The maximum payment limit of the general outpatient co-ordination fund for urban workers insured by Shanghai medical insurance is 300 yuan per month, including medical expenses and medical expenses. The maximum annual payment limit for minors and students is 1000 yuan, and the medical expenses are limited; The maximum annual payment for other urban and rural residents is 600 yuan, and the medical expenses are limited. The maximum payment limit of outpatient chronic disease co-ordination fund is 200 yuan for urban workers and 50 yuan for urban and rural residents. In terms of hospitalization, the deductible line for urban workers is 1.600 yuan to1.654,38+0.20 yuan, and the annual cumulative maximum payment limit is 445,500 yuan, and the annual maximum payment limit for serious illness allowance is 222,700 yuan; The minimum payment line for urban and rural residents is 1 10,000 yuan, the annual cumulative maximum payment limit is 1.82 million yuan, and the annual maximum payment limit for serious illness allowance is 1.2 to1.80 million yuan. The amount may change due to different regional policies.
Basic principles of medical insurance:
1, principle of mutual assistance * * *: medical insurance is based on the principle of collective mutual assistance and risk * * *, and provides medical expenses protection for the insured through individual and unit contributions;
2. Policy principle: Medical insurance policy is influenced by national macro-control and local government policy orientation, and medical insurance policies in different regions will be different;
3. The principle of graded burden: the medical insurance system usually adopts the method of graded burden, and individuals, units and governments share the medical expenses;
4. Principle of rational use: encourage the insured to use medical resources rationally, avoid waste and ensure the sustainability of medical insurance fund;
5. Principle of dynamic adjustment: The management and use of medical insurance fund is a process of dynamic adjustment, which will be adjusted in time according to factors such as economic development level and changes in medical expenses.
To sum up, Shanghai's overall medical insurance quota varies according to the types of participation and local policies. The maximum 300 yuan/month for urban workers, kloc-0/000 yuan/year for minors and students, 600 yuan/year for other residents, 200 yuan/month for urban workers with chronic diseases, and 50 yuan/month for urban and rural residents. Deductible line for hospitalization of urban workers1600-120 yuan, with annual limit of 445,500 yuan, serious illness allowance of 222,700 yuan, deductible line for urban and rural residents 1000 yuan, annual limit of182,000 yuan and serious illness allowance/kloc.
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.