The latest regulations on the scope of Shanghai medical insurance reimbursement in 2017
Shanghai basic medical insurance reimbursement scope
Shanghai basic medical insurance reimbursement scope includes:
1, general outpatient consultation fees, specialist outpatient consultation fees, emergency consultation fees of designated medical institutions;
2, bed fees of general wards of designated medical institutions;
3, outpatient decoction fees;
4, medical expenses incurred by designated medical institutions for medical treatment, dispensing of medicines, or dispensing of medicines by designated retail pharmacies;
5, medical expenses in line with the basic medical insurance diagnostic and treatment programs, medical service facilities, the scope of medicines, and the payment standards.
Medicare part of the payment of diagnostic and treatment items include
1, diagnostic and treatment equipment:
Magnetic resonance imaging (MRI) examination and treatment fees;
Cardiac and angiography X-ray machine (including digital subtraction equipment) (DSA) examination and treatment fees;
Single Photon Emission Computer Scanning Device (SPECT) examination fee;
Hyperbaric oxygen treatment fee (except for rescue treatment);
Extracorporeal shock wave lithotripsy treatment fee.
2. Single-use and implantable artificial organs and medical materials:
Implantable crystal material fee;
Heart valve material fee;
Catheter and intraluminal stent material fee for diagnosis and intervention of coronary artery disease;
Materials for peripheral and neurovascular interventions.
Shanghai migrant workers' health insurance reimbursement scope: medical expenses incurred in hospitalization or emergency observation room for observation, temporarily excluded from outpatient major diseases, family hospital beds, medical treatment, as well as all kinds of health insurance reduction treatment. However, the individual medical account is limited to outpatient care, and is exclusively for outpatient care, and is used to pay for outpatient emergency medical expenses in accordance with the city's basic medical insurance regulations, as well as the costs of purchasing medicines at designated retail pharmacies.
The scope of reimbursement under the New Farmers' Cooperative Medical Insurance: outpatient co-ordination, inpatient co-ordination, and outpatient reduction subsidy (secondary compensation) co-ordination fund expenditures.
Explanation of contents
Outpatient (including emergency) co-ordination fund expenditure: refers to the co-ordination fund to pay for outpatient outpatient clinics of participants in the annual cumulative range of basic diagnostic and treatment items and the basic drug directory of the scope of the reimbursement of less than 5,000 yuan.
Inpatient Coordination Fund Expenditures: refers to the compensation expenditures paid by the Coordination Fund for the expenses of participants' inpatient hospitalization in accordance with the scope of the basic diagnostic and treatment items and the basic medicines list, or the medicines list of outpatient major illnesses of more than 5,000 yuan.
Comprehensive Fund Expenditures for Major Disease Reduction Subsidies (Secondary Compensation): refers to the compensation expenditures from the Comprehensive Fund for those whose one-time out-of-pocket medical expenses are still more than 50% of the family's annual income even if the participant is entitled to inpatient comprehensive compensation or outpatient comprehensive compensation of more than 5,000 yuan. The standard of compensation is the same as the hospitalization compensation, and it can be increased by 10-20 percentage points for the low-income households, five-guaranteed households, and households with disabled persons confirmed by the civil affairs.
What is not covered by Shanghai Medical Insurance?
1. Those that should be paid from the Workers' Compensation Insurance Fund;
2. Those that should be borne by a third party;
3. Those that should be borne by the public ****health;
4. Those who seek medical treatment outside China.
Shanghai health insurance reimbursement FAQs
1. My mom is 45 years old and I plan to enroll her in the New Farmers' Cooperative.
Answer: The reimbursement scope of Shanghai New Farmers' Cooperative includes outpatient coordination, inpatient coordination, and major disease reduction subsidies (secondary compensation) for the overall fund expenses.
2. Our unit is located in Huangpu District, Shanghai, the unit of an employee encountered a car accident during work hours, the employee himself is not responsible for, has now been hospitalized, this situation can be handled for medical insurance reimbursement?
A: According to your description, the situation of your employee belongs to the third party should be borne by the third party, so it does not belong to the scope of payment of Shanghai medical insurance, should be paid by the third party.
3. I'm from Hunan, but I've been working in Shanghai, and my organization has purchased medical insurance for me. Can I get outpatient medical treatment under the medical insurance for migrant workers?
A: The medical insurance for migrant workers can only reimburse the medical expenses incurred in hospitalization or emergency observation room, and is not entitled to the outpatient major illnesses, family hospital bed medical treatment, and all kinds of medical insurance reduction treatment.
Shanghai new policy on major medical insurance in 2017
Shanghai officially launched the urban residents of major medical insurance, four kinds of major diseases can be reimbursed another 50%. Anyone who participates in the basic medical insurance for urban residents in Shanghai can also enjoy the residents' major medical insurance on top of the basic medical insurance treatment, without additional contributions. Participants can enjoy the treatment of major disease insurance in the form of reimbursement.
Four kinds of major diseases can be reimbursed another 50%:
The four kinds of major diseases refer to: severe uremia, kidney transplantation, malignant tumors, and partial mental illness. Dialysis treatment for severe uremia, anti-rejection treatment for kidney transplantation, malignant tumor treatment, and treatment for some psychiatric diseases, the individual out-of-pocket expenses incurred within the scope of payment of basic medical insurance will be reimbursed by the funds of the urban residents' major disease insurance by another 50%.
Additionally, medical expenses incurred by Shanghai college students suffering from hemophilia and aplastic anemia can also be included in the residents' major disease insurance coverage.
Participating residents suffering from the above major illnesses will be included in the coverage of the residents' major disease insurance, and 50% of the individual's out-of-pocket expenses (hereinafter referred to as "out-of-pocket expenses") incurred at the designated medical institutions of the city's basic medical insurance will be reimbursed by the funds of the residents' major disease insurance. Among them, the insured residents who have participated in the city's primary and secondary school students, infants and young children hospitalization medical mutual fund, should be deducted from the part of the mutual fund, the remaining out-of-pocket expenses, and then reimbursed by the residents of the major medical insurance funds 50%.
How to be reimbursed:
Participating residents' out-of-pocket expenses incurred after January 30 this year that meet the scope of the residents' major medical insurance shall be reimbursed by the residents' major medical insurance by voluntarily choosing one of the above-mentioned commercial insurance institutions within six months from the date of the receipt of medical expenses. The commercial insurance organization selected by the insured residents when they first apply for reimbursement of the residents' major medical insurance shall be the designated agency for handling the residents' major medical insurance reimbursement in the current year; once selected, no change shall be made during the year in principle.
Hotline inquiry:
How for urban residents still do not understand the residents of the health insurance, you can call the Shanghai medical insurance service hotline 962218 for consultation.
Shanghai medical insurance reimbursement of new policy related articles:
1. 2016 Shanghai major medical insurance reimbursement of new policy
2. Shanghai medical insurance policy
3. 2016 Shanghai medical insurance policy what
4. 2017 Shanghai medical insurance have what policy
5. Shanghai major medical insurance new policy
Extended reading: insurance how to buy, which is good, hand to teach you to avoid the insurance of these "pits"