Shanghai residents' medical insurance outpatient reimbursement policy

Medical insurance plays a very important role in our life. We may get sick, but this is when medical insurance comes into play. Our medical insurance reimbursement includes outpatient service, hospitalization and so on. So what is the reimbursement policy of Shanghai medical insurance outpatient service and what is the reimbursement process? Let me give you a detailed introduction.

1. What is the reimbursement policy for outpatient medical insurance in Shanghai?

Outpatient and emergency reimbursement ratio:

Qifubiaozhun for medical expenses of outpatient emergency (including family sickbed) of the insured, specifically:

1, persons aged 60 and above, severely disabled persons, primary and secondary school students and infants are 300 yuan;

2./kloc-500 yuan for people over 0/8 and under 60.

3, more than Qifubiaozhun, urban and rural residents medical insurance fund to pay according to the following proportion: in the community health service center (or medical institutions) outpatient emergency, pay 70%; Second-level medical institutions outpatient emergency 60%; In the third-level medical institutions outpatient emergency, pay 50%.

4, the insured in the village clinic medical expenses, not included in Qifubiaozhun, paid by the urban and rural residents medical insurance fund 80%.

Second, the reimbursement process

1, settlement procedures for inpatient and outpatient treatment of special diseases:

Designated medical institutions should report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination;

The medical insurance agency pre-allocated the hospitalization and outpatient co-ordination expenses for special diseases last month;

Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

2. Emergency settlement procedures:

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

The above is the knowledge about Shanghai outpatient medical insurance reimbursement. Medical insurance saves a lot of expenses during illness, and the reimbursement rate is also relatively high. So everyone must participate in medical insurance. Medical expenses are quite expensive now, and having medical insurance can reduce everyone's burden.