1. For employees on the job, once the medical expenses incurred in hospitalization or emergency observation room exceed the deductible line (1500 yuan), the proportion paid by the overall fund is 85%.

2. The threshold for retirees to be hospitalized or observed in emergency observation room is 1.200 yuan and 700 yuan respectively, and the corresponding reimbursement rates are 92% and 80% respectively. 123456789

3. The maximum payment limit of medical insurance for employees in Shanghai is 550,000 yuan, 80% of which is reimbursed by the local supplementary medical insurance fund and 20% is borne by individuals.

Shanghai employee medical insurance hospitalization reimbursement process;

1. When seeking medical treatment, the insured shall show the medical insurance card to the designated hospital? To prove the identity and registration of the insured, the medical insurance reimbursement is directly settled by the medical insurance and the hospital, and the individual does not need to pay first and then reimburse. At the time of checkout, the balance and cash of personal medical insurance card shall be paid by the insured.

2. After receiving the reimbursement materials, the window staff will issue the Receipt of Hospitalization Medical Expenses of Shanghai Insured Persons to the insured persons.

3, after receiving the information, generally within fifteen working days, the medical insurance department will complete the audit, the basic medical insurance fund reimbursement by the bank outlets into the insured person's smart ic card financial account, the insured person can withdraw cash from the bank outlets with the IC card.

4. Fifteen working days later, the insured person who is hospitalized can receive the Calculation Form for Medical Reimbursement of Social Medical Insurance from the business hall window of the Municipal Social Security Bureau with the receipt of medical expenses of the insured person in Shanghai.

To sum up, the new standard of reimbursement ratio of medical insurance for employees in Shanghai reflects the government's commitment to improving the level of medical security for employees, reducing the medical burden of employees by increasing the reimbursement ratio, and ensuring that employees can obtain necessary medical services.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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 medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.