Shanghai medical insurance deductible paragraph standard 2022

Shanghai medical insurance reimbursement rate in 2022 Shanghai's working employees need to first use up the amount credited to their medical insurance for the year when they visit the outpatient or emergency clinic to enter the deductible segment, of which the amount is 1,500 yuan. When it comes to reimbursement of hospitalization medical expenses, only if the amount exceeds the deductible segment by more than RMB 1,500 can they be reimbursed by the medical insurance according to different ratios.

Shanghai urban workers' medical insurance reimbursement ranges from 50% to 75%, depending on the patient's age and the grade of the hospital. Generally speaking, if an employee under 44 years of age exceeds the threshold of 1,500 yuan for outpatient and emergency treatment, he or she will be reimbursed 65 percent of the amount by the medical insurance at a first-class hospital, 60 percent of the amount by a second-class hospital, and 50 percent of the amount by a third-class hospital. If an active employee over the age of 45 exceeds the outpatient emergency room threshold of 1,500 yuan, the health insurance will reimburse 75 percent for an active employee attending a level 1 hospital, 70 percent for an active employee attending a level 2 hospital, and 60 percent for an active employee attending a level 3 hospital.

In addition, hospitalization, emergency observation room, stay in the hospital for observation of the active employees, urban workers health insurance maximum payment limit of 390,000 yuan, the coordinated reimbursement rate of up to 85%. Among them, the reimbursement rate for the outpatient major illness coordinated medical insurance is 85 percent, and the reimbursement rate for the family hospital bed medical insurance is 80 percent.

Shanghai Medical Insurance Reimbursement Scope in 2022

1, the medical expenses incurred by the insured whose medical relationship is in the city for emergency treatment in medical institutions in foreign provinces and cities, the medical expenses incurred in the city for pre-hospital emergency treatment, and the medical expenses incurred for emergency treatment during the period when the Social Security Card or Medical Insurance Card is reported to have been damaged or reported to have been lost.

2. Outpatient and emergency medical fees, emergency observation and inpatient medical fees incurred in the place of residence of the insured person whose medical relationship is in a foreign province or city.