Proportion of reimbursement for hospitalization social security in Shanghai

Proportion of medical insurance reimbursement for urban and rural residents in Shanghai from 2065438 to 2006

Proportion of hospitalization reimbursement

Qifubiaozhun for hospitalization (including observation in emergency observation room) is as follows: first-level medical institution 50 yuan, second-level medical institution 100 yuan, and third-level medical institution 300 yuan. The medical expenses incurred by insured residents in each hospitalization, which exceed the Qifubiaozhun, shall be paid by the urban and rural residents' medical insurance fund according to the following proportions: 90% of the elderly and severely disabled people over 60 years old who are hospitalized in community health service centers (or first-class medical institutions); If you are hospitalized in a secondary medical institution, you will pay 80%; 70% for hospitalization in tertiary medical institutions; Persons under the age of 60 pay 80% for hospitalization in community health service centers (or first-class medical institutions), 75% for hospitalization in secondary medical institutions and 60% for hospitalization in tertiary medical institutions.

1. Outpatient emergency

The medical expenses incurred by the insured in the outpatient and emergency departments (including family beds) shall be paid by the urban and rural residents' medical insurance fund according to a certain proportion, and the rest shall be borne by individuals.

Qifubiaozhun is: 300 yuan for the elderly aged 60 and above, severely disabled, primary and secondary school students and infants; /kloc-500 yuan for people over 0/8 and under 60.

The proportion of urban and rural residents' medical insurance fund payment is: 70% in the outpatient emergency of community health service center (or first-class medical institution); Second-level medical institutions outpatient emergency 60%; In the third-level medical institutions outpatient emergency, pay 50%.

The medical expenses incurred by the insured in the village clinic clinic are not included in the Qifubiaozhun, and 80% are paid by the urban and rural residents' medical insurance fund.

2. Hospitalization

The medical expenses incurred by each hospitalization (including emergency observation room observation) of the insured shall be set with the minimum payment standard. The part exceeding Qifubiaozhun shall be paid by the urban and rural residents' medical insurance fund according to a certain proportion, and the rest shall be borne by individuals.

Qifubiaozhun is: 50 yuan, a first-class medical institution; 100 yuan, a secondary medical institution; 300 yuan, a tertiary medical institution.

The proportion of urban and rural residents' medical insurance fund payment is: 90% of the elderly and severely disabled people aged 60 and above are hospitalized in community health service centers (or first-class medical institutions), 80% in second-class medical institutions and 70% in third-class medical institutions; Persons under the age of 60 pay 80% for hospitalization in community health service centers (or first-class medical institutions), 75% for hospitalization in secondary medical institutions and 60% for hospitalization in tertiary medical institutions.

3. Medical treatment of serious diseases

The medical expenses incurred by the insured in the designated medical institutions of this Municipality due to serious illness shall be reimbursed by the insured to the serious illness insurance agency for 50% after medical insurance settlement.

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