The netizen's helpful answer is basically correct. I will only add that the comprehensive medical insurance purchased by Shenzhen residents is superior to other types of medical insurance.

Discounts of comprehensive medical insurance (the following discounts are not available in hospitalization medical insurance and labor medical insurance):

1. All designated medical insurance hospitals in Shenzhen can register by swiping their medical insurance cards Seeing a doctor (the registration fee is 12 to 14 yuan cheaper than the registration fee without swiping the medical insurance card, because when the medical insurance card is swiped to register, the Social Security Bureau directly pays a subsidy of 12 to 14 yuan to the hospital).

2. Hold a comprehensive medical insurance card to see a doctor in a community health service, and you will get a 30% discount on medicine and examination fees.

3. Protect outpatient services for serious illnesses and reduce the risk of “poverty due to illness”. For example, if you spend RMB 100,000 a year on outpatient care, then comprehensive medical insurance will reimburse you approximately 60% or nearly 70% (the calculation method is more complicated, I will put it below).

————When you use comprehensive medical insurance for hospitalization, you have to pay a few hundred yuan out-of-pocket. Generally, 90% of the remaining treatment costs can be reimbursed. The hospitalization medical insurance is also 90%, and the ratio of labor medical insurance is 50%. ~70%. You will see that the three types of medical insurance can enjoy a large proportion of insurance coverage for hospitalization. Only outpatient services are the most preferential for comprehensive medical insurance. The preferential ratio depends on the actual expenses of the insured.

——————————Calculation process of 30% discount for outpatient services——————————————

—— ——————It will be easier to understand the principle of medical insurance reimbursement by starting with over-treatment and cash-out————————

Medical insurance is to protect your basic medical needs. In principle, " "Over-examination" and "over-treatment"

Prevent "over-examination". For example, if you can diagnose the condition by taking an X-ray, you should not waste medical insurance money on issuing a CT application form for you.

Prevent "over-treatment". For example, if you can cure your disease by taking medicine for three days, you should not waste medical insurance money to prescribe medicines for 30 days;

Medical insurance essentially "concentrates all insured persons" "People's money is used to protect the insured who need it most." Everyone spends money on serious illness on the treatment of minor illnesses, causing the medical insurance fund to make ends meet and unable to treat the patients with serious illnesses who need the money most. This is not in line with the standards of medical insurance. original intention.

Comprehensive medical insurance has a personal account (comprehensive medical insurance is the only one among the three types of medical insurance in Shenzhen that has a personal account).

The Social Security Bureau has a special term "health check-up" for "self-requesting a check-up". The accumulated balance of a personal account must exceed the baseline for the year before it can be used for a health check-up. For example, starting from July 1 this year, the baseline is 4,595 yuan. Assume that the balance of the poster’s personal account on the medical insurance card is 4,700 yuan today. Then, 105 yuan of it can be used for the poster’s “health examination”; if the balance of the personal account is 4,600 yuan , then 5 yuan of it can be used for "health examination"; if the personal account is less than 4,595 yuan, you cannot use the medical insurance health examination and can only pay for the physical examination at your own expense.

To put it simply, the usage of personal accounts is not at the discretion of the insured. The Social Security Bureau has certain restrictions on this. The insured can use the amount exceeding RMB 4,595 for his or her own health check-up and personal expenses. Vaccinations for family members (family members specifically refer to children, spouses, and parents who have purchased medical insurance in Shenzhen).

A small number of high-income earners, because of their high income, pay more for medical insurance, and have accumulated a very high balance in their personal accounts, ranging from ten thousand to tens of thousands. They are anxious that they cannot spend all their money on medical treatment. No problem. , available for physical examination and medical treatment for family members.

Most middle-income earners don’t pay much for medical insurance, and their personal account balances have just reached last year’s average monthly income (the average monthly income in Shenzhen in 2011 was 4,595 yuan). No, it can’t be used to treat family members (in fact, paying for medical treatment with a bank card for family members is the same price, and there are no discounts or discounts in the family channel).

If you are below the 4,595 yuan line, you can only see a doctor based on your actual condition. The doctor will prescribe whatever examination you need and treat you as you need. In a word, you can meet your insurance requirements. People’s basic medical needs!

For things that go beyond basic medical needs, such as seeing a dental department and finding cavities, the medical insurance will reimburse you for the cost of tooth fillings; after tooth extraction, you need to have ceramic teeth installed. The medical insurance considers dental implants to be a luxury item, an icing on the cake, a beauty project, and medical insurance We will not reimburse you for the cost of dental implants and teeth cleaning. Please pay for it at your own expense. Thank you for your understanding!

According to calculations, people in Shenzhen only spend 200 to 300 yuan each time for outpatient treatment. If they see a doctor 3 to 10 times a year, will the money in their personal account be fully spent? Most of it cannot be used up, which means that the goal of ensuring the basic medical needs of the insured has been achieved.

For that small group of people, such as patients with serious illnesses or chronic diseases, who need regular follow-up visits and long-term medication, the money in their personal accounts is completely insufficient. After the money in their personal accounts is used up, they have to pay a lot of money for medical treatment. . How to protect this type of patients? Patients only need to swipe the medical insurance card to register and pay the fee. The Social Security Bureau will automatically accumulate the cash paid by swiping the medical insurance card. When the annual out-of-pocket payment reaches 2,757 yuan, the patient can automatically receive a 30% discount by swiping the medical insurance card when seeing a doctor.