The outpatient services of the town insurance can only use account funds. If the money on the medical insurance card is used up, it will be self-pay and cannot be reimbursed.
If you are hospitalized, you must first pay the deductible yourself (in the same medical insurance year, the first hospitalization is 1,168 yuan, and each subsequent hospitalization is 584 yuan), and then 80% will be reimbursed. For amounts exceeding 280,000 yuan, 20% will be reimbursed.
Whether you pay five insurances and one housing fund or three housing funds, the treatment is different.
You can patiently read the detailed instructions below.
The five insurances and one fund are as follows: Outpatient services: The expenses incurred by active employees for outpatient and emergency medical treatment within one year that comply with the provisions of the basic medical insurance for urban employees in this city will be paid from their personal medical accounts in the current year, and the shortfall will be paid by the individual.
The standard for outpatient and emergency care is 1,500 yuan, and the excess amount will be paid by the additional fund in a certain proportion, that is: for outpatient and emergency care in first-, second-, and third-level medical institutions, 65%, 60%, and 50% will be paid by the additional fund respectively.
Outpatient serious illness: 85% of the medical expenses incurred by employees undergoing dialysis for severe uremia, chemotherapy and radiotherapy for malignant tumors will be paid by the overall fund.
The rest will be paid from the balance of their personal medical accounts over the years, and the employee will be responsible for the shortfall.
Hospitalization (including hospital observation in the emergency observation room): Expenses incurred by active employees for hospitalization within one year that comply with the provisions of this city’s basic medical insurance for urban employees are set as a hospitalization deductible of 1,500 yuan, and medical expenses above the hospitalization deductible are planned by the overall
The fund pays 85%.
2. Those who pay the three funds are as follows: Outpatient service: Establish a personal medical account (exclusively for outpatient service), which can be used to purchase medicines at designated pharmacies designated by the city’s medical insurance and for outpatient and emergency treatment at designated medical institutions under the city’s medical insurance, until it is used up.
Hospitalization: The payment of medical expenses incurred by non-urban migrant workers who are hospitalized or kept in the emergency observation room for observation shall be in accordance with the relevant provisions of the "Shanghai Basic Medical Insurance Measures for Urban Employees".
Migrant employees with non-urban household registration are temporarily not entitled to outpatient serious illness and home hospital bed medical treatment.
Family hospital beds: 80% of the medical expenses incurred by family hospital beds will be paid by the overall fund, and the rest will be paid by the balance of personal medical accounts over the years. The shortfall will be borne by the individual.