Shanghai medical insurance refers to the medical security services provided by medical institutions at all levels, cooperative units and social welfare institutions in Shanghai. According to the provisions of the Measures for the Administration of Basic Medical Insurance for Urban and Rural Residents in Shanghai, the medical insurance hospitalization Qifubiaozhun refers to all medical expenses borne by the insured during the continuous hospitalization in the same hospital or medical institution, and the part exceeding the standard is paid by the medical insurance fund. As of 2023, the Qifubiaozhun for medical insurance hospitalization in Shanghai is 800 yuan, that is to say, when the medical expenses borne by the insured during hospitalization do not exceed 800 yuan, they will all be borne by themselves. If the expenses exceed 800 yuan, the excess shall be reimbursed by the medical insurance fund, and the self-payment ratio shall be implemented according to the regulations. It is worth noting that outpatient medical expenses for chronic diseases and special diseases are not included in the calculation of Qifubiaozhun. This means that as long as the outpatient treatment expenses for chronic diseases and special diseases meet the requirements, it will not affect the insured's out-of-pocket hospitalization expenses.
What are the conditions for Shanghai medical insurance? Shanghai medical insurance is applicable to urban residents and rural residents in Shanghai, as well as employees employed in state-owned enterprises, institutions and institutions in Shanghai. Eligible residents can participate in medical insurance through individual payment, family co-payment or unit payment.
Shanghai medical insurance hospitalization Qifubiaozhun is one of the important bases for reimbursement of medical expenses of insured persons. We need to fully understand and master the relevant regulations, rationally plan medical expenses and avoid unnecessary economic pressure. At the same time, we also need to pay attention to the changes and adjustments of medical insurance policies, and timely understand and adapt to new policies and standards.
Legal basis:
Article 18 of the Medical Insurance Law of People's Republic of China (PRC) the State Council and the people's governments of provinces, autonomous regions and municipalities directly under the Central Government shall, according to the level of economic and social development and the needs of medical security, determine the medical insurance treatment standards and publish them in a timely manner; Changes in medical insurance treatment standards should be announced in advance.