1, outpatient reimbursement

Under normal circumstances, there is no deductible line for outpatient clinics. As long as they buy medical insurance, they can enjoy outpatient reimbursement. Within a medical insurance year, there is no deductible line for general outpatient service. As for the reimbursement amount of medical insurance, the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of the co-ordination fund is 400 yuan.

2. Proportion of hospitalization reimbursement

The reimbursement amount of hospitalization medical insurance is determined according to the time of enrollment. In other words, the longer we pay the premium, the higher the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the total will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

3. Secondary reimbursement ratio

After the second reimbursement, the insured can reimburse again. The expenses incurred by the insured for the first hospitalization are part of the scope of payment of the basic medical insurance for urban residents. After the basic medical insurance fund is paid in proportion, the insured person's personal burden exceeds 8,000 yuan, and the serious illness insurance fund will give a "second reimbursement" to the excess part according to the proportion of 55%.

Insured residents who have been hospitalized for many times within one year, after receiving the basic medical insurance and the "second reimbursement" insurance, the individual will bear more than 25,000 yuan of hospitalization medical expenses (including the compliant and reasonable self-funded part) each year, which will be reimbursed again by the serious illness insurance fund at 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan.

Legal basis:

Measures of Shanghai Municipality on Basic Medical Insurance for Employees Article 3 The maximum payment limit of pooling funds mentioned in these Measures refers to the maximum payment limit of medical expenses incurred by employees in designated medical institutions within one year.