What is the standard of Shanghai employee hospitalization reimbursement

1, Shanghai workers health insurance hospitalization reimbursement

To the hospital outpatient, emergency treatment, the medical expenses of more than 2,000 yuan can be reimbursed, the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70%. For retirees over 70 years of age, the reimbursement rate is 80% for expenses over $1,300. The hospitalization reimbursement rate is related to the level of the hospital in which the insured person is staying: 1. If the insured person is staying in a tertiary hospital, the employee pays 15% of the expenses from the starting standard to 30,000 RMB, which is 85% of the reimbursement rate; 2. For the expenses from 30,000 RMB to 40,000 RMB, the employee pays 10% of the reimbursement rate and is reimbursed 90% of the reimbursement rate; 3. For the expenses exceeding 40,000 RMB and up to the payment limit, 95% of the expenses can be reimbursed, and the employee only has to pay 5% of the payment rate. 4. For retirees, the individual payment rate is 60% of that for active (i.e., the above) employees, but below the threshold, the individual pays. Procedure: a. Employee expense reimbursement (a) to submit materials. 1, diagnostic certificate. 2, the original invoice. 3, a copy of the medical record (stamped). 4, a detailed list of expenses. 5, transfer approval form or verification of failure to comply with the approval procedures of the hospitalization (transfer). (ii) Business process Submission of materials - Examination of materials - Production of reimbursement documents - Review of materials - The final review of materials - payment of treatment (c) processing time limit of 15 working days. The first thing you need to do is to get a good deal of money from the company, and then you can get a good deal of money from the company, and then you can get a good deal of money from the company, and then you can get a good deal of money from the company. The outpatient medical insurance reimbursement ratio of urban workers: 1, active employees: outpatient exemption amount of 2000 yuan, that is, in the outpatient medical expenses, more than 2000 yuan will be reimbursed part of the reimbursement ratio of 50%; 2, retired employees: outpatient exemption amount of 1300 yuan, that is, in the outpatient medical expenses, more than 1300 yuan will be reimbursed part of the reimbursement, 70 years of age, and so on, and so on, and so on. The reimbursement rate is 70% for those under 70 years of age and 80% for those over 70 years of age.3. Maximum Limit: No matter which category of people, the maximum limit of outpatient and emergency large medical expenses is 20,000 RMB.4. Special Diseases: Within a medical insurance year, the exemption limit for outpatient medical treatment of special diseases is 400 RMB, and the reimbursement rate of medical expenses in line with the prescribed treatment scope is the same as that of general hospitalization treatment. Legal basis: "Shanghai municipal workers of major medical insurance policy implementation rules" Article 6 employees for medical treatment; (a) employees need to outpatient medical treatment of major illnesses, according to the provisions of the medical institutions for major medical registration procedures. Each registration is valid for six months, more than six months after the need to continue medical care or within six months of the need to change the medical institution, you can go to the medical institution of the major illnesses in accordance with the provisions of the medical institutions to re-register or to the new change of the medical institution to apply for registration procedures. (b) residence or employment in foreign provinces and cities of the workers, confirmed by the city health insurance center or district health insurance center, should be to the local health insurance designated medical institutions; local health insurance is not implemented, you can go to the local health administrative department approved the establishment of the township health center above the medical institutions. If an employee in this city has an emergency in a foreign province or city, he or she shall go to a medical institution in accordance with the above provisions. (c) Employees who seek medical treatment at designated medical institutions for work-related injuries or occupational diseases shall present the relevant certificates.

3,Shanghai hospitalization medical insurance reimbursement ratio 2022

2022 Shanghai medical insurance reimbursement ratio Shanghai in the active employees in the outpatient, emergency, you need to first use up the amount of the year medical insurance credited to the deductible paragraph, which is the amount of the deductible paragraph of the 1500 yuan. In terms of reimbursement of hospitalization medical expenses, only if the excess amount exceeds RMB 1,500 can the medical insurance reimburse the expenses according to different percentages. The reimbursement of Shanghai urban workers' medical insurance ranges from 50% to 75%, depending on the age of the patient and the grade of the hospital. Generally speaking, if an employee under the age of 44 and exceeds the threshold of RMB 1,500 for outpatient and emergency treatment, the medical insurance will reimburse 65% of the cost of treatment at a first-class hospital, 60% of the cost of treatment at a second-class hospital, and 50% of the cost of treatment at a third-class hospital. If a working employee over 45 years of age exceeds the threshold of 1,500 yuan for outpatient and emergency treatment, the health insurance will reimburse 75% of the amount for a working employee attending a first-class hospital, 70% for a working employee attending a second-class hospital, and 60% for a working employee attending a third-class hospital. In addition, for in-patient, emergency observation room and in-patient observation, the maximum payment limit of urban workers' medical insurance is 390,000 yuan, and the reimbursement rate is as high as 85%. Among them, the reimbursement rate of outpatient medical insurance is 85%, and the reimbursement rate of family hospital bed medical insurance is 80%. 2022 Shanghai Medical Insurance Reimbursement Scope1, the medical expenses incurred by the insured person whose medical relationship is in this city in the emergency treatment of the medical institutions in foreign provinces and cities, the medical expenses incurred by the pre-hospital emergency treatment in this city, the medical expenses incurred in the emergency treatment during the period of reporting the loss of the Social Security Card or the Medical Insurance Card.2, the medical expenses incurred by the insured person whose medical relationship is in foreign provinces and cities in the emergency treatment of the medical institutions in foreign provinces and cities. If a participant in a foreign province or city has outpatient and emergency medical expenses, emergency observation room observation and hospitalization medical expenses in his/her place of residence, he/she should bring his/her valid ID card (ID card, household registration book, etc.), social security card or medical insurance card, outpatient medical fee receipt, emergency medical fee receipt, relevant medical history and photocopies of medical documents, and the medical insurance card. Medical history information and copy, emergency page and copy of "Outpatient and Emergency Medical Record Book" (medical expenses incurred at local designated medical institutions for those whose medical relationship is with the city). If the "medical insurance card" is damaged, it is also necessary to provide the "medical insurance card damage notification form". 2, hospital observation expense reimbursement application for hospitalization and emergency observation room hospital observation expense reimbursement, the participant should provide a special receipt for medical expenses, hospitalization during the medical cost list (emergency observation room hospital observation medical cost list) and a copy of the hospitalization (observation) summary and a copy of the hospital discharge (observation) and copy of the 3, outpatient major medical expenses for sporadic reimbursement application processing For outpatient major medical expenses reimbursement, the participant should provide a special receipt for outpatient medical expenses, a certificate of diagnosis of the disease and a copy of the certificate, and a copy of the relevant examination report.4. Delegation of reimbursement to another personThe participant can delegate another person to handle the reimbursement on behalf of the participant. The delegated person should bring his/her own and the participant's valid documents (ID card, household register, etc.) when handling the claim. Legal basis: Chapter 3 of the Social Insurance Law of the People's Republic of China Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall pay the basic medical insurance premiums in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance of employees in the employing organization, and other flexibly employed persons may participate in the basic medical insurance of employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.