90% of first-level hospitals, 87% of second-level hospitals, and 85% of third-level hospitals, with a total hospitalization reimbursement of 300,000 yuan.

Hospitalization deductible: The first hospitalization deductible within a calendar year is 1,300 yuan, and each subsequent hospitalization is 650 yuan.

Scope of hospitalization reimbursement by social security card: hospitalization expenses incurred by insured persons in medical insurance designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and Class A hospitals selected by individuals.

The "Shanghai Employees' Mutual Aid Association's Special Serious Illness Group Mutual Aid Medical Insurance Plan" is a plan of Shanghai Municipality to further cooperate with the reform of the city's basic medical insurance system for urban employees and carry forward the glorious tradition of unity, friendship and mutual aid of the working class, so that those who unfortunately suffer from special serious diseases can

Employees receive timely and effective treatment and a specially revised plan for early recovery.

In order to further cooperate with the reform of the basic medical insurance system for urban employees in this city and carry forward the glorious tradition of unity, friendship and mutual aid of the working class, so that employees who unfortunately suffer from special serious diseases can receive timely and effective treatment and early recovery, the "Special Serious Illness Group Mutual Aid" is specially revised

Medical Insurance Plan" (hereinafter referred to as the Plan).

All female employees under the age of 55 and male employees under the age of 60 (including employees of township enterprises and migrant workers) can participate in this plan as a group under the unified organization of their unit based on the principle of voluntariness.

Each unit must have 75% of its employees participating.

Those with a total number of employees less than or equal to 10 must participate 100%.

The following materials must be provided when participating in the insurance: 1. A copy of the "Shanghai Social Insurance Premium Payment Notice" for this month or the previous month. Units that do not participate in the city's social insurance must provide a copy of the report that correctly reflects the number of employees in the unit.

2. The "Insurance Form" that is completely filled out and stamped with the official seal; 3. A computer CD (printed list is not required) or U

Disk (must provide printed roster in duplicate).

In order to reduce the workload of the insured units and improve the accuracy of the information of the insured persons, when the insured units renew their insurance upon expiration, they can download the list of insured persons for the previous period from the Association’s website [1] and make a copy of the list for the current period.

The additions and subtractions to the insured list are then made into a computer CD or USB flash drive.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" that meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be deducted from the basic medical insurance fund in accordance with national regulations.

Pay.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.

Article 28 of the "Financial System of Social Insurance Funds": Expenditures of the basic medical insurance fund for employees include expenditures on basic medical insurance benefits for employees, transfer expenditures, subsidies for subordinate expenditures, expenditures transferred to superiors, and other expenditures.

The benefits expenditures of the basic medical insurance for employees shall be included in the benefits expenditures of the basic medical insurance co-ordination fund for basic medical insurance for employees and the personal account benefits of basic medical insurance for employees according to regulations.

The employee basic medical insurance unified fund benefit expenditure refers to the medical compensation expenditure paid by the unified fund within the payment range of the unified fund according to regulations, above the minimum payment standard and below the maximum payment limit, including hospitalization expenses, outpatient serious illness and outpatient overall expenses.

.

In areas where maternity insurance and employee basic medical insurance are merged and implemented, maternity benefits will be included in the employee basic medical insurance co-ordinating fund benefits expenditure.

Expenditures on maternity benefits include expenditures on maternity medical expenses and maternity allowances.

Expenditures for employee basic medical insurance personal account benefits refer to expenditures incurred from personal accounts in accordance with regulations, which mainly include outpatient expenses paid by individuals, hospitalization expenses, and medical expenses incurred in designated retail pharmacies.

In principle, funds in personal accounts cannot be used for non-medical expenses.

The employee basic medical insurance fund's subsidized expenditures at lower levels and the expenditures transferred to higher levels shall be listed in the overall fund and personal account fund respectively according to the specific circumstances.

The transfer expenditures of the basic medical insurance fund for employees shall be disbursed in the personal account fund.