Legal analysis: There are two types of medical insurance benefits for retirees in Shanghai: those under 69 and those over 7. On April 1st every year, the medical insurance bureau will inject funds into the personal medical insurance account. In recent years, the funds injected each year are 1,12 yuan for those under 69 and 1,28 yuan for those over 7. The funds in the account will be used first, and then they will enter the conceited stage after being used up. The amount is 7 yuan, and it will enter the * * * after surpassing 7 yuan.
The medical insurance benefits for retirees under 69 years old in Shanghai shall be based on the following standards:
Outpatient service: the expenses incurred by retirees in emergency treatment within one year that meet the requirements of the basic medical insurance for urban workers in this city shall be paid by their personal medical accounts in that year, and the insufficient part shall be paid by individuals to the standard of self-financing for emergency treatment, and the standard is 7 yuan, and the excess part shall be paid by additional funds in a certain proportion, that is, in emergency treatment of first-,second-and third-class medical institutions.
Out-patient illness: 92% of the medical expenses incurred by retirees during dialysis for severe uremia, chemotherapy and radiotherapy for malignant tumors will be paid by the overall fund. The rest is paid by the balance funds in the individual medical account over the years, and the insufficient part is borne by the individual.
hospitalization (including observation in the emergency observation room): the expenses incurred by retirees in hospitalization within one year that meet the requirements of the basic medical insurance for urban workers in this city are set with hospitalization deductible line (the retirees before December 31, 2 are 7 yuan; For those who retired after January 1, 21, it was 12 yuan), and 92% of the medical expenses above the hospitalization deductible line were paid by the overall fund.
Family sickbeds: 8% of the medical expenses incurred by family sickbeds will be paid by the overall fund, and the rest will be paid by the surplus funds of individual medical accounts over the years, and the insufficient part will be borne by individuals.
maximum payment limit: the maximum payment limit of the overall fund is 28, yuan. The medical expenses above Qifubiaozhun incurred by retirees in hospitalization and emergency observation room for observation within a medical insurance year, as well as the medical expenses of outpatient serious illness or family sickbed, which are below the maximum payment limit, shall be paid according to the above provisions. 8% of the medical expenses above the maximum payment limit of the overall fund shall be paid by the additional fund, and the rest shall be borne by the individual.
For retirees over p>7 years old, according to the following standards:
Outpatient service: the expenses incurred by retirees in emergency treatment within one year that meet the requirements of the basic medical insurance for urban workers in this city shall be included in their personal medical accounts in that year, and the insufficient part shall be paid by individuals to the standard of self-financing for emergency treatment. The standard is 7 yuan, and the excess part shall be paid by additional funds according to a certain proportion, that is, those in emergency treatment in first-,second-and third-level medical institutions shall be paid by additional funds respectively.
Out-patient illness: 92% of the medical expenses incurred by retirees during dialysis for severe uremia, chemotherapy and radiotherapy for malignant tumors will be paid by the overall fund. The rest is paid by the balance funds in the individual medical account over the years, and the insufficient part is borne by the individual.
hospitalization (including observation in the emergency observation room): the expenses incurred by retirees in hospitalization within one year that meet the requirements of the basic medical insurance for urban workers in this city are set with hospitalization deductible line (the retirees before December 31, 2 are 7 yuan; For those who retired after January 1, 21, it was 12 yuan), and 92% of the medical expenses above the hospitalization deductible line were paid by the overall fund.
Family sickbeds: 8% of the medical expenses incurred by family sickbeds will be paid by the overall fund, and the rest will be paid by the surplus funds of individual medical accounts over the years, and the insufficient part will be borne by individuals.
maximum payment limit: the maximum payment limit of the overall fund is 28, yuan. The medical expenses above Qifubiaozhun incurred by retirees in hospitalization and emergency observation room for observation within a medical insurance year, as well as the medical expenses of outpatient serious illness or family sickbed, which are below the maximum payment limit, shall be paid according to the above provisions. 8% of the medical expenses above the maximum payment limit of the overall fund shall be paid by the additional fund, and the rest shall be borne by the individual.
Legal basis: Social Insurance Law of the People's Republic of China
Article 12 The employing unit shall pay the basic old-age insurance premium in proportion to the total wages of its employees as stipulated by the state and record it in the basic old-age insurance pooling fund.
employees should pay the basic old-age insurance premium according to the proportion of their salary stipulated by the state and record it in their personal accounts.
individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual account respectively.
article 23 employees shall participate in the basic medical insurance for employees, and the employer and employees shall pay the basic medical insurance premiums in accordance with the state regulations.
individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employing unit and other flexible employees can participate in the basic medical insurance for employees, and individuals will pay the basic medical insurance premium according to state regulations.
article 35 an employer shall pay work-related injury insurance premiums according to the total wages of its employees and the rates determined by social insurance agencies.
article 44 employees shall participate in unemployment insurance, and the employer and employees shall pay unemployment insurance premiums in accordance with state regulations.
article 53 employees shall participate in maternity insurance, and the employer shall pay the maternity insurance premium according to the provisions of the state, while employees shall not pay the maternity insurance premium.