Reimbursement expenses of three types of insured persons in Shanghai medical insurance

The three types of medical insurance participants in Shanghai include retirees, retirees and college graduates, and the proportion and scope of medical expenses reimbursement are different.

There are three types of medical insurance in Shanghai: residents' medical insurance, employees' medical insurance and the new rural cooperative medical system. Among them, employee medical insurance includes one, two and three types of insured persons. The first type of insured persons are regular employees and their families, the second type of insured persons are retirees and their spouses, and the third type of insured persons include college graduates who take the form of individual contributions. The proportion and scope of reimbursement of medical expenses of the three types of participants in Shanghai medical insurance are different. Among them, the reimbursement rate of Class I insured personnel is the highest, reaching 80%; The reimbursement rate of the second-class insured is 75%; The reimbursement rate of the three types of insured persons is 70%. In addition, the three types of insured persons also need to pay a certain out-of-pocket fee. In the specific scope of reimbursement, the first, second and third categories of insured persons are basically the same, including outpatient medical treatment, inpatient medical treatment, medicine fees and so on. However, the reimbursement ratio of individual projects may be different, depending on the local medical insurance policy.

What should I do if the medical expenses of the three types of insured exceed the limit? Shanghai Medical Insurance has an annual limit on the reimbursement of the three types of insured persons. If the medical expenses exceed the limit, you need to bear the extra expenses yourself. At the same time, the medical insurance bureau will make appropriate adjustments according to the actual situation.

When using medical services, Shanghai medical insurance participants should be clear about their reimbursement ratio and limit to avoid overspending. At the same time, it is suggested to choose a better medical institution when the medical expenses are high and increase the reimbursement ratio.

Legal basis:

"Social Insurance Law of People's Republic of China (PRC)" Article 23 Retirees and former employees participate in the basic medical insurance for urban workers and the new rural cooperative medical system and enjoy the basic medical insurance benefits.