How to calculate the self-sufficient section of Shanghai medical insurance?

If the annual medical expenses of the insured exceed a certain proportion of their annual income, the overall burden reduction of medical insurance will be implemented. Specific personnel include: those who are unable to find employment due to serious illness or most reasons, and the annual self-funded medical expenses exceed the minimum living standard of this municipality by more than 25%;

The annual income of on-the-job employees is 80% or less of the minimum wage standard of employees in this Municipality last year, and the annual self-funded medical expenses have reached more than 25% of the minimum wage standard of employees in this Municipality last year; The annual income of employees is between 80% of the minimum wage of employees in the previous year and the minimum wage, and the annual self-funded medical expenses exceed 25% of their annual income;

The annual income of employees is above the minimum wage of employees in the previous year and below the average annual wage of employees 1.5 times, and the annual self-funded medical expenses have reached more than 30% of their annual income; The annual income of on-the-job employees is more than 1.5 times and less than 3 times of the average annual salary of employees in this city, and the annual self-funded medical expenses exceed 40% of their annual income;

The annual pension of retirees is 80% or less of the minimum wage standard of employees in this Municipality last year, and the annual self-funded medical expenses have reached more than 25% of the minimum wage standard of employees in this Municipality last year; The annual pension of retirees is between 80% and 80% of the minimum wage standard of employees in this Municipality in the previous year, and the annual self-funded medical expenses exceed 25% of their annual pension;

The annual pension of retirees is above the minimum wage of employees in the previous year in this Municipality, and the accumulated annual self-funded medical expenses exceed their annual pension by more than 30%.

In line with the comprehensive burden reduction conditions of medical insurance, if the annual self-funded medical expenses exceed the relevant provisions of the implementation measures, the excess self-funded medical expenses will be reduced by 90%.

The so-called annual self-funded medical expenses refer to the medical expenses paid by individuals in cash in accordance with the basic medical insurance regulations of this Municipality in a medical insurance year, that is, the medical expenses that meet the basic medical insurance diagnosis and treatment items, medical service facilities, medication scope and payment standards;

These include the self-funded medical expenses for the classification of diagnosis and treatment items, the self-funded bed expenses for the classification of Class B wards, and the self-funded drug expenses for the use of Class B drugs in this city's basic medical insurance drug list.

Extended data

According to the relevant provisions of "Trial Measures for Serious Illness Insurance for Urban and Rural Residents in Shanghai", the insured persons of basic medical insurance for urban and rural residents in Shanghai are all applicable to serious illness insurance for urban and rural residents. This also means that the insured can enjoy the treatment of serious illness insurance for urban and rural residents without additional payment after participating in residents' medical insurance every year.

The Shanghai Municipal Bureau of Human Resources and Social Security said that residents' serious illness insurance implemented a "community referral" system. Insured persons suffering from four kinds of serious diseases need to be referred for treatment because of their illness. They must go through the referral procedures at the community health service center, and then go to the second-and third-level designated medical institutions for medical treatment.

For four kinds of diseases, such as dialysis treatment of severe uremia, anti-rejection treatment of kidney transplantation, treatment of malignant tumor and treatment of some mental diseases, the reimbursement ratio of urban and rural residents' serious illness insurance fund has increased from 50% to 55%, further reducing the burden of medical expenses for seriously ill patients.

Eastern reimbursement process. Com-Shanghai four diseases will be raised to 55% at their own expense.

Phoenix. Eight categories of people in Shanghai can enjoy comprehensive burden reduction of medical insurance.