Shanghai Medical Insurance Application Guidelines Reimbursement Ratios There is a minimum payment standard for medical expenses incurred by insured persons in outpatient emergencies (including home hospital beds). The part of the cumulative medical expenses exceeding the threshold within one year shall be borne by the Urban and Rural Residents Medical Insurance Fund in accordance with the

A certain percentage is paid and the remainder is borne by the individual.

The minimum payment standard is: 300 yuan for persons aged 60 and above, severely disabled persons, primary and secondary school students and infants; 500 yuan for persons over 18 years old and under 60 years old.

The payment ratio of the urban and rural residents' medical insurance fund is: 70% for outpatient emergency treatment at a community health service center (or first-level medical institution); 60% for outpatient emergency treatment at a secondary medical institution; and 60% for outpatient emergency treatment at a third-level medical institution.

Pay 50%.

The medical expenses incurred by insured persons at outpatient clinics in village clinics are not included in the minimum payment standard, and 80% is paid by the Urban and Rural Residents Medical Insurance Fund.

When an insured person is hospitalized, a deductible standard is set for the medical expenses incurred by the insured person each time they are hospitalized (including stay in the emergency observation room for observation).

The portion exceeding the minimum payment standard will be paid by the Urban and Rural Residents Medical Insurance Fund in a certain proportion, and the remaining portion will be borne by the individual.

The minimum payment standards are: RMB 50 for first-level medical institutions, RMB 100 for second-level medical institutions, and RMB 300 for third-level medical institutions.

The payment ratio of the urban and rural residents' medical insurance fund is: 90% for those who are 60 years old and above, and those with severe disabilities who are hospitalized in community health service centers (or first-level medical institutions), 80% for those who are hospitalized in second-level medical institutions, and 80% for those who are hospitalized in third-level medical institutions.

70% of the payment for hospitalization in a first-level medical institution; for persons under 60 years old, 80% of the payment for hospitalization at a community health service center (or first-level medical institution), 75% for hospitalization at a second-level medical institution, and 75% for hospitalization at a third-level medical institution.

Pay 60%.

Reimbursement Scope 1: Current employees shall pay 2% of their monthly salary (11% for the unit) for medical insurance.

When visiting an outpatient or emergency department, you need to first use the amount included in the medical insurance for that year. After using it, you will enter the self-payment section. The self-payment amount is 1,500 yuan.

If an active employee needs hospitalization, as long as he pays medical insurance, most of the medical expenses can be borne by the medical insurance.

First of all, you are responsible for the minimum payment line of 1,500 yuan. Expenses exceeding the minimum payment line can be reimbursed by medical insurance on a proportional basis.

If the amount exceeds the maximum payment limit, it can also be paid from the additional fund on a pro rata basis.

2 Retirees 3 Non-working retirees 4 College students More detailed information: 2016 Shanghai’s latest medical insurance policy Shanghai Medical Insurance Reimbursement Standards and Scope Situations that are not reimbursed: According to the provisions of the "Social Insurance Law", the following medical expenses are not included in the Urban and Rural Residents Medical Insurance Fund

Scope of payment: (1) Should be paid from the work-related injury insurance fund; (2) Should be paid by a third party; (3) Should be paid by the public health department; (4) Medical treatment abroad.

Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the urban and rural residents' medical insurance fund shall pay first.

After the urban and rural residents' medical insurance fund has paid in advance, it has the right to recover from the third party.

Reimbursement conditions 1. Participate in insurance and pay normally (referring to still being insured and paying when discharged) and the benefit review period has expired (insurance and payment as an organization have been completed for 30 days, and insurance and payment as an individual have been completed for 6 months) 2

. The diseases comply with the "Basic Medical Insurance Inpatient Disease Catalog" 3. Complete reimbursement materials. To apply for outpatient and emergency medical expense reimbursement, insured persons should bring valid documents (ID card, household register, etc.), "Social Security Card"

》 or "Medical Insurance Card", special receipts for outpatient medical expenses, special receipts for emergency medical expenses, relevant medical history information and copies, "Outpatient and Emergency Medical Record Book" emergency appendix and copy (the medical relationship is for people in this city)

Medical expenses incurred by medical insurance designated medical institutions).

If the "Medical Insurance Card" is reported damaged, a "Medical Insurance Card Damage Notification Form" must also be provided.

To apply for reimbursement of hospitalization and emergency observation room expenses, the insured should provide special receipts for medical expenses, a list of medical expenses during hospitalization (list of medical expenses for emergency observation room) and copies, and discharge (

View) summary and copy.

To apply for sporadic reimbursement of outpatient serious illness medical expenses, the insured should provide special receipts for outpatient medical expenses, disease diagnosis certificates and copies, and relevant inspection reports and copies.

Entrusting Others to Reimburse The insured may entrust others to handle the reimbursement on their behalf.

The entrusted party must also bring the valid documents of himself and the insured person (ID card, household register, etc.) when applying.