1, reimbursement ratio of on-the-job employees:

(1) outpatient and emergency services: deductible, 1500 yuan. The insured person can only go to the medical insurance for reimbursement after seeing a doctor for more than 1500 yuan;

(2) Hospitalization and emergency observation room stay in hospital for observation and treatment: deductible line 1.500 yuan. The insured person can only go to the medical insurance for reimbursement after seeing a doctor for more than 1500 yuan;

2, retired workers reimbursement ratio:

(1) Outpatient and emergency: Employees can enjoy health insurance for life after retirement as long as they pay 15 years before retirement, and individuals do not have to pay;

(2) Hospitalization and emergency observation room stay in hospital for observation and treatment: retirees who are hospitalized beyond the deductible standard only need to pay 8%, and most of them are paid by the medical insurance fund.

Medical insurance coverage:

1, reimbursement of basic medical insurance drugs: our country now divides drugs into three categories: A, B and C, of which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;

2. Reimbursement of basic medical service facilities: this reimbursement scope mainly refers to bed fees, first-aid bed fees, medical treatment fees, etc. Expenses incurred by the insured in the process of medical treatment and nursing in designated medical insurance institutions;

3. Reimbursement of basic medical insurance diagnosis and treatment items: it must be a safe and effective diagnosis and treatment item, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.

To sum up, after the adjustment of Shanghai medical insurance, employees' medical insurance outpatient visits and hospitalization visits can be reimbursed.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.