1 For retirees under 70 years old, the reimbursement rate for expenses exceeding 1300 yuan is 85%.
2. For retirees over 70 years old, the reimbursement rate is 90% for those whose expenses exceed 1.300 yuan.
3. The reimbursement rate is related to the hospital level, which is 85% to 95% in tertiary hospitals, 87% to 97% in secondary hospitals and 90% to 97% in community hospitals.
4. The accumulative reimbursement limit is 300,000 yuan.
The scope and policy of medical insurance reimbursement:
1. Reimbursement conditions: you must see a doctor in a designated medical institution and meet the reimbursement conditions stipulated in the medical insurance policy;
2. Reimbursement ratio: according to different levels of medical institutions and patient medical insurance types, the reimbursement ratio will be different;
3. deductible line: medical insurance reimbursement usually has a deductible line, and medical expenses below the deductible line are not reimbursed;
4. Top line: there is a maximum amount of medical insurance reimbursement, and individuals need to pay for the excess;
5. Self-funded items: some drugs and treatment items are not covered by medical insurance reimbursement and need to be fully borne by individuals;
6. Drug List: Medicare drugs are divided into Class A and Class B, and different categories of drugs have different reimbursement rates.
To sum up, the proportion of hospitalization reimbursement for Shanghai medical insurance varies according to age and hospital level. For retirees under 70 years old, if they exceed 1.300 yuan will reimburse 85%, those over 70 years old will reimburse 90%, tertiary hospitals will reimburse 85% to 95%, secondary hospitals will reimburse 87% to 97%, and community hospitals will reimburse 90% to 97%. The cumulative upper limit of all reimbursement is 30.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 26
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.