Q:

What are the differences between medical insurance payments for employees of Shenzhen enterprises?

A:

If the employee is a Shenzhen resident, the enterprise is required to pay first grade medical insurance and it is unchangeable; If the employee is a non-resident of Shenzhen, the enterprise can choose any grade between 1-3 for medical insurance payment.  

Q:

Except for medical insurance, are pension/employment injury/unemployment/maternity insurance also with different grades in Shenzhen?

A:

There are 5 kinds of social insurances in Shenzhen, including pension insurance, medical insurance, employment injury insurance, unemployment insurance, maternity insurance, whereas only medical insurance is classified into 3 grades.

Q:

What are the differences between the contribution standard of medical insurance in Shenzhen?

A:

The contribution rate for medical insurance of first grade is 7.2% based on the employee’s salary of last month. Enterprise pay 5.2% and employee pay 2%.
The contribution rate for medical insurance of second grade is 0.8%, based on the on-post employee’s average salary of last year in Shenzhen. Enterprise pay 0.6% (basic medical insurance 0.5% + local supplementary medical insurance 0.1%) and employee pay 0.2%.
The contribution rate for medical insurance of third grade is 0.55%, based on the on-post employee’s average salary of last year in Shenzhen. Enterprise pay 0.45% (basic medical insurance 0.4% + local supplementary medical insurance 0.05%) and employee pay 0.1%.

Q:

What are the differences for medical institutions?

A:

The insured of first grade can access any designated medical facilities in Shenzhen.
The insured of second grade is required to access medical treatment in binding social health centre, their hospitalization can be in any designated medical facilities, and their medical treatment for clinic serious illness is required to be in appointed facilities.
The insured of third grade is required to access medical treatment in binding social health centre, their clinic serious illness is required to be hospitalized in appointed facilities for medical treatment.

Q:

What are the differences for general clinic treatment?

A:

Personal account of first grade insured is allowed to pay medical costs within directory of general clinic medical insurance. 70% of basic medical expenses of first grade insured will be paid by personal account, 30% will be paid by co-ordination fund.

Grade A & B medicine for the insured of second/third grade will be paid 80% and 60% separately by co-ordination fund of community clinic. If the medicine belongs to health insurance directory as well as used by the insured of second/third grade, the co-ordination fund will pay 90% of medical costs with maximum payment of RMB120.
Within a medical insurance year, the total payment of clinic medical costs for the insured of second/third grade is not allowed to exceed RMB1,000 in Shenzhen.

Q:

What are the differences for family sharing of personal medical account?

A:

If the accumulated amount of personal medical account exceeds 5% of on-post average salary of last year in Shenzhen, the extra part can pay OTC within directory of medical insurance in a designated pharmacy, which also can pay basic medical costs & local supplementary medical costs for the insured of first grade and their spouse and immediate family who have already joined Shenzhen basic medical insurance in designated medical facilities. The extra part can pay costs of physical examination and vaccination for the insured of first grade and their spouse & immediate family who have already joined Shenzhen basic medical insurance as well.

Neither of the insured of second/third grade can pay costs of medicine in a pharmacy by personal medical account (social insurance card).

Q:

What are the cost differences for examination and treatment through clinic large equipment?

A:

80% of medical costs for first grade insured will be paid by co-ordination fund.
The medical costs for second/third grade insured will be paid based on unit price of general medical items, which is not allowed to exceed RMB120.

Q:

What are the differences for treatment of clinic serious illness?

A:

The costs of clinic serious illness can be paid from 60% to 90% by co-ordination fund for insured of first/second/third grade according to the length of continuous coverage.

Q:

What are the differences of treatment for hospitalization?

A:

The part above the starting line of basic medical costs & local supplementary medical costs can be paid by 95% or 90% separately for hospitalization of the insured of first and second grade.
There are two kinds of situations for hospitalization of the insured of third grade:

1. The insured is hospitalized in a binding social health centre or transferred to a designated hospital from the centre, the reimbursement ratio for the part above the starting line of basic medical costs & local supplementary medical costs are as following:
   First level hospital: 85% Second level hospital: 80% / Third level hospital: 75%
2. If the insured is hospitalized in a designated hospital directly, the costs will be paid by 90% of the payment standard of above item 1.