First, Shanghai retired workers medical insurance policy documents
The payment standard of medical insurance for serious illness of retirees is 200 yuan. Of which 100 yuan shall be paid by the unit and 100 yuan shall be paid by the individual. 200 yuan's payment standards are formulated by the state. No matter which year you retire, the standard will not change. If the policy changes, it means unification has changed, and everyone's standards are the same. But it depends on how the unit is. For example, some units go bankrupt and individuals need to pay in full.
Shanghai Retired Workers' Medical Insurance Policy (Shanghai Retired Workers' Medical Insurance Policy Document)
Second, Shanghai's requirements for enjoying medical insurance after retirement
As long as you have paid for medical insurance in Shanghai for 15 years, you can enjoy medical insurance for life after retirement, which is the shortest payment time in China. Other provinces and cities need more time to enjoy health insurance for life.
At present, retirees under the age of 74 1.680 yuan every year, and retirees over the age of 75 1.890 yuan every year, which will be credited to personal accounts in July. After using it up, 300 yuan, who retired before 2000, and 700 yuan, who retired afterwards, were reimbursed 90% for medical insurance in the first-class hospital, 80% for the second-class hospital and 70% for the third-class hospital.
Third, the latest medical insurance policy document for retired employees in Shanghai
The maximum payment limit of the employee medical insurance pooling fund ranges from 550,000 yuan to 570,000 yuan, and the part exceeding the maximum payment limit will continue to be reimbursed 80% according to the regulations.
The balance of medical insurance accounts of retired employees in the current year: those under 74 years old are included in 1680 yuan, and those over 75 years old are included in 1890 yuan.
Four, Shanghai retired workers medical insurance policy documents
Payment process of mutual medical insurance for retired workers in Shanghai;
1. Fill in the complete Registration Form of Supplementary Medical Assistance Plan for Retired Employees in Shanghai.
2. Copy the electronic document of the list of insured persons (serial number, name, ID number and insured four fields) made in EXCEL format to the U disk, and submit the list of insured persons to the nearest District Federation of Trade Unions Service Office.
3. Paid financial vouchers.
Payment method:
1, credit certificate (copy with bank seal provided when applying for insurance)
2. Online banking (provide printed proof of payment when applying for insurance)
3. Cash remittance documents (a copy stamped with the bank seal shall be provided when applying for insurance)
4. Withholding the guarantee fee (the applicant can apply for more than 10).
5. Download the medical insurance policy document for retired employees in Shanghai.
Retired workers pay a large amount of medical insurance at the community affairs center for the first time with their ID cards and agree to deduct it from the pension every year and write an agreement.
legal ground
Measures of Shanghai Municipality on Improving the Outpatient Security Mechanism of Basic Medical Insurance.
Second, the main task
(1) Improve the personal account calculation and payment method. From July 1 day, 2023, all the basic medical insurance premiums paid by employees will be included in my personal medical account, and the inclusion standard is 2% of my insured payment base, and all the basic medical insurance premiums paid by the unit will be included in the overall fund. Individual accounts of retirees are allocated by the overall fund according to the quota, and the specific standards are under 74 years old 1680 yuan/year, and over 75 years old 1890 yuan/year.
(two) to enhance the outpatient service * * * economic security function. We will improve the medical insurance outpatient expense guarantee mechanism for employees, and adjust the outpatient and emergency standards from July 2023 1.
1. On-the-job employees: the standard of self-supporting part of outpatient and emergency departments is adjusted to 500 yuan. The excess is paid by the overall fund according to the following standards: 80% of the outpatient and emergency departments of first-class medical institutions are paid by the overall fund; Secondary medical institutions outpatient emergency, pooling funds to pay 75%; Third-level medical institutions outpatient emergency, pooling funds to pay 70%.
2. Retirees: after (1)200 1 1, the standard of self-supporting for outpatient and emergency departments is adjusted to 300 yuan. The excess is paid by the overall fund according to the following standards: 85% is paid by the overall fund for outpatient and emergency departments of first-class medical institutions; Secondary medical institutions outpatient emergency, co-ordination fund to pay 80%; Third-level medical institutions outpatient emergency, pooling funds to pay 75%. (2) For retirees who retired before 65438+February 3/KLOC-0 in 2000, the standard of outpatient and emergency services was adjusted to 200 yuan. The excess is paid by the overall fund according to the following standards: 90% of the outpatient emergency of the first-class medical institutions is paid by the overall fund; Secondary medical institutions outpatient emergency, co-ordination fund to pay 85%; Third-level medical institutions outpatient emergency, the overall fund to pay 80%.
(3) Standardizing the scope of use of personal accounts. Personal accounts are mainly used to pay out-of-pocket expenses of insured persons within the policy scope of designated medical institutions or designated retail pharmacies. From July 2022 1, the scope of personal accounts will be gradually expanded. Personal accounts can be used to pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions, as well as the expenses incurred by individuals in purchasing medicines, medical devices and medical consumables in designated retail pharmacies. Explore the personal accounts of spouses, parents and children participating in the basic medical insurance for urban and rural residents. Personal accounts shall not be used for public health expenses, physical fitness or health care consumption and other expenses that are not covered by the basic medical insurance.
(four) to enhance the supplementary guarantee function of local additional funds. The local additional medical insurance premiums paid by the employer are all included in the local additional fund and accounted for separately. From June 65438+1 October1day in 2023, the outpatient and emergency medical expenses will be included in the payment scope of the overall fund, and will no longer be paid by local additional funds. Local supplementary funds continue to pay all kinds of burden reduction expenses, including the overall burden reduction of employees' medical insurance, as well as medical expenses above the maximum payment limit of some overall funds. Explore the multi-channel financing and supplementary guarantee functions of local additional funds in coping with the aging population.
(5) Strengthen supervision and management. Improve the management service measures, innovate the system operation mechanism, guide the rational use of medical resources, ensure the stable operation of medical insurance funds, and give full play to the guarantee function. Strictly implement the budget management system of medical insurance fund, and strengthen the construction of fund audit system and internal control system. Further improve the dynamic management mechanism of the whole process of personal accounts and strengthen the audit of the use and settlement of personal accounts. Strengthen the supervision of medical behavior and medical expenses, improve the supervision system of administrative law enforcement at the municipal and district levels, continue to carry out special actions to crack down on fraud and insurance fraud, strengthen joint supervision across departments, strengthen social supervision, and accelerate the construction of intelligent supervision system. Accelerate the construction of the primary medical service system, improve the contract service of family doctors, standardize the long-term prescription management, and guide the insured to seek medical treatment at the primary level.
(six) improve the payment mechanism that is suitable for outpatient service. Strengthen the linkage of "three doctors" and promote the deepening of the reform of the medical and health system. We will continue to deepen the reform of payment methods of medical insurance, promote the system of payment by disease (DIP) and the system of payment by disease diagnosis (DRG) under the general budget management, and provide better medical services for the masses and reduce their burden of medical treatment. Scientifically and reasonably determine the payment standard of medical insurance, and guide the active use of drugs with definite curative effect and reasonable price. In addition, eligible "internet plus" medical services will be included in the scope of payment.