Social security benefits for retirees in Shanghai

According to the provisions of the Measures of Shanghai Municipality on Basic Medical Insurance for Employees:

Article 25 (Outpatient Emergency Medical Expenses for Retirees)

The expenses incurred by retirees other than those specified in Article 26 and Article 28 of these Measures for outpatient emergency treatment or dispensing in designated retail pharmacies within one year shall be paid by their personal medical accounts in the current year. The insufficient part shall be paid by the individual to the outpatient and emergency 700 yuan, and the excess part shall be paid according to the following provisions (excluding the expenses incurred in dispensing in designated retail pharmacies):

(a) under the age of 69, in the first-class medical institutions outpatient emergency, 80% paid by the additional fund; Secondary medical institutions outpatient emergency, paid by the additional fund 75%; Third-level medical institutions outpatient emergency, paid by the additional fund 70%. Among them, those who were born before1955 65438+February 3 1, joined the work before 65438+February 3 1 in 2000, and retired after 200 1 exceeded the standard of outpatient and emergency treatment. Secondary medical institutions outpatient emergency, paid by the additional fund 80%; Third-level medical institutions outpatient emergency, paid by the additional fund 75%.

(two) the elderly over 70 years old, in the first-class medical institutions outpatient emergency, paid by the additional fund 85%; Secondary medical institutions outpatient emergency, paid by the additional fund 80%; Third-level medical institutions outpatient emergency, paid by the additional fund 75%.

Expenses other than those specified in Article 26 and Article 28 of these Measures incurred by the personnel who have gone through retirement formalities before June 5438+February 3, 2000/KLOC-0 within one year for outpatient emergency treatment or dispensing medicines at designated retail pharmacies shall be included in the individual medical account and paid by the year's overall fund. The insufficient part is paid by the individual according to the self-funded standard of outpatient and emergency services, and the excess part is paid according to the following provisions (excluding the expenses incurred in dispensing drugs in designated retail pharmacies): 90% is paid by the supplementary fund of outpatient and emergency services of first-class medical institutions; In the secondary medical institutions outpatient emergency, paid by the additional fund 85%; Third-level medical institutions outpatient emergency, paid by the additional fund 80%.

The standard medical expenses for outpatient and emergency services of retirees and the rest paid by additional funds shall be implemented in accordance with the provisions of this article. Personal medical accounts have surplus funds over the years, which shall be paid by the surplus funds over the years. If the payment is still insufficient, it shall be borne by the retirees.

The expenses incurred by retirees in dispensing drugs in designated retail pharmacies can be paid by the balance funds of individual medical accounts over the years.

Twenty-sixth (outpatient serious illness and family bed medical expenses)

Medical expenses incurred by outpatient dialysis of severe uremia, treatment of malignant tumor (chemotherapy, endocrine specific therapy, radiotherapy, isotope therapy, interventional therapy, traditional Chinese medicine treatment), treatment of some mental diseases (schizophrenia, moderate and severe depression, mania, obsessive-compulsive disorder, mental retardation with psychosis, epilepsy with psychosis, paranoid psychosis) (hereinafter referred to as "outpatient serious illness") and medical expenses incurred by on-the-job employees. For retirees, 92% will be paid by the overall fund. The rest shall be paid by the surplus funds of individual medical accounts over the years, and if the balance is still insufficient, it shall be borne by individual employees.

80% of the medical expenses incurred by employees' family beds are paid by the overall fund, and the rest are paid by the surplus funds of individual medical accounts over the years. If the cost is still insufficient, the employee shall bear the responsibility.

Article 28 (Medical Expenses for Retirees' Hospitalization and Emergency Observation Room)

Retirees in the hospital or emergency observation room to observe the medical expenses paid by the overall fund should set a minimum payment standard. For those who retire before 65438+February 3, 20001,the minimum payment standard is 700 yuan; If you retire after 200 1, 1, 1, the minimum threshold is 1200 yuan.

Retirees in the hospital or emergency observation room within one year to observe the occurrence of medical expenses, accumulated more than Qifubiaozhun, by pooling funds to pay 92%.

The medical expenses incurred by retirees below Qifubiaozhun and the remaining medical expenses paid by the overall fund shall be paid by the surplus funds of individual medical accounts over the years, and if they are still insufficient, the retirees shall bear the responsibility.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.