Shenzhen social security has a limit.

1, the annual limit of outpatient service is 800 yuan, and the excess is at one's own expense.

2. Hospitalization limit: The maximum payment limit is 50,000 yuan, 1 yuan, 1 year, 2 years, 3 years and 6 years respectively, and there is no maximum payment limit for those who have been insured for more than 6 years.

Forty-third hospital medical insurance, medical insurance for migrant workers insured in the selected community health service center outpatient (including emergency) expenses according to the following provisions:

(a) Class A drugs and Class B drugs belonging to the basic medical insurance drug list shall be paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively;

(two) belong to the basic medical insurance directory of medical items or medical materials, a single price below 120 yuan, paid by the community outpatient co-ordination fund 90%; If the single price exceeds 120 yuan, the community outpatient co-ordination fund will pay 120 yuan;

(III) The outpatient medical expenses incurred by the insured who need to be referred to other designated medical institutions with the approval of the settlement hospital due to illness, or the emergency medical expenses incurred in non-settlement hospitals, shall be reimbursed by the community outpatient co-ordination fund according to the provisions in the first and second paragraphs of this article.

The outpatient medical expenses (including emergency) paid by the community outpatient co-ordination fund to each inpatient medical insurance insured within one medical insurance year shall not exceed the maximum of 800 yuan.

Article 44

The hospitalization expenses incurred by the insured belong to the scope of the basic medical insurance drug list, retirees are included in the accounting scope of the basic medical insurance serious illness pooling fund by 95%, and other personnel are included by 90%.

The basic medical expenses incurred by the insured belong to the diagnosis and treatment items and general medical materials in the basic medical insurance catalogue. Retirees are included in the accounting scope of the basic medical insurance serious illness pooling fund by 95%, and other personnel are included by 90%.

When the insured person is hospitalized, due to illness, he needs to do basic medical insurance diagnosis and treatment projects, use special medical materials, install or replace artificial organs, and use disposable medical materials with a unit price of more than 1 1,000 yuan, which are included in the accounting scope of the basic medical insurance serious illness pooling fund according to 90% of its domestic popular price; If there is no domestic general comparable price, 60% of the general import price will be included in the bookkeeping scope of the basic medical insurance serious illness pooling fund.

The maximum bed fee for comprehensive medical insurance and inpatient medical insurance is not more than 50 yuan/day, and the maximum bed fee for migrant workers' medical insurance is not more than 35 yuan/day.

Article 45

According to different hospital levels, different hospitalization deductible lines are set up. First-class and below hospitals in the city 100 yuan, second-class hospitals in the city, 200 yuan, third-class hospitals in the city, 300 yuan, and non-local hospitals in 400 yuan.

Belong to the basic medical insurance serious illness co-ordination fund accounting within the scope of hospitalization deductible below the hospitalization medical expenses, the basic medical insurance serious illness co-ordination fund will not pay.

If the insured person is referred to different hospitals for hospitalization, the hospitalization deductible line shall be calculated respectively.

Article 46

The maximum payment limit of the basic medical insurance pooling fund in each medical insurance year is linked to the number of years that the insured person has participated in the basic medical insurance continuously. For those who have been insured for less than half a year, less than 1 year, less than 2 years, less than 3 years, less than 2 years and more than 3 years, the maximum payment limit is 0.5 times, 1 time and 2 times of the average salary of employees in this city in the previous year respectively.

Article 47

Comprehensive medical insurance, hospitalization medical insurance insured hospitalization included in the basic medical insurance accounting scope of medical expenses, higher than the hospitalization deductible and lower than the maximum payment limit of the overall fund, by the basic medical insurance serious illness overall fund to pay in full.

The medical expenses incurred by the insured person of migrant workers' medical insurance in hospitalization and included in the accounting scope of basic medical insurance are paid by the basic medical insurance serious illness pooling fund according to the hospital level in different proportions, and the payment proportions of first-class hospitals, second-class hospitals, third-class hospitals and hospitals outside the city are 95%, 90%, 80% and 70% respectively, and the rest are paid by the insured person.

Medical insurance for migrant workers insured for work or business trip, in non settlement hospital emergency hospitalization expenses, according to the provisions of the preceding paragraph, should be reimbursed for 90% of the expenses, conditional medical institutions can implement accounting.

Article 48

Retirees who participate in comprehensive medical insurance can enjoy a one-time local supplementary medical insurance retirement subsidy of 500 yuan, and a monthly local supplementary medical insurance subsidy of 20 yuan, which will be charged by the municipal social insurance institution from the local supplementary medical insurance fund and included in the personal account, which can be used for my health examination.

Article 49

The maximum payment limit of local supplementary medical insurance fund in each medical insurance year is linked to the time when the insured person continuously participates in local supplementary medical insurance. For those who have been insured for half a year but are less than 1 year, less than 2 years, less than 3 years and less than 6 years, the maximum compensation limit is 50,000 yuan and150,000 yuan respectively.

The number of years of local supplementary medical insurance calculated before the implementation of these measures can be calculated continuously.

Measures of Shenzhen Municipality on Social Medical Insurance-Shenzhen Social Insurance Fund Management Bureau