How much does Shanghai medical insurance reimburse

Participants in Shanghai's health insurance should know that local health insurance reimbursement includes outpatient reimbursement and inpatient reimbursement, and their reimbursement rates are different.... Overall, the reimbursement rate of Shanghai medical insurance is between 50% and 90%, with the range of outpatient reimbursement being 50%-80% and hospitalization reimbursement being 60%-90%.... Outpatient Reimbursement. For outpatient emergency treatment at community health service centers (or first-level medical institutions), 70% is paid; for outpatient emergency treatment at second-level medical institutions, 60% is paid; and for outpatient emergency treatment at third-level medical institutions, 50% is paid. ... Participants in the village health clinic outpatient clinic medical costs, not counted in the starting standard, by the urban and rural residents health insurance fund to pay 80%....

Reimbursement ratio of urban and rural residents' medical insurance

Primary and secondary school students and infants and young children:

Outpatient emergency (including family hospital beds)

1, outpatient emergency outpatient starting standard of 300 yuan;

2, the village health clinic is not counted as the starting standard;

3, the starting standard of the following medical costs, paid by the individual;

4, over the starting standard of the above

Hospitalization (including emergency observation room observation)

1, each hospitalization of medical costs incurred to set the starting standard, specifically: level 1 hospitals 50 yuan, level 2 hospitals 100 yuan, level 3 hospitals 300 yuan;

2, the starting standard of the medical costs below the individual to pay;

3, more than the starting standard of the medical cost of level 1 hospitals 20% of the individual's own responsibility, the Habitat Insurance Fund to pay 80%. hospitals, 20% of the individual's responsibility, 80% of the Home Insurance Fund; secondary hospitals, 25% of the individual's responsibility, 75% of the Home Insurance Fund; tertiary hospitals, 40% of the individual's responsibility, 60% of the Home Insurance Fund.

University students:

Outpatient emergency (including home hospital beds)

1. On-campus outpatient: medical expenses incurred in the on-campus outpatient clinic will be paid by the respective institution at no less than 90%, and the rest will be paid by the individual;

2. Off-campus outpatient emergency: outpatient emergency treatment will be paid for primary and secondary school students in accordance with the Habitat Insurance, as follows: outpatient medical expenses for outpatient emergency will be paid at the threshold of 300 yuan, with the annual accumulated amount exceeding the threshold at the end of each year. The part of the annual accumulation above the starting line: 30% of the individual responsibility of the first-class hospitals, the Home Insurance Fund to pay 70%; 40% of the individual responsibility of the second-class hospitals, the Home Insurance Fund to pay 60%; the third-class hospitals, 50% of the individual responsibility, the Home Insurance Fund to pay 50%; the village health clinic, 20% of the individual responsibility, the Home Insurance Fund to pay 80%.

Hospitalization, emergency observation room observation

1, each hospitalization of medical costs incurred in the starting standard, specifically: primary hospitals 50 yuan, secondary hospitals 100 yuan, tertiary hospitals 300 yuan;

2, the starting standard of the medical costs below the individual to pay;

3, more than the starting standard of the medical costs of the first-class hospitals The individual is responsible for 20% of the medical expenses and the Home Insurance Fund pays 80%; the individual is responsible for 25% of the medical expenses and the Home Insurance Fund pays 75%; and the individual is responsible for 40% of the medical expenses and the Home Insurance Fund pays 60% in tertiary hospitals.

Persons between 19 and 59 years old:

Outpatient emergency care (including home hospital beds)

1, outpatient emergency outpatient starting standard of 500 yuan;

2, village health clinics are not counted as the starting standard;

3, medical expenses below the starting standard are paid by the individual;

4, over the starting standard of the medical costs, the first-level hospitals The individual is responsible for 30% of the medical expenses above the starting payment standard, and the Home Insurance Fund pays 70%; the individual is responsible for 40% of the medical expenses in the second-level hospitals, and the Home Insurance Fund pays 60%; the individual is responsible for 50% of the medical expenses in the third-level hospitals, and the Home Insurance Fund pays 50%; and the individual is responsible for 20% of the medical expenses in the village health centers, and the Home Insurance Fund pays 80%.

Hospitalization (including emergency observation room observation)

1, each hospitalization of medical costs incurred to set the starting standard, specifically: level 1 hospitals 50 yuan, level 2 hospitals 100 yuan, level 3 hospitals 300 yuan;

2, the starting standard of the medical costs below the individual to pay;

3, more than the starting standard of the medical cost of level 1 hospitals 20% of the individual's own responsibility, the Habitat Insurance Fund to pay 80%. hospitals will pay 20% of the medical expenses and the Home Insurance Fund will pay 80%; secondary hospitals will pay 25% of the medical expenses and the Home Insurance Fund will pay 75%; tertiary hospitals will pay 40% of the medical expenses and the Home Insurance Fund will pay 60%.

People between 60 and 69 years old:

Outpatient emergency care (including home hospital beds)

1, outpatient emergency outpatient starting standard of 300 yuan;

2, village health clinics are not counted as the starting standard;

3, medical expenses below the starting standard are paid by the individual;

4, medical expenses exceeding the starting standard, the primary hospitals The individual is responsible for 30% of the medical expenses above the starting payment standard, and the Home Insurance Fund pays 70%; the individual is responsible for 40% of the medical expenses in the second-level hospitals, and the Home Insurance Fund pays 60%; the individual is responsible for 50% of the medical expenses in the third-level hospitals, and the Home Insurance Fund pays 50%; and the individual is responsible for 20% of the medical expenses in the village health centers, and the Home Insurance Fund pays 80%.

Hospitalization (including emergency observation room observation)

1, each hospitalization of medical costs incurred to set the starting standard, specifically: level 1 hospitals 50 yuan, level 2 hospitals 100 yuan, level 3 hospitals 300 yuan;

2, the starting standard of the medical costs below the individual to pay;

3, more than the starting standard of the medical cost of level 1 hospitals 10% of the individual's own responsibility, the Habitat Insurance Fund to pay 80%. hospitals, 10% of the individual's responsibility, the Home Insurance Fund pays 90%; secondary hospitals, 20% of the individual's responsibility, the Home Insurance Fund pays 80%; tertiary hospitals, 30% of the individual's responsibility, the Home Insurance Fund pays 70%.

People over 70 years old:

Outpatient emergency (including home hospital beds)

1, outpatient emergency outpatient starting standard of 300 yuan;

2, village health clinics are not counted as the starting standard;

3, medical expenses below the starting standard are paid by the individual;

4, medical expenses exceeding the starting standard, the first-level hospitals will pay 30% of the medical expenses, and the Habitat Insurance Fund will pay 80%; the third-level hospitals will pay 30%, and the Home Insurance Fund will pay 70%. The individual pays 30% of the medical expenses above the threshold, and the Home Insurance Fund pays 70%; the individual pays 40% of the medical expenses in the second-level hospitals, and the Home Insurance Fund pays 60%; the individual pays 50% of the medical expenses in the third-level hospitals, and the Home Insurance Fund pays 50%; and the individual pays 20% of the medical expenses in the village health centers, and the Home Insurance Fund pays 80%.

Hospitalization (including emergency observation room observation)

1, each hospitalization of medical costs incurred to set the starting standard, specifically: level 1 hospitals 50 yuan, level 2 hospitals 100 yuan, level 3 hospitals 300 yuan;

2, the starting standard of the medical costs below the individual to pay;

3, more than the starting standard of the medical cost of level 1 hospitals 30% of the individual's own responsibility, the Home Insurance Fund to pay 80%. hospitals will pay 30% of the medical expenses out of their own pockets, and the Habitat Insurance Fund will pay 70%; second-level hospitals will pay 40% of the medical expenses out of their own pockets, and the Habitat Insurance Fund will pay 60%; third-level hospitals will pay 50% of the medical expenses out of their own pockets, and the Habitat Insurance Fund will pay 50%; and the village health centers will pay 20% of the medical expenses out of their own pockets, and the Habitat Insurance Fund will pay 80

Legal Basis

The People's Republic of China and the State of Regulations on Basic Medical Insurance for Urban Workers

Article 27 Personnel of employers who pay basic medical insurance premiums in accordance with these Regulations shall enjoy basic medical insurance benefits.

Article 28 Individual accounts shall be used to pay for medical expenses beyond the scope of payment by the integrated fund; if the individual account is insufficient to pay for such expenses, the individual shall be responsible for them.