Proportion of hospitalization reimbursement for social security in Shanghai

The reimbursement rate of hospitalization social security in Shanghai is as follows:

1, the following part of Qifubiaozhun shall be paid by the surplus funds of individual account over the years, and the insufficient part shall be borne by the insured;

2. Above Qifubiaozhun, 85% of the part below the maximum payment limit shall be paid by the overall fund, and the rest shall be paid by the balance funds in personal accounts over the years. If there is still insufficient payment, it shall be borne by the insured;

3, the part above the maximum payment limit, 80% paid by the additional fund, the insured person to bear 20%.

Note: The threshold for reimbursement of hospitalization social security in Shanghai is 1500 yuan, and the maximum payment limit is 550,000 yuan.

Hospitalization (including emergency observation room observation). The minimum payment standard is set for the medical expenses incurred by Shanghai urban and rural residents in each hospitalization when they participate in medical insurance, specifically: 50 yuan, a first-level medical institution; Kloc-0/00 yuan, a second-level medical institution; and 300 yuan, a third-level medical institution. More than Qifubiaozhun above part of the medical expenses, residents' medical insurance fund to pay according to the following proportion:

The elderly aged 60 and above, as well as severely disabled people who are hospitalized in community health service centers (or first-class medical institutions), pay 90%; Secondary medical institutions pay 80%; Third-level medical institutions pay 70%.

Persons under the age of 60 who are hospitalized in community health service centers (or first-class medical institutions) will be paid 80%; Secondary medical institutions pay 75%; Third-level medical institutions pay 60%.

Legal basis:

People's Republic of China (PRC) social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.