Proportion of medical insurance reimbursement for employees in Shanghai

The medical expenses of employees under 40 in Shanghai exceed 1500 yuan, of which 65% can be reimbursed. On-the-job employees can be reimbursed 60% of the medical expenses for seeing a doctor in a secondary hospital. If it is a tertiary hospital, employees can be reimbursed 50% through medical insurance. Employees over the age of 45 who pay more than 1500 yuan in outpatient service can be reimbursed for 75% of medical insurance, 70% in secondary hospitals and 60% in tertiary hospitals.

Reimbursement materials:

1, valid identity document of the insured.

2, the insured medical insurance card or social security card

3. Shanghai Bank medical insurance ID card or bank debit card with UnionPay logo.

4. Details are as follows:

(1) When applying for reimbursement of outpatient and emergency medical expenses, you should also bring the special receipt for outpatient medical expenses/special receipt for emergency medical expenses, relevant medical history materials and photocopies, emergency attached pages, and photocopies of outpatient and emergency medical record books (medical expenses incurred by local personnel in designated medical institutions in this city). If the medical insurance card reports the loss, it is also necessary to provide the Notice of Reporting the Loss of the Medical Insurance Card.

(2) When applying for reimbursement of hospitalization observation expenses in emergency observation room, the insured shall also provide special receipt for medical expenses, list of medical expenses during hospitalization (list of medical expenses observed in emergency observation room) and its copy, discharge summary and copy.

(3) When applying for sporadic reimbursement of outpatient medical expenses for serious illness, the insured shall also provide special receipts for outpatient medical expenses, disease diagnosis certificates and photocopies, relevant inspection reports and photocopies.

5, medical insurance agencies required to provide other relevant information.

6. If you entrust others to handle it, you must also provide the valid identity certificate of the client.

Outpatient and emergency treatment

In 2022, the outpatient and emergency departments of retired workers in this city will be divided into the following three sections:

(1) account part, first use personal account funds to pay outpatient and emergency expenses;

(2) During the self-financing period, after the account is used up, outpatient and emergency expenses will be paid by individuals in cash;

(3) * * * payment, outpatient and emergency expenses outside the self-financing period shall be jointly borne by the medical insurance fund and personal cash.

legal ground

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

Article 24 The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.