According to the Implementation Measures of Shanghai Municipality on Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients (Hu Fu Gui 18 [20265438]No.), starting from July next year, the reimbursement deductible standard for general outpatients in Shanghai will be lowered, and the proportion of outpatient reimbursement will be increased.

Specifically, the deductible standard for on-the-job employees was adjusted to the amount of my current medical insurance card +500 yuan, which was 1 1,000 yuan lower than before.

The deductible line for retirees is based on the retirement date of 200 1 1. If the retirement time is late, the deductible line standard is adjusted to the amount included in my current medical insurance card +300 yuan; For those who retired before, the deductible standard is adjusted to the amount included in my current medical insurance card +200 yuan. 400 yuan and 100 yuan were lowered respectively.

There is no maximum amount of reimbursement for outpatient service in Shanghai, as long as it is above the deductible line, it can be reimbursed in proportion. After July next year 1, Shanghai will adjust and improve the outpatient reimbursement ratio policy while lowering the deductible.

Specifically, the proportion of employee reimbursement is adjusted to 80% for first-class hospitals, 75% for second-class hospitals and 70% for third-class hospitals. The New Deal abolished the previous policy of dividing the reimbursement ratio by age group (as shown in the following table), and increased the reimbursement ratio by 5%-20%.

The reimbursement rate for retirees is also based on the retirement time of 200 1 1 1.

For those who retire later, the reimbursement ratio is adjusted to: 85% for first-class hospitals, 80% for second-class hospitals and 75% for third-class hospitals;

For those who retired before, the reimbursement ratio was adjusted to: 90% for first-class hospitals, 85% for second-class hospitals and 80% for third-class hospitals.

The New Deal adjusted the previous practice of dividing the reimbursement ratio by age (as shown in the following table), and at the same time increased the reimbursement ratio by 5%.

In addition, within the deductible line, Shanghai will gradually expand the scope of use of medical insurance cards from July this year 1.

The medical expenses incurred by me, my spouse, parents and children in designated hospitals and the expenses incurred by me in purchasing medicines, medical devices and medical consumables in designated retail pharmacies shall be paid by my medical insurance card and included in the calculation range of my deductible.

The expenses paid by individuals whose spouses, parents and children participate in the basic medical insurance for urban and rural residents may soon be paid by medical insurance cards and included in the deductible.

Legal basis:

Article 27 of the Social Insurance Law of People's Republic of China (PRC) * * * If an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the fixed number of years stipulated by the state, he will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state; If it is not reached, it can be paid to the fixed number of years stipulated by the state. Basic medical insurance for urban workers: (1) Personal account transfer method Personal account funds are transferred based on my salary income and retirement expenses in the previous year, according to the following three age groups: under 45 years old, 2.3% is transferred; Persons over the age of 45 who have not reached the statutory retirement age are counted as 2.5%; Retirees who reach the statutory retirement age are counted as 3.4%. (2) Overall fund payment method