How much can Shanghai medical insurance reimburse

Shanghai medical insurance reimbursement rates are as follows:

1, hospitalization reimbursement

(1) active employees: deductible 1500 yuan, reimbursement rate of 85%, the maximum reimbursement amount of 460,000;

(2) retirees: deductible 1,200 yuan, reimbursement rate of 92%, the maximum reimbursement amount of 460,000;

(3) the former retired elderly: deductible 700 yuan, reimbursement rate of 92%, the maximum reimbursement amount of 460,000;

2, outpatient emergency reimbursement deductible of $700, reimbursement rate of 92%, maximum reimbursement of $460,000;

2. Outpatient Emergency Reimbursement

(1) Children and students: deductible of $300, reimbursement rate of 70% for first-level hospitals, 60% for second-level hospitals, and 50% for third-level hospitals;

(2) Aged 19-59: deductible of $500, reimbursement rate of 70% for first-level hospitals, and 50% for second-level hospitals reimbursement rate of 70%, secondary hospital reimbursement rate of 60%, and tertiary hospital reimbursement rate of 50%;

(3) Age 60 or above: $300 deductible, primary hospital reimbursement rate of 70%, secondary hospital reimbursement rate of 60%, and tertiary hospital reimbursement rate of 50%.

Methods of checking the reimbursement rate of medical insurance:

1. Local inquiry

Participants can directly bring their ID cards and resident medical insurance cards to the service hall of the local social security bureau to print out a list of contributions, which can be used to check the relevant information in detail. This method is more direct, suitable for people who do not know how to access the Internet, do not know how to use telephone self-service and have time, and is more suitable for elderly people of a certain age;

2, telephone inquiry

Participants can directly call the Social Security Administration telephone number 12333 to make inquiries. Follow the voice prompts to operate, you need to enter the social security card number as well as the account password. This kind of inquiry is also more convenient and fast, is the first choice of many people;

3, online inquiry

Online inquiry is suitable for people who know how to operate the computer, and do not have much leisure time to operate. First find the local social security bureau online, open the web page, enter your personal social security card account number, query password and ID number and other personal information, you can query to their latest account information, convenient and fast.

In summary, the amount of money that can be reimbursed by Shanghai's health insurance depends on the medical institution that the participant chooses to visit, the actual medical expenses, the reimbursement rate, the starting line and other factors, and may reimburse a few hundred dollars, or a few thousand or even tens of thousands of dollars. Overall, the older the participant is and the more medical expenses he or she has incurred, the greater the amount of reimbursement will be.

Legal basis:

Article 23 of the Social Insurance Law of the People's Republic of China

Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall pay the basic medical insurance premiums in accordance with the state regulations***.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.