Shanghai children's medical insurance reimbursement standard

Shanghai children's medical insurance reimbursement standards are as follows:

1, hospitalization reimbursement standard

The reimbursement rate of first-class hospitals is 80%, and the minimum payment standard is 50 yuan/time;

The reimbursement rate of secondary hospitals is 75%, and the minimum payment standard is 100 yuan/time;

The reimbursement rate of tertiary hospitals is 60%, and the minimum payment standard is 300 yuan/time;

2, emergency reimbursement standards

The threshold for reimbursement of primary and secondary school students and infants in 300 yuan is 70% for first-class hospitals, 60% for second-class hospitals and 50% for third-class hospitals.

Reimbursement scope:

1, medical expenses insurance liability in medical insurance coverage.

Part of the expenses still borne by individuals after reimbursement of basic medical insurance, serious illness insurance and medical assistance in the medical insurance catalogue. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,10.5 million free of compensation, the reimbursement rate is 80%, and the reimbursement rate for continuous participation is increased to 85%;

2, medical insurance liability outside the scope of hospitalization expenses.

The expenses outside the medical insurance catalogue are still borne by individuals after being reimbursed by basic medical insurance, serious illness insurance and medical assistance. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,1.8,000 free of compensation, the reimbursement rate is 60%, and the reimbursement rate for continuous participation is increased to 65%;

3, outpatient specific high drug cost insurance liability

The part of the drug expenses paid in designated hospitals and pharmacies, which is borne by individuals, shall be liable for compensation within the agreed scope of insurance liability. 700,000 insured amount, 26 kinds of drugs, and 20,000 yuan shared with the insurance responsibility of outpatient drugs/hospitalization medical insurance expenses for rare diseases, with a compensation ratio of 80%;

4. Clearly stipulate the insurance liability of outpatient drugs/hospitalization medical insurance expenses for rare diseases.

The part of the drug expenses paid in designated hospitals and pharmacies, which is borne by individuals, shall be liable for compensation within the agreed scope of insurance liability. 300,000 insured amount, 12 drugs, sharing 20,000 yuan with the insurance responsibility of outpatient specific high drug expenses, and the reimbursement ratio is 70%.

To sum up, basic medical insurance (including basic medical insurance for urban workers and basic medical insurance for urban and rural residents) is closely related to inclusive prices. Focus on ensuring the high medical expenses caused by major diseases and accidental injuries, and provide more adequate protection for major diseases. Compared with general commercial insurance, there are no restrictions on the age and occupation of the insured, and the health conditions are more tolerant. At the same time, the product also expanded the treatment cost of 20 kinds of high-priced specific drugs and 10 kinds of designated rare disease drugs outside the medical insurance catalogue.

Legal basis:

Article 2 of People's Republic of China (PRC) Insurance Law

The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.

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This Law is applicable to insurance activities in People's Republic of China (PRC).

Article 5

The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.