Self-financing part of medical insurance for retirees in Shanghai

Shanghai medical insurance conceit standard:

Using Shanghai medical insurance can reimburse some medical expenses, but some of them need to be borne by themselves. Provisions on reimbursement of medical expenses of the insured to selected medical institutions: reimbursement amount = (total medical expenses -400 yuan) 75%, and individual pays = (total medical expenses -400 yuan) x25%+400 yuan. Let's give a simple example: the total medical expenses are 2400 yuan, the out-of-pocket expenses are (2400-400)25%+400=500+400=900, and the reimbursement is (2400-400) x75= 1500 yuan.

For medical treatment in Shanghai, no matter how much medical expenses you spend when you are hospitalized, you must first deduct the amount you bear on the basis of the medical expenses, and then enjoy reimbursement according to the corresponding proportion. This also means that even if medical insurance can cover most of it, you need to bear part of it yourself, which is called deductible.

Shanghai medical insurance reimbursement for medical treatment in different places:

1. Travel abroad

Shanghainese who are on business trips in other places seek medical treatment in local designated medical insurance hospitals or hospitals above township health centers approved by the administrative department of health. Emergency medical expenses (including emergency hospitalization) that meet the basic medical insurance provisions can be paid in advance by the insured in cash, and afterwards, they can apply for reimbursement in the neighboring district and county medical insurance service centers or street medical insurance service points (agencies) (the application can be made within 6 months from the date when the hospital issues a medical fee receipt). When reimbursing, you should bring your ID card (if you entrust someone else to do it, you should also provide the valid certificate of the agent), social security card or medical insurance card, the original receipt of medical expenses, relevant medical history data and copies (summary and copy of hospital discharge, list and copy of medical expenses). The insured directly under the municipal unit shall apply for sporadic reimbursement to the municipal medical insurance affairs center.

2. Working outside for a long time

For those who have worked in other provinces for a long time, if they need to use Shanghai Medical Insurance for reimbursement of medical treatment in different places, they need to bring their ID card (if they entrust others, they also need to provide their agent ID card), social security card or medical insurance card, and proof of residence in different places (such as a copy of the household registration certificate of the foreign head of household, etc.), and primary and secondary school students and infants should also provide proof of studying in other provinces and cities to go to the nearby district and county medical insurance center or street (township) medical insurance service point to handle the transfer of medical treatment relationship.