★ Doorman emergency department is used to pay by credit card.
General registration fees, outpatient and emergency inspection fees, you may only need to pay a few dollars after swiping your card.
★ Drugstore buys medicine
You can only buy those within the scope of medical insurance, so that Class A drugs may not need to be paid by yourself, and Class B drugs may have to be paid in part. If they are part of Class B or Class C drugs, they will have to pay at their own expense.
★ Show your social security card when you are in hospital.
The hospitalization expenses are automatically removed from the card, and the self-sufficient part is removed and paid according to the reimbursement ratio.
Reimbursement amount
0 1 On-the-job staff's emergency treatment and hospitalization treatment
■ On-the-job employees: outpatient and emergency treatment
★ You need to use up the amount included in the medical insurance in that year first, and then enter the self-funded section. The self-paid amount is 1500 yuan.
★ When our out-of-pocket expenses exceed 1500 yuan, we will reimburse them according to the following proportion.
Note: The medical expenses of the outpatient and emergency departments at their own expense and the rest after the negative expenses are paid by the medical insurance fund. If there are surplus funds in the personal medical insurance account over the years, they shall be paid by the surplus funds over the years first, and the insufficient part shall be borne by the insured.
■ On-the-job employees: stay in hospital or emergency observation room for observation and treatment.
★ If hospitalization is needed, most medical expenses can be borne by medical insurance as long as medical insurance is paid.
★ First of all, we need to pay the hospitalization deductible for 1500 yuan.
★ Expenses exceeding the deductible can be paid by the medical insurance pooling fund in proportion. As shown in figure:
From 0: 00 on July 1 year, the medical insurance for employees in this city will enter the medical insurance year of 20021year (July/year 20021year to June 30, 2022), and the maximum payment limit of the employee medical insurance pooling fund will be increased from 550,000 yuan to 570,000 yuan. The part above the maximum payment limit,
02 outpatient and emergency treatment and hospitalization treatment of retired workers
■ Outpatient and emergency treatment for retired workers
★ As long as you pay 15 years of employee medical insurance before retirement, you can enjoy medical insurance for life after retirement, and individuals don't have to pay.
★ Retired employees are older, and they may go to the hospital more frequently than before. Fortunately, the country is considerate, the standard of self-sufficiency is lower than that of on-the-job employees, and the reimbursement ratio is higher than that of on-the-job employees. As shown in figure:
Note: After the outpatient and emergency medical expenses and the negative expenses are paid by the medical insurance fund, the remaining medical expenses will be paid by the surplus funds in the past years if they are credited to the personal medical account, and the insufficient part will be borne by the insured.
■ Retired employees: in-patient or emergency observation, stay in the hospital for observation and treatment.
★ If retirees are hospitalized beyond the deductible standard, they only need to pay 8%, and most of them are paid by the medical insurance pooling fund. The specific payment situation is as follows:
Second, Shanghai medical insurance reimbursement process and required materials 1, to apply for reimbursement of outpatient and emergency medical expenses, the insured should bring valid documents (ID card, household registration book, etc.), Social Security Card or Medical Insurance Card, special receipt for outpatient medical expenses, special receipt for emergency medical expenses, relevant medical history data and copies, emergency attachment page and copies of the Record Book of Outpatient and Emergency Medical Treatment (medical expenses incurred by people with medical relations in this city at designated medical institutions in this city) If the Medical Insurance Card is reported to be damaged, a Notice of Damage to the Medical Insurance Card is also required.
2, apply for hospitalization and emergency observation room hospitalization expenses reimbursement, the insured shall provide special receipt for hospitalization medical expenses, medical expenses list and copy during hospitalization, discharge summary and copy; Special receipt for medical expenses, list and copy of medical expenses for hospitalization in emergency observation room.
3. To apply for sporadic reimbursement of outpatient medical expenses for serious illness, the insured shall provide special receipts for outpatient medical expenses, disease diagnosis certificates and photocopies, relevant inspection reports and photocopies. 4. The insured person may entrust others to handle it on his behalf. The client needs to bring the valid certificates (ID card, household registration book, etc.) of himself and the insured at the time of handling.
4. Handling:
The insured person shall apply for sporadic reimbursement of medical expenses with relevant documents and materials to the nearby district and county medical insurance centers or service points as required.