Shanghai medical insurance conceit standard in 2022

Proportion of medical insurance reimbursement in Shanghai in 2022: When working as a doorman or emergency in Shanghai, you need to use up the included amount of medical insurance in that year and enter the self-funded part, of which the self-funded part is 1.500 yuan. In terms of reimbursement of hospitalization medical 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%. In addition, the maximum payment limit of medical insurance for urban employees is 390,000 for on-the-job employees' hospitalization, emergency observation room and hospitalization observation, and the overall reimbursement rate is as high as 85%. Among them, the reimbursement rate of outpatient serious illness medical insurance is 85%, and the reimbursement rate of family bed medical insurance is 80%.

Scope of medical insurance reimbursement in Shanghai in 2022:

1. The medical expenses incurred by the insured in the emergency treatment of medical institutions in other provinces and cities, the medical expenses incurred in the pre-hospital emergency treatment in this city, and the emergency medical expenses incurred during the loss of social security cards or medical insurance cards.

2. Insured persons from other provinces and cities with medical relations, outpatient and emergency medical expenses, emergency observation room and hospitalization medical expenses.

legal ground

People's Republic of China (PRC) social insurance law

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.