Shanghai major medical insurance reimbursement ratio

Legal analysis: Generally speaking, insured Shanghai residents suffering from serious illnesses, outpatient emergency (including family hospital beds) and hospitalization (including emergency observation room hospital observation) in the city's basic medical insurance designated medical institutions, in line with the city's basic medical insurance regulations, the individual portion, included in the scope of payment of the residents of the major medical insurance, the residents of the major disease insurance funds reimbursement of 50% of these.

Secondly, the conditions for enrollment in Shanghai's major medical insurance: the residents' major medical insurance applies to all the insured who participate in the city's urban residents' basic medical insurance (hereinafter referred to as "insured residents"). The insured residents do not need to make separate contributions, and the out-of-pocket expenses incurred in accordance with the scope of payment of the residents' major medical insurance can be reimbursed in the form of enjoying the benefits of the residents' major medical insurance.

Legal basis: "Notice on Doing a Good Job of Basic Medical Security for Urban and Rural Residents in 2019" I. Improvement of the financing standard of urban and rural residents' medical insurance and major disease insurance In 2019, the per capita financial subsidy standard for urban and rural residents' medical insurance was increased by 30 yuan to not less than 520 yuan per person per year, and half of the new financial subsidy was used to improve the protection capacity of major disease insurance (on the per capita financing standard in 2018) (an increase of 15 yuan on the 2018 per capita financing standard); individual contributions synchronized with the addition of 30 yuan to reach 250 yuan per person per year. The central financial administration, in accordance with the Notice of the General Office of the State Council on the Issuance of the Reform Program for the Division of Financial Authority and Expenditure Responsibility between the Central and Local Governments in the Field of Medical and Health Care (Guo Ban Fa [2018] No. 67), will implement a staggered subsidy for provinces, autonomous regions, municipalities directly under the central government, and municipalities with separate plans. Provincial-level finances should increase the tilt toward deeply impoverished areas and improve the financial sharing methods at the provincial level and below. Local finances at all levels shall arrange for the full amount of financial subsidies in accordance with the regulations, and make timely disbursements in accordance with the regulations. In accordance with the requirements of the Circular of the State Council on the Implementation of Several Fiscal Policies to Support the Citizenship of the Agricultural Transfer Population (Guo Fa [2016] No. 44), for those who participate in the insurance policy with a residence permit, individuals will pay the fees according to the same standards as local residents, and the finances at all levels will give subsidies according to the same standards as local residents. Medical security departments at all levels should orderly promote the work of urban and rural residents before and after the transfer of responsibility for the collection and management of medical insurance premiums, to ensure that the quantitative targets for annual financing are put in place.