Shanghai social security card includes five insurance and one fund
Medical Insurance, Work Injury Insurance, Maternity Insurance, Pension Insurance and Housing Provident Fund.
However, they are adjusted almost every year.
So many people are not clear about their specific benefits.
Here, let’s take a look!
The medical insurance card has three roles.
One is to see the outpatient clinic used to pay by card.
The second is to buy drugs in pharmacies.
The third is the hospitalization when presented with medical insurance, and then the hospitalization costs are automatically transferred
(80% reimbursement after deducting the self-payment).
In 2015, Shanghai residents’ medical insurance treatment is not adjusted, the same as in 2014. The details are as follows.
① Emergency outpatient clinics.
The starting payment standard for medical expenses incurred in outpatient clinics for insured residents is 300 RMB for people aged 60 and above and urban people with severe disabilities, and 1,000 RMB for people over 18 and under 60 years of age.
The accumulated medical expenses in excess of the starting standard within a year, the residents’ medical insurance fund will be paid in the following proportion: in community health service centers (or primary medical institutions), the fund pays 65%; secondary medical institutions 55%; tertiary medical institutions 50%.
② Hospitalization.
Insured residents each hospitalization more than the starting standard (50 yuan for primary medical institutions, 100 yuan for secondary medical institutions, 300 yuan for tertiary medical institutions) part of the medical expenses, the residents of the medical insurance fund to pay the following proportion.
For people aged 60 and above, and people with severe disabilities in urban areas, the fund will pay 90% of the medical expenses in community health service centers (or primary medical institutions); 80% in secondary medical institutions; and 70% in tertiary medical institutions.
For people under 60 years of age, the fund pays 80% for those who seek medical treatment at community health service centers (or first-class medical institutions); 70% for second-class medical institutions; and 60% for third-class medical institutions.
The pension insurance fund for urban and rural residents is composed of individual contributions, collective subsidies and government subsidies.
Individual Contribution
Those who participate in urban and rural residents’ pension insurance should pay pension insurance premiums in accordance with the regulations.
The individual contributions are currently set at 12 levels: 500, 700, 900, 1100, 1300, 1500, 1700, 1900, 2100, 2300, 2800, and 3300 yuan per year.
Participants can choose their own contribution levels and get more money when they pay more.
Collective subsidies
1, the village collective economic organizations in conditions should give subsidies to the participants’ contributions, the subsidy standard by the villagers’ committee held a villagers’ meeting, or by the village collective economic organizations held a meeting of members to determine democratically.
2, to encourage communities with the conditions to include collective subsidies in the scope of funding for community public welfare.
3. Encourage other social and economic organizations, public welfare and charitable organizations, and individuals to provide financial support for the contributions of the participants. The amount of subsidies and funding will not exceed the highest contribution grade standard.
Government subsidies
The government pays the full amount of the basic pension to the participants who meet the conditions for receiving urban and rural residents’ pension insurance benefits.
The district and county governments subsidize the contributions of the participants who are registered in the district. The standards are as follows.
Maternity insurance includes two benefits, one is maternity subsistence allowance and the other is maternity medical fee subsidy.
Maternity medical expenses
Medical expenses incurred during pregnancy, childbirth or termination of pregnancy by female workers during pregnancy and childbirth in accordance with the regulations.
Maternity Allowance
Female workers are entitled to maternity allowance during maternity leave. The maternity allowance is based on the average monthly salary of employees on duty in the previous year in the region to which they belong, and is paid according to the prescribed maternity leave. If the maternity allowance is lower than the standard of her salary, the employer shall make up for it.
Maternity allowance = the unit’s average monthly salary ÷ 30 (days) x the number of days of leave
Maternity leave calculation.
1.The basic maternity leave is 98 days, of which 15 days can be taken before delivery.
2.If there is a difficult birth (such as Caesarean section, Ⅲ degree perineal rupture), the maternity leave can be increased by 30 days.
3.For miscarriage less than four months pregnant, according to the opinion of the medical department, 15 days to 30 days of maternity leave is granted.
4.Miscarriage of more than four months of pregnancy (including four months), 42 days of maternity leave.
5. 35 days are added for voluntary birth of an only child. For late childbirth, an additional 15 days.
One-time childbirth nutrition allowance
A certain percentage of the average monthly salary of employees on duty in the previous year in the region to which it belongs is paid. The specific percentage is determined by the people’s government of the coordinating region.
Family planning surgery expenses
Includes medical expenses incurred for the placement or removal of intrauterine devices, miscarriage, induction of labor, sterilization and reassessment surgery for family planning.
Leave allowance for male employees
The leave allowance for male employees who have enrolled in the insurance program shall be based on the average monthly salary of employees on duty in the previous year in the region to which they belong and shall be paid according to the specified leave period.
Caregiver’s leave allowance = the unit’s average monthly salary ÷ 30 (days) x the number of days of leave
Maternity insurance fund will not pay the following expenses.
1.Expenses that do not comply with the national and provincial urban workers’ basic medical insurance and maternity insurance drug catalogs, treatment items, medical service facility items and related medical consultation management regulations.
2. Costs incurred due to medical accidents.
3. Expenses for the treatment of complications of childbirth outside the delivery period.