How much is the self-payment stage of on-the-job medical insurance in Shanghai?

Individual pays = (total medical expenses -400 yuan) x25%+400 yuan; Reimbursement amount = (total medical expenses -400 yuan) x75%.

Extended data

Some drugs, disposable articles and special treatments (such as the treatment of postoperative analgesia pump) in medical insurance are not covered by medical insurance reimbursement, and they are at your own expense, so you need to pay all or part of the expenses yourself.

So when you are in hospital, try to remind your attending doctor that you are covered by medical insurance. In this way, the competent doctor will try to use the drugs and treatments in the medical insurance catalogue, and some self-funded drugs and treatments will be used with your consent.

Of course, the purpose of medical insurance is to ensure that the insured can see the onset of the disease and provide basic medical security. Therefore, when making medical insurance drugs and treatment plans, it will not be comprehensive, and some expensive drugs and new treatment plans still cannot enter the medical insurance catalogue.

But I think with the gradual improvement of living standards, the scope of medical insurance will gradually expand to meet everyone's medical requirements.

Personal expenses: This part of drugs or articles and materials are not covered by medical insurance and need to be paid in full by the insured.

Individual pays: although some medicines, articles and materials are included in the scope of medical insurance, the insured needs to pay a certain proportion first: for example, 10% medicines and 30%-40% materials. This part of the money paid by the insured is called self-care:

Personal conceit: there is a certain reimbursement ratio for the expenses included in medical insurance. For example, about 90% of the hospitalization reimbursement of retired employees, the remaining 10%, and deductible expenses are paid by the patients themselves, which is generally the deductible.

Settlement procedure:

(1) Settlement procedures for inpatient and outpatient treatment of special diseases

Designated medical institutions shall submit the expense list, hospitalization list and related materials of discharged patients 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 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.