I. Shanghai retired workers' medical insurance policy documents
The standard contribution for retirees' major medical insurance is 200 yuan. Among them, 100 yuan is paid by the unit, and the other 100 yuan is paid by the individual. The contribution standard of 200 yuan is unified by the state, no matter what year of retirement, the standard will not change. If there is a change in policy, it is a uniform change, and the standard is the same for all. But it depends on how the unit, like some units have gone bankrupt, then you need to pay the full amount of the individual.
Shanghai retired workers health insurance policy (Shanghai retired workers health insurance policy documents)
Two, the Shanghai Municipality after retirement health insurance enjoyment requirements
Shanghai Municipality's health insurance payment as long as the 15 consecutive years can be in the retirement of lifelong enjoyment of medical insurance, which in the whole country is the shortest time to pay, other provinces and municipalities are required to pay more time in order to enjoy lifelong medical insurance.
Currently, Shanghai's retirees under 74 years of age 1680 yuan per year, more than 75 years of age 1890 yuan per year, July into the personal account, after the exhaustion of the 2000 years before the retirement of the personal responsibility of 300 yuan, after the personal responsibility of 700 yuan, followed by the first level of hospitals medical insurance reimbursement of 90%, the second level hospitals is 80%, the third level hospitals is 70%, these are the scope of the outpatient emergency The scope of the
Three, Shanghai retired workers health insurance policy documents latest
Employee health insurance integrated fund maximum payment limit, will be from 550,000 yuan → 570,000 yuan, the maximum payment limit above the part, still in accordance with the provisions of the continued reimbursement of 80%
Retired workers in the current year, the balance of the health insurance account: 74 years of age counted as less than 1,680 yuan, 75 years of age counted as more than 1,890 yuan.
Four, Shanghai retired workers health insurance policy documents
Shanghai retired workers mutual medical insurance payment process:
1, fill out a complete "Shanghai retired workers hospitalization supplemental medical care mutual insurance protection plan enrollment registration form"
2, with the EXCEL format production The list of insured persons (serial number, name, ID number and four fields of dry insurance) in EXCEL format should be copied to a USB flash drive and submitted to the service office of the nearest District Federation of Trade Unions.
3. Financial vouchers of paid contributions.
Methods of payment:
1. Credit vouchers (a copy of which is stamped with the bank's business seal at the time of enrollment)
2. Internet banking (a printout of the payment vouchers is provided at the time of enrollment)
3. Cash withdrawal slips (a copy of which is stamped with the bank's business seal at the time of enrollment)
4. Withholding of protection fees (for 10 or more persons)
5. More than 10 people can apply)
5. Shanghai retired workers health insurance policy documents to download
Retired workers with ID card for the first time to the community affairs center to pay a large amount of health insurance and agree to the subsequent annual deductions from the pension to write a good agreement.
Legal basis
"Improvement of Shanghai workers basic medical insurance outpatient **** relief protection mechanism implementation measures"
The second, the main tasks
(a) improve the individual account crediting method. Since July 1, 2023, the basic medical insurance premiums paid by active employees are all credited to their individual medical accounts, with a crediting standard of 2% of their contribution base, and the basic medical insurance premiums paid by the unit are all credited to the integrated fund. Retirees' individual accounts are credited by the integrated fund at a fixed rate, which is 1,680 yuan/year for those under the age of 74 and 1,890 yuan/year for those over the age of 75.
(ii) Enhancement of the outpatient **** relief protection function. Improve the outpatient expense protection mechanism of employee health insurance, and from July 1, 2023, adjust the standard of outpatient emergency treatment.
1. Active employees: the standard of outpatient emergency outpatient self-payment section is adjusted to 500 yuan. The exceeding part will be paid by the coordinated fund according to the following standards: 80% of outpatient emergency treatment in first-class medical institutions, 75% of outpatient emergency treatment in second-class medical institutions, and 70% of outpatient emergency treatment in third-class medical institutions.
2. Retirees: (1) For those who retired after January 1, 2001, the standard of outpatient and emergency care deductible section was adjusted to 300 yuan. The exceeding part is paid by the coordinated fund according to the following standards: 85% of the coordinated fund is paid for outpatient emergency treatment in a first-class medical institution; 80% of the coordinated fund is paid for outpatient emergency treatment in a second-class medical institution; 75% of the coordinated fund is paid for outpatient emergency treatment in a third-class medical institution. (2) For those who retired before December 31, 2000, the standard for the outpatient emergency self-payment section is adjusted to 200 yuan. The excess shall be paid by the coordinated fund according to the following standards: 90% of outpatient emergency treatment in first-class medical institutions; 85% of outpatient emergency treatment in second-class medical institutions; 80% of outpatient emergency treatment in third-class medical institutions.
(3) Standardize the scope of use of individual accounts. Individual accounts are mainly used to pay for out-of-pocket expenses within the scope of policy incurred by insured persons at designated medical institutions or designated retail pharmacies.
From July 1, 2022 onwards, the scope of use of individual accounts will be expanded step by step. The individual account can be used to pay for the medical expenses incurred by the insured person, his/her spouse, parents and children at the designated medical institutions, as well as the expenses incurred by the insured person for the purchase of medicines, medical equipments and medical consumables at the designated retail pharmacies. Explore the use of individual accounts for the personal contributions of spouses, parents and children to participate in basic medical insurance for urban and rural residents, etc. Individual accounts shall not be used for public **** health expenses, sports and fitness or health care consumption, and other expenditures that are not covered by basic medical insurance.
(d) Enhancement of the function of local additional funds to supplement the guarantee. The local supplementary medical insurance premiums paid by employers are all included in the local supplementary fund and are separately accounted for. from January 1, 2023, outpatient and emergency medical expenses are included in the scope of payment by the integrated fund and are no longer paid by the local supplementary fund. The local supplementary fund will continue to pay for the reduced costs, including the comprehensive reduction of employees' medical insurance, and part of the medical costs above the maximum payment limit of the coordinated fund. The local supplementary funds will be explored to play the functions of multi-channel financing and supplementary protection in coping with the aging of the population.
(v) Strengthening supervision and management. Improve management and service measures, innovate the system operation mechanism, guide the rational use of medical resources, ensure the stable operation of the medical insurance fund, and give full play to the protection function. Strictly implement the budget management system of the medical insurance fund, and strengthen the fund audit system and the construction of internal control system. It has further improved the dynamic management mechanism for the entire process of individual accounts, and strengthened the auditing of the use and settlement of individual accounts. It has strengthened the supervision of medical behaviors and medical expenses, improved the administrative and law enforcement supervision system at the municipal and district levels, continued to carry out special actions to combat fraud and insurance fraud, strengthened inter-departmental joint supervision, reinforced social supervision, and accelerated the construction of an intelligent supervision system. It has also accelerated the construction of the primary medical service system, improved the contracted services of family doctors, standardized the management of long-term prescriptions, and guided insured persons to seek first medical treatment at the primary level.
(6) Improving the payment mechanism compatible with outpatient ****ancial protection. Strengthening the "three doctors" linkage, and promoting the deepening of the reform of the medical and health system. Implementing the multi-dimensional and composite health insurance payment methods under total budget management, such as capitation payment, payment by type of disease and payment by bed day, continuing to deepen the reform of the health insurance payment method, promoting the DIP system, and the DRG system, to provide the public with better quality medical services, and reduce the burden of the public on medical treatment and medical care. Medical insurance payment standards have been scientifically and reasonably determined to guide the proactive use of medicines with proven efficacy and reasonable prices. Further, the qualified "Internet +" medical service programs will be included in the payment scope.