1, medical insurance payment policy-outpatient emergency

Outpatient emergency payment is divided into three stages:

1) Personal account part: First use up the current year's account funds-personal responsibility part:

2) different quotas are determined according to working/retirement and age, which can be offset by the balance of account funds over the years-additional fund payment part:

3) Different payment ratios are determined according to working/retirement, age group and hospital level, and the personal conceit can be offset by the balance of account funds over the years.

2, medical insurance payment policy-outpatient illness and family beds

Outpatient serious illness:

1) Overall fund payment: 85% on the job; Retire 92%

2) The rest: the balance of personal account over the years, and the insufficient part is at your own risk.

3) The period of validity of outpatient registration of serious illness is 6 months (once every 6 months).

A sickbed in a patient's home.

1) Overall fund payment: 80%

2) The rest: the balance of personal account over the years, and the insufficient part is at your own risk.

3, medical insurance payment policy-inpatient or emergency observation room.

1) Qifubiaozhun: On-the-job 1500 yuan; The old man retired to 700 yuan; The minimum refund threshold is 65,438 yuan +0.200 yuan: the balance of personal account is paid over the years, and the insufficient part is borne by the individual.

2) Above Qifubiaozhun: On-the-job employees pay 85% from the overall fund; For retirees, the overall fund pays 92%; The remaining part of the overall fund payment is paid by the balance funds of individual accounts over the years, and the insufficient part is borne by individuals.

4. Medical insurance payment policy-above the maximum payment limit.

1) Maximum compensation standard: 340,000 yuan.

2) Scope: medical expenses of outpatient service for critical illness; Medical expenses for family beds; Medical expenses above Qifubiaozhun for hospitalization or emergency observation. Accumulate year by year.

3) Payment: 80% is paid by the additional insurance fund, and 20% is borne by the individual.

5, medical insurance payment policy-designated pharmacies

1) Only personal account funds can be used.

2) You can write prescriptions outside the hospital and buy over-the-counter drugs that meet the requirements of medical insurance. Some pharmacies can prepare Chinese herbal pieces.

6, medical insurance payment policy-other

Retired cadres, old Red Army, 1-6 disabled revolutionary soldiers: no hukou, no medical expenses.

Shanghai primary and secondary school students' medical insurance payment amount: 90 yuan.

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