1, the medical expenses of the insured paid by the residents' medical insurance fund in the medical insurance year shall be deductible. Specifically: if you seek medical treatment in a community health service center (or a first-class medical institution), the fund will pay 85%; Secondary medical institutions for medical treatment, the fund pays 75%; Three medical institutions for medical treatment, the fund pays 65%;

2. There is no Qifubiaozhun for outpatient medical expenses for serious illness paid by residents' medical insurance fund during the medical insurance year;

3. If the medical expenses of the residents' medical insurance fund exceed the capping line in the medical insurance year, the residents' medical insurance fund can compensate the excess again. The specific proportion is: 60% of the minimum minimum payment of 50,000 yuan; 50,000 yuan to 6.5438+500,000 yuan to pay 70%; 654.38 yuan+500,000 yuan or more will be paid 80%.

The overall payment conditions of Shanghai medical insurance in 2023 are as follows:

1, the expenses incurred by drugs, diagnosis and treatment items and medical service facilities within the scope of medical insurance catalogue shall be included in the payment scope of the overall fund;

2, medical insurance fund payment standard set Qifubiaozhun, maximum payment limit and payment ratio;

3, the insured in the community health service center (or medical institutions) for medical treatment, the fund to pay 85%; For medical treatment in secondary medical institutions, the fund pays 75%; For medical treatment in tertiary medical institutions, the fund pays 65%;

4. Residents' medical insurance fund does not set qifubiaozhun for outpatient medical expenses of seriously ill insured persons;

5. If the medical expenses of the residents' medical insurance fund exceed the capping line, the residents' medical insurance fund can compensate the excess again. The specific proportion is: 60% of the minimum minimum payment of 50,000 yuan; 50,000 yuan to 6.5438+500,000 yuan to pay 70%; 654.38 yuan+500,000 yuan or more will be paid 80%.

To sum up, the above are the conditions for the overall payment of Shanghai medical insurance. You can consult relevant departments if you have any questions.

Legal basis:

Article 7 of the Regulations of People's Republic of China (PRC) Municipality on the Basic Medical Insurance for Urban Workers.

The basic medical insurance premium is paid jointly by the employer and the employees. Among them, the employer pays 5%-7% of the total monthly salary of its employees, and the rate of employees paying basic medical insurance premium is not less than 2% of their total monthly salary.

Article 8

The monthly payment salary of employees is determined according to their actual total wages, but it shall not be less than 60% of the average monthly salary of employees in the city, county and autonomous county where it is located. The following medical insurance premiums that should be paid by myself shall be paid by the employer.