Shanghai social security reimbursement ratio

The proportion of medical insurance reimbursement in Shanghai is between 50% and 90%. Shanghai medical insurance reimbursement includes outpatient and emergency reimbursement and hospitalization reimbursement, and the reimbursement ratio of the two parts is different. The reimbursement rate for outpatient and emergency services is between 50% and 80%, and the reimbursement rate for hospitalization is between 60% and 90%.

legal ground

Article 28 of the Social Insurance Law

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.