How much can Shanghai medical insurance clinic reimburse?

1. How many outpatients are there in Shanghai?

social security

undertake

From July 20265438 1 day, the upper limit of Shanghai social security payment base was adjusted to 3 10 14 yuan/month. The lower limit of social security payment base should be 60% of the average wage of employees in full-caliber urban units. Considering the impact of COVID-19 epidemic on economic and social development, in order to reduce the burden on enterprises, the lower limit of Shanghai social security payment base will be put in place in two years, from July 2002 1 year to July 5975 yuan/month/year.

2. How many social security departments are responsible for reimbursement in Shanghai?

Outpatient reimbursement content: 70% of the annual accumulated emergency medical expenses of the elderly over 60 years old, severely disabled, primary and secondary school students, infants and young children exceed that of 300 yuan. Secondary medical institutions pay 60%; Tertiary medical institutions pay 50%.

/kloc-for those over 0/8 but under 60 years old, if the annual accumulated outpatient and emergency medical expenses exceed that of 500 yuan, they shall seek medical treatment in community health service centers (or first-class medical institutions), and the residents' medical insurance fund shall pay 70%; Secondary medical institutions pay 60%; Tertiary medical institutions pay 50%.

The insured in the village clinic outpatient medical treatment, not included in the Qifubiaozhun, direct payment of 80%.

Proportion of reimbursement for hospitalization (including observation in emergency observation room)

Minimum payment standards are set for medical expenses incurred by urban and rural residents in each hospitalization, specifically: 50 yuan, a first-level medical institution, 100 yuan, and 300 yuan, a third-level medical institution. More than Qifubiaozhun above part of the medical expenses, residents' medical insurance fund to pay according to the following proportion:

160 years old and above, as well as severely disabled people, who are hospitalized in community health service centers (or first-class medical institutions), pay 90%; Secondary medical institutions pay 80%; Third-level medical institutions pay 70%.

Persons under the age of 260 who are hospitalized in community health service centers (or first-class medical institutions) will be paid 80%; Secondary medical institutions pay 75%; Tertiary medical institutions pay 60%

3. How many outpatients in Shanghai bear half of the social security?

If you pay five insurances and one gold, the outpatient expenses will be paid in the medical insurance card first, and then enter the independent part of 1500 after use. When it exceeds 1500, there will be different reimbursement rates according to the level of the hospital, which will be directly recorded when the hospital pays.

4. Shanghai social security outpatient reimbursement ceiling

Proportion of medical insurance reimbursement in Shanghai

First, the proportion of outpatient and emergency reimbursement

1, outpatient emergency of community health service center (or medical institution), 70% reimbursement;

2 secondary medical institutions outpatient emergency reimbursement 60%;

3, in the outpatient emergency of tertiary medical institutions, pay 50%.

Second, the proportion of hospitalization reimbursement

1, community health service center (or first-class medical institution) pays 90% for hospitalization;

2, secondary medical institutions pay 80% for hospitalization;

3. 70% are hospitalized in tertiary medical institutions;

People under the age of 4.60

1 80% hospitalization in community health service centers (or first-class medical institutions);

75% were hospitalized in secondary medical institutions,

3. 60% were hospitalized in tertiary medical institutions.

Proportion of medical insurance payment in Shanghai

The contribution rate of medical insurance employers in Shanghai is 1 1%, and the individual contribution rate is 2%.

5. Provisions of Shanghai Medical Insurance on the number of visits per month

There is no limit to the number of times and the amount is limited. Only one card can be used at a time.

There is no limit to the number of times you can use coupons in Shanghai. However, at present, each person can draw at most three coupons, namely 1, 100 minus 50, and 2 over 50 minus 25. You can use them through the same merchant or different merchants in the same day. Three coupons must be used separately, and only after three times can they be fully reduced, and each consumption will be written off 1 coupon.

6. How much can Shanghai employee social security clinic reimburse?

The reimbursement of medical insurance for urban workers in Shanghai varies from 50% to 75% according to the age of patients and the level of hospitals. Generally, on-the-job employees under the age of 44 exceed the deductible line of emergency 1500 yuan.

On-the-job employees can be reimbursed for 65% medical insurance when they see a doctor in a first-class hospital.

The medical insurance for employees in secondary hospitals can be reimbursed by 60%.

The medical insurance for employees in tertiary hospitals can be reimbursed by 50%.

Top line: No matter what level of hospital, it is 550,000 yuan, and the part above the maximum payment limit will continue to be reimbursed 80% according to regulations.

7 Shanghai outpatient medical insurance reimbursement ceiling

Shanghai basic medical insurance insured treatment:

The medical expenses incurred by the insured of Shanghai basic medical insurance in outpatient emergency (including family beds) and hospitalization (including emergency observation room staying in hospital for observation) that meet the requirements of these measures shall be paid by the Shanghai basic medical insurance fund according to the following proportion, and the rest shall be borne by the insured personally:

(1) For people over 70 years old, 70% will be paid for hospitalization and 50% for outpatient emergency;

(two) people over the age of 60 and under the age of 70, 60% in hospital and 50% in outpatient emergency;

(3) For those over 60 years old and under 08 years old, 50% will be paid for hospitalization, and 50% will be paid for outpatient emergency medical expenses exceeding 1000 yuan;

(four) primary and secondary school students and infants, hospitalization pay 50%, outpatient emergency pay 50%.

The insured in the community health service center (or medical institutions) outpatient medical treatment, paid by the municipal basic medical insurance fund 60%.

8. How many medical insurance clinics can be reimbursed in Shanghai?

Outpatient medical insurance reimbursement is not zero bottom line reimbursement, and it can only be reimbursed if it exceeds the prescribed threshold. And the insured person needs to go to the designated hospital to see a doctor in order to reimburse the expenses.

1) On-the-job employees: the deductible is 2,000 yuan, and the medical expenses incurred in the outpatient department are only reimbursed if it exceeds 2,000 yuan, and the reimbursement ratio is 50%.

(2) Retired employees: the deductible line is 1300, of which 70% are retired employees under 70 years old and 80% are over 70 years old.

(3) Special diseases: within one year, the deductible line for outpatient reimbursement of special diseases is 400 yuan.

9 Shanghai medical insurance outpatient reimbursement ceiling

At least 70 years of age and above, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur within one settlement year. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

10. Shanghai Medical Insurance Clinic Super 1500.

The reimbursement rate is still very high.

proportion

Under normal circumstances, employees in Shanghai need to use up the amount of medical insurance in the current year when they are at the door or in emergency, and enter the self-funded part, of which the self-funded part is 1500 yuan. In terms of reimbursement of hospitalization expenses, as long as it exceeds 1500 yuan, it can be reimbursed by medical insurance in different proportions.

The reimbursement of medical insurance for urban workers in Shanghai varies from 50% to 75% according to the age of patients and the level of hospitals. Generally, employees under the age of 44 exceed the deductible line for outpatient and emergency treatment 1.500 yuan. Employees who see a doctor in a first-class hospital can be reimbursed by medical insurance for 65%, and employees who see a doctor in a second-class hospital can be reimbursed by medical insurance for 60%. The medical insurance for employees in tertiary hospitals can be reimbursed by 50%. Employees over the age of 45 who exceed the outpatient and emergency deductible line 1.500 yuan will be reimbursed 75% for medical insurance for employees in the first-level hospitals and 70% for employees in the second-level hospitals; The medical insurance for employees in tertiary hospitals can be reimbursed by 60%.