Proportion of outpatient reimbursement in different places in Shanghai

What is the reimbursement rate of outpatient service in different places in Shanghai?

The proportion of reimbursement for outpatient services in different places in Shanghai refers to the proportion that can be reimbursed by medical insurance when seeking medical treatment outside Shanghai. At present, the reimbursement rate of outpatient service in different places in Shanghai ranges from 50% to 80%, depending on the medical insurance policy of the place where the patient is treated and the medical insurance scheme that the individual participates in.

First, understand the medical insurance policy

First of all, we need to know Shanghai's medical insurance policy, as well as the areas for medical treatment, including the reimbursement ratio, reimbursement scope and reimbursement standards of medical insurance clinics. Relevant information can be obtained through official channels such as local social security bureau and medical insurance bureau.

Second, choose designated medical institutions.

When seeking medical treatment in different places, you need to choose a local designated medical institution for treatment. You can check the list of designated medical institutions through official channels such as local social security bureau and medical insurance bureau.

Third, go through the formalities of medical treatment in different places.

After choosing a designated medical institution, you need to go to the local medical insurance management institution for medical treatment in different places. For the specific process, please consult the local medical insurance management institution or social security bureau.

4. Reimbursement with relevant certificates

After outpatient treatment in different places, you need to submit relevant documents (including ID card, medical insurance card, outpatient medical records, invoices, etc.). ) to the local medical insurance management institutions for reimbursement. The reimbursement ratio and specific amount depend on the local medical insurance policy.

The reimbursement rate of outpatient service in different places in Shanghai should be determined according to the policies of the insured places and the level of hospitals in different places. Generally speaking, under the condition of meeting the requirements of medical treatment in different places, the insured person will seek medical treatment in the outpatient department of a hospital outside Shanghai, and the medical expenses will be paid in advance by the individual. After discharge, submit the relevant materials to the social security agency of the insured place for reimbursement. The proportion of reimbursement is generally between 50% and 75%, and the specific proportion depends on the payment grade of the insured and the level of the hospital in different places.

To sum up:

The reimbursement rate of outpatient service in different places in Shanghai depends on the medical insurance policy of the place where the patient is treated and the medical insurance scheme that the individual participates in, which is generally between 50% and 80%. Before seeking medical treatment in different places, you need to know the local medical insurance policy and choose designated medical institutions for treatment. At the same time, you need to go through the formalities of medical treatment in different places and submit reimbursement with relevant documents.

Legal basis:

Article 32 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "Social insurance agencies shall pay social insurance benefits to people who participate in social insurance in a timely manner in accordance with regulations."

Article 33 of the Measures for Basic Medical Insurance for Urban Workers in Shanghai stipulates: "If the insured person goes to a different place for medical treatment, the medical insurance fund shall pay the medical expenses in accordance with the provisions of these Measures."