In-service employee
1. If you need to be hospitalized, as long as you pay medical insurance, most of the medical expenses can be borne by medical insurance.
2. First of all, we need to pay the deductible fee of 1500 yuan.
3, more than the deductible expenses can be paid by medical insurance in proportion.
The minimum payment standard is: paid by the surplus funds of individual medical accounts over the years (the insufficient part is paid by employees themselves).
Above Qifubiaozhun, but below the maximum payment limit: 85% is paid by the overall fund, and the rest of medical expenses are paid by the surplus funds of individual medical accounts over the years. If the payment is still insufficient, the employee will pay by himself.
Above the maximum payment limit: 80% of additional fund payment+20% of individual payment.
From 0: 00 on July 1 2022, the medical insurance for employees in this city will enter the medical insurance year of 2022 (from July 1 2022 to June 30, 2023), and the maximum payment limit of the employee medical insurance pooling fund will be raised from 570,000 yuan to 590,000 yuan, and the part above the maximum payment limit will continue to be reimbursed 80% according to regulations.
retired worker
Retirees who are hospitalized beyond the deductible only need to pay 8%, and most of them are paid by the medical insurance fund.
For those who retire before 65438+February 3, 20001,the minimum payment standard is 700 yuan; If you retire after 200 1, 1, 1, the minimum threshold is 1200 yuan.
The minimum payment standard is: paid by the surplus funds of individual medical accounts over the years (the insufficient part is paid by retirees themselves).
Above Qifubiaozhun, but below the maximum payment limit: 92% is paid by the overall fund, and the rest of the medical expenses are paid by the surplus funds of individual medical accounts over the years. If the payment is still insufficient, it will be paid by the retirees themselves.
Above the maximum payment limit: 80% of additional fund payment+20% of individual payment.
Primary and secondary school students and infants
1. The minimum threshold of medical expenses per hospitalization is: 50 yuan, a first-class hospital; 100 yuan, a second-class first-class hospital; 300 yuan, a third-class first-class hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, 20% of the first-class hospital, family insurance fund to pay 80%; The secondary hospital pays 25% and the living insurance fund pays 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
college student
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, 20% of the first-class hospital, family insurance fund to pay 80%; The secondary hospital pays 25% and the living insurance fund pays 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
People between the ages of 65 and 438
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, 20% of the first-class hospital, family insurance fund to pay 80%; The secondary hospital pays 25% and the living insurance fund pays 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
People aged 60 to 69
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, the first-class hospital individual pays 10%, and the home insurance fund pays 90%; The secondary hospital pays 20% and the living insurance fund pays 80%; The third-level hospital pays 30%, and the residential insurance fund pays 70%.
People over 70 years old
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, 30% of the first-class hospital individual pays, home insurance fund pays 70%; The secondary hospital pays 40% and the home insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
legal ground
Measures of Shanghai Municipality on Basic Medical Insurance for Employees (Order No.8 of Shanghai Municipal Government)
Article 27 (Medical Expenses of Hospitalization and Emergency Observation Room for On-the-job Employees)
The medical expenses for on-the-job employees' in-hospital observation or emergency observation in-hospital observation shall be paid by the overall fund, and the Qifubiaozhun shall be set. The minimum payment standard is 1500 yuan.
The medical expenses incurred by employees in hospitalization or emergency observation room within one year shall be paid by the overall fund 85%.
The medical expenses incurred by employees below Qifubiaozhun and the remaining medical expenses paid by the overall fund shall be paid by the surplus funds of individual medical accounts over the years, and if the expenses are still insufficient, the employees shall bear the responsibility.
Article 28 (Medical Expenses for Retirees' Hospitalization and Emergency Observation Room)
Retirees in the hospital or emergency observation room to observe the medical expenses paid by the overall fund should set a minimum payment standard. For those who retire before 65438+February 3, 20001,the minimum payment standard is 700 yuan; If you retire after 200 1, 1, 1, the minimum threshold is 1200 yuan.
Retirees in the hospital or emergency observation room within one year to observe the occurrence of medical expenses, accumulated more than Qifubiaozhun, by pooling funds to pay 92%.
The medical expenses incurred by retirees below Qifubiaozhun and the remaining medical expenses paid by the overall fund shall be paid by the surplus funds of individual medical accounts over the years, and if they are still insufficient, the retirees shall bear the responsibility.