This period of validity is the medical insurance year, that is, from April 1st of that year to March 31st of the following year.

Questions and answers on basic medical insurance for urban residents in Shanghai

1. Why should the Trial Measures for Basic Medical Insurance for Urban Residents in Shanghai be implemented?

since p>21, the basic medical insurance system in this city has been continuously developed and improved, with about 13 million people participating in various basic medical insurance, but some urban residents are still not covered by the basic medical insurance system, and their high medical expenses often make individuals and families unbearable. The implementation of basic medical insurance for urban residents (referred to as "residents' medical insurance") is an important measure to implement the spirit of the 17th National Congress of the Communist Party of China and the Guiding Opinions of the State Council on Launching the Pilot Project of Basic Medical Insurance for Urban Residents, which is conducive to relieving some urban residents' worries about seeing a doctor, realizing that everyone enjoys basic medical insurance and promoting social harmony.

2. Who can participate in residents' medical insurance?

people who have not participated in the basic medical insurance for urban workers, the medical insurance for small towns and the new rural cooperative medical system in this city and meet one of the following conditions can participate in the residents' medical insurance: ① people with urban household registration over 18 years old in this city. ② Primary and secondary school students and infants registered in this Municipality, including: persons under the age of 18 registered in this Municipality, students enrolled in various secondary schools between the ages of 18 and 2, and dropouts who hold the Certificate of the People's Republic of China for the Disabled or are still undergoing serious medical treatment; Among the children of talents introduced in this city, those under the age of 18 who hold the Shanghai Residence Permit, and students registered in various secondary schools aged 18 to 2. (3) Other personnel, specifically including: those who have gone through retirement (post) procedures in other places, have been registered in the household registration of this city, and have not implemented medical security, among the educated youth and their spouses from other provinces who have been mobilized by this city to support the construction in other places; The spouse of the urban household registration personnel in this city has not been reported to the urban household registration in this city yet, and there is no medical insurance personnel; The spouse of the talents introduced in this city holds the "Shanghai Residence Permit" and has no medical insurance.

3. What medical insurance benefits can the insured enjoy?

The residents' medical insurance fund will pay the medical expenses incurred by the insured in outpatient emergency (including family sickbeds) and hospitalization (including observation in emergency observation room) according to the following proportions: ① For those over 7 years old, 7% will be paid in hospital; Outpatient emergency payment 5%. (2) 6 years old and under 7 years old, 6% for hospitalization; Outpatient emergency payment 5%. (3) Those who are over 18 years old and under 6 years old will be paid 5% in hospital; Outpatient emergency medical expenses accumulated more than 5% of the annual 1 yuan. 5 primary and secondary school students and infants, 5% for hospitalization; Outpatient emergency payment 5%. In addition, in order to encourage patients to go to the community health service center for medical treatment, the medical insurance fund pays 6% of the outpatient medical expenses incurred by the insured in the community health service center. The expenses other than those paid by the residents' medical insurance fund shall be borne by the insured.

4. What are the criteria for financing residents' medical insurance and how much do individuals pay?

the residents' medical insurance fund shall be borne by the government except the individual contributions. The fund-raising standard and individual payment standard are determined by age, tentatively as follows: ① For those over 7 years old, the fund-raising standard is 1,5 yuan per person per year, of which the individual payment is 24 yuan. ② For those over 6 years old and under 7 years old, the financing standard is 1,2 yuan per person per year, of which the individual pays 36 yuan. (3) over 18 years of age and under 6 years of age, the funding standard is 7 yuan per person per year, of which the individual pays 48 yuan. 5 Primary and secondary school students and infants, the fund-raising standard is 26 yuan per person per year, and the individual pays 6 yuan.

5. What should I do if it is difficult for urban residents and other personnel to pay their own fees?

the government gives subsidies to all insured persons according to their different age groups, and at the same time gives subsidies to the individual contributions of urban subsistence allowances.

urban residents shall be subsidized by individual contributions on a monthly basis according to the method of first participating in insurance and then subsidizing. After the urban subsistence allowances are insured, they shall go through the formalities of individual payment subsidy at the street (town) social assistance affairs management office where they receive the subsistence allowance. During the period of enjoying the minimum living guarantee in this city, the individual payment subsidy will be paid with the subsistence allowance every month according to the following standards: ① Those who enjoy the grain and oil assistance in urban subsistence allowances, and those who pay 6 yuan annually, each person will be given a monthly subsidy to 5 yuan; Individual annual payment of 24 yuan, 2 yuan per person per month; Individual annual payment of 36 yuan, 3 yuan per person per month; Individuals who pay annual fees in 48 yuan will be given monthly subsidies in 4 yuan. (2) other personnel in the urban subsistence allowances families, individuals bear 12 yuan every year, and the rest of the individual contributions are subsidized by 3 yuan every month. Special government relief workers who enjoy the regular quantitative living allowance from the civil affairs department of this Municipality shall be fully subsidized by the government in part for individual contributions.

6. Do the elderly survivors of employees, the elderly in cities and the severely disabled in cities and towns need to participate in residents' medical insurance?

people who have enjoyed the medical insurance benefits for the elderly survivors of employees, the elderly in cities and the severely disabled in cities and towns are directly included in the scope of residents' medical insurance, and individuals do not pay fees, and the part paid by individuals is still fully subsidized by the government. After the implementation of residents' medical insurance, those who meet the conditions of the elderly survivors of employees, the elderly in urban areas and the severely disabled in urban areas will be fully subsidized by the government.

7. where can I apply for medical insurance for residents?

(1) Primary and secondary school students and children in kindergartens (institutes) shall go through the registration and payment procedures by their schools and kindergartens.

(2) Other personnel shall go through the registration and payment procedures at the medical insurance service point of the neighborhood (town) community affairs acceptance center where they are registered or receive the Shanghai Residence Permit.

(3) Those who have enjoyed the basic medical security benefits for the elderly survivors of employees, the elderly in cities and the severely disabled in cities and towns do not need to go through the registration procedures.

8. when should I go through the registration and payment procedures? When do you enjoy medical insurance benefits?

people who meet the conditions of insurance need to go through the formalities of registration and payment from October 1st to December 2th every year, and enjoy medical insurance benefits from January 1st to December 31st of the following year.

Next year will be the first year for residents' medical insurance. This year, the time for registration and payment will be extended to March 2th, 28. After registration and payment, all insured persons will enjoy medical insurance benefits from January 1st.

in the middle of the year, people who meet the conditions of medical insurance for residents in this city can join the insurance midway, but they need to pay the annual fee and enjoy the corresponding medical insurance benefits from the 1st of the following month to the 31st of December of that year.

9. after the basic medical insurance for primary and secondary school students and infants is incorporated into the residents' medical insurance, what changes have been made to the medical insurance benefits?

Primary and secondary school students and infants originally only enjoyed hospitalization and outpatient treatment for serious illness, but did not enjoy outpatient and emergency medical treatment. After being included in residents' medical insurance, they can enjoy outpatient and emergency medical treatment, and the medical insurance treatment for primary and secondary school students and infants has been greatly improved.

1. Can the insured enjoy the family members' labor insurance medical care of the unit and other basic medical insurance benefits in this city?

after the insured enjoys the residents' medical insurance benefits, they will no longer enjoy the medical insurance benefits for family members of the unit and other basic medical insurance benefits stipulated by this municipality.

11. What are the rules for the insured to seek medical treatment?

The insured person can seek medical treatment in the designated community health service center (or first-class hospital) in the whole city; If the patient needs to be referred to a secondary or tertiary hospital for medical treatment due to illness, he shall be referred to the community health service center. Emergency treatment and hospitalization can be treated in all designated hospitals of medical insurance in this city.

Primary and secondary school students and infants can seek medical treatment in the nearest designated medical insurance hospital. Hospitalization is still based on the current zoning and on-demand referral methods, which are operated by the Municipal Red Cross Children's Hospital Medical Mutual Fund Management Office.

12. how do the insured pay for medical treatment?

the insured should hold a social security card (including a student status card) or a medical insurance card and the Shanghai basic medical insurance outpatient and emergency medical record book for medical treatment. The medical expenses incurred by the insured to take a card for medical treatment shall be paid by the residents' medical insurance fund and settled by the hospital, and the rest shall be paid by the individual in cash.

At the initial stage of the implementation of residents' medical insurance, due to the tight time, some insured persons can't get a card for medical treatment at the moment, so they can only pay the medical expenses in cash and then reimburse them. Please understand.

13. which medical expenses are not paid by the residents' medical insurance fund?

the following medical expenses will not be paid by the residents' medical insurance fund: ① medical expenses incurred abroad or abroad. ② Medical expenses incurred in non-designated hospitals in this city. ③ Medical expenses that do not meet the payment scope of medical insurance medication, examination and treatment. Medical expenses incurred due to suicide, self-mutilation, fighting, drug abuse, medical accidents and traffic accidents, and medical expenses that should be borne by a third party according to law.

14. If the insured person needs to temporarily live in other provinces and cities, can he enjoy the medical insurance benefits for residents in this city?

if the insured needs to live in other provinces and cities, they can go through the relevant formalities at the medical insurance service point of the nearest street (town) community affairs acceptance center in this city, and then they can go to the local designated medical insurance hospital for medical treatment and enjoy the medical insurance benefits of the residents in this city.

15. under what circumstances can the medical expenses paid by individuals in cash be reimbursed?

the medical expenses that can be reimbursed are as follows: ① the medical expenses incurred by the insured in the emergency treatment in the designated hospital of medical insurance in this city without medical certificate or referral procedures. (2) medical expenses incurred during the period when the insured has not yet received the medical certificate. (3) the insured in other provinces and cities hospital emergency and emergency hospitalization medical expenses. 5 medical expenses incurred by the insured in other provinces and cities that meet the requirements after handling the relevant procedures.

16. how can the insured reimburse the medical expenses?

within 3 months from the date of medical expenses, the medical expenses paid by the insured person in cash shall be reimbursed by presenting his social security card (including student status card) or medical insurance card, the Shanghai Basic Medical Insurance Emergency Medical Record Book, medical expense receipt and relevant medical history data to the nearest medical insurance service point of the street (town) community affairs acceptance center or the district/county medical insurance affairs center.

17. how to apply for a social security card (or medical insurance card)?

(1) Handling of social security cards: Those who meet the application conditions can make an appointment at the application outlets by telephone or directly go to the street (town) social security card application service outlets to apply for social security cards (including student status cards). When applying, you need to bring your ID card, household registration book, application form (citizens with collective household registration need to bring the household registration certificate issued by the local police station or police station) and other relevant materials.

(2) Handling of medical insurance card: In order to facilitate the insured to take the card for medical treatment, the insured can apply for a medical insurance card without handling a social security card. When applying, you need to bring your ID card or household registration book, and apply for a medical insurance card at the nearest street (town) community affairs acceptance center medical insurance service point or district and county medical insurance affairs center.

18. how to report the loss and reissue the social security card (or medical insurance card) after it is lost?

(1) Loss reporting and replacement of social security card: ① Loss reporting: When the social security card is lost, the cardholder should immediately call 962222 to report the loss, or go to the nearest replacement card outlet to report the loss in writing. ② Reissue: The loss-reporting person can bring his/her ID card and household registration book to the replacement card outlet to apply for reissuing, or he/she can apply for reissuing at the same time as going through the written loss reporting procedures.

(2) Report the loss and reissue the medical insurance card: ① Report the loss: When the medical insurance card is lost, the cardholder should immediately call 962218 to report the loss, or go to the nearest street (town) community affairs acceptance center medical insurance service point or district/county medical insurance affairs center to report the loss in writing. ② Reissue: The loss-reporting person needs to bring his/her ID card or household registration book, etc., and apply for reissuance at the medical insurance service point of the nearest street (town) community affairs acceptance center or the district/county medical insurance affairs center.

19. Who are the applicants for the expanded social security card?

the following persons who have registered in this city and have not applied for social security cards (including student status cards) can apply for social security cards: ① infants aged -6 years without student status (born after September 1, 21). ② First-year primary school students. ③ Students enrolled in technical schools, vocational schools and technical secondary schools. Residents aged 16-18 who have no high school status. (5) residents over the age of 18.

2. How to consult the policies and information about residents' medical insurance?

if you need to consult the policies and information about residents' medical insurance, you can call the medical insurance hotline 962218 or visit the website of "Shanghai Medical Insurance".

Further reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.