay, the medical insurance will reimburse you for the cost of filling teeth; After tooth extraction, ceramic teeth should be inserted. The medical insurance thinks that dental inlay is a luxury, which is icing on the cake and a beauty project. The medical insurance will not reimburse you for the cost of dental inlay and tooth cleaning. Please thank you for your understanding at your own expense!

According to the calculation, Shenzhen people spend 2~3 yuan every time they see a doctor. If they see a doctor 3~1 times a year, can they spend all the money in their personal account? Most of them are inexhaustible, which means that the goal of ensuring the basic medical needs of the insured has been achieved.

that small number of people, such as seriously ill patients, such as patients with chronic diseases, need regular follow-up visits and long-term medication, and the money in their personal accounts is completely insufficient, and they have to pay a lot of money for medical treatment after running out of money in their personal accounts. How to protect this type of patients? Patients only need to swipe their medical insurance card to register, pay the medical insurance card, and the cash paid by swiping the medical insurance card will be automatically accumulated by the Social Security Bureau. When the annual out-of-pocket payment is 2757 yuan, the medical insurance card can be automatically discounted when seeing a doctor.

suppose that from July 1st, 212 to June 3th, 213 (this time range belongs to a medical insurance year, every year), the outpatient basic medical expenditure of patient A is as high as 5, yuan, excluding the personal account balance of 4, yuan on July 1st, 212, excluding the monthly personal account payment in 13 yuan (this figure is nonsense, everyone is different), and then excluding the self-payment of 2,757 yuan. The remaining expenses = 5,-4,-13 * 12-2,757 = 41,683 yuan. The Social Security Bureau reimbursed 7% of this 41,683 yuan, that is, 29,178.1 yuan, and the patient's burden was 3%, that is, 12,54.9 yuan. The outpatient basic medical expenditure in this year is 5, yuan, and the total personal account and cash payment of patients = 4+13 * 12+2757+1254.9 = 2,821.9 yuan, that is, 41.6% of 5, yuan; The social security bureau reimbursed 29,178.1 yuan, that is, 58.4% of 5, yuan < P > If the balance of patient B's personal account was 1 yuan on July 1, 212, the basic outpatient medical expenses from July 12 to June 13 were 4, yuan, and the discounted expenses = 4-1-13 * 12-2757 = 35,583 yuan. The Social Security Bureau reimbursed 7%, that is, 24,98.1 yuan, and the total payment of Patient B in the current year = 1+13 * 12+2757+1,674.9 = 15,91.9 yuan, that is, 37.8% of 4, yuan; The Social Security Bureau reimbursed 24,98.1 yuan, or 62.3% of 4, yuan.

If the personal account balance of Patient C is 1 yuan on July 1st, 212, the basic outpatient medical expenses from July 12th to June 13th are 8, yuan, and the discounted expenses = 8-1-13 * 12-2757 = 75,583 yuan. The patient will bear 3% of the expenses, that is, 22,674.9 yuan, and the Social Security Bureau will reimburse 7 yuan. The Social Security Bureau reimbursed 52,98.1 yuan, or 66.1% of 8, yuan.

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first, compare b and c, the initial balance of their personal accounts is 1 yuan, but the annual expenses of b are 4, yuan, and those of c are 8, yuan. The outpatient expenses of c are heavier, but the reimbursement ratio is higher, which is closer to 7%. This shows that the patients with greater burdens will get higher protection.

Let's compare A with B. A's personal account initially accumulated 4, yuan, which means that he was healthy before and seldom saw a doctor. B's personal account initially accumulated in 1 yuan, which may be a long-term doctor, and his personal account is often insufficient. A's annual expenses are 5, yuan and B's annual expenses are 4, yuan, but B's reimbursement ratio is higher than A's. Why? Because the money in A's personal account is not included in the 3% discount, assuming that A's personal account was originally in 1 yuan, then the expense of 3,9 yuan is bound to be 3% discount, and then A's reimbursement ratio will be higher than B's. This shows that the less money accumulated in the patient's personal account, the faster it will reach the threshold of 2757. The more money accumulated in personal accounts, that is, patients with higher income or healthier health, will reach the self-payment threshold slowly. This is reasonable. People with more personal accounts or higher incomes are healthier. Theoretically, their financial ability is better than that of patients with chronic diseases who have been seeing a doctor for a long time. The different reimbursement rates of AB and AB also reflect that under the current reimbursement system, they are inclined according to their financial ability.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Then I swiped my medical insurance card and paid cash for medical treatment. In that year, I reached the threshold of paying 2,757 yuan, and got a 3% discount from the Social Security Bureau. This kind of behavior is taking advantage of loopholes. If everyone does this, the medical fund will be hollowed out, which will affect the normal operation of the medical fund and violate the original intention of medical insurance. Therefore, cashing out is an act resolutely prohibited by the Social Security Bureau.

If the personal account balance is less than 4,595 yuan, but they ask the doctor for "over-examination", they can't get the support of medical insurance, so they can only pay for it at their own expense. Of course, this degree is in the hands of doctors, who decide whether it is an over-examination and whether it meets the medical insurance regulations.

If the doctor overthecks for a good workload and allows patients to pay for medical insurance, the Social Security Bureau will naturally not tolerate this waste of medical insurance funds.

Further reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.