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Which policies help low or middle-income insurance participants?
(02.21.2008)

I. Maintain the related post-retirement medical insurance standards:

1. Eligible subjects

All employed persons that have participated in the Basic Medical Insurance for Urban Employees in Shanghai, and who are male aged 48 years or older, or who are female, aged 43 years or older, and who are assessed by the Shanghai Labor Ability Assessment Center as having no overall working ability due to severe or dangerous illness.

2. Applicable standards

Refer to the related post-retirement Medical Insurance standards.

3. Procedures

The applicant's employment organization shall apply at the local district/county Medical Insurance Office with: the Final Assessment by the Shanghai Labor Ability Assessment Center, the illness diagnosis by the dedicated medical institution, plus the incompetence certificate by the organization. The Medical Insurance Affairs Center shall submit the pre-reviewed documents to the Shanghai Health Insurance Bureau. The Bureau shall review the documents jointly with the Shanghai Labor and Social Security Bureau and the Shanghai Health Bureau before the 25th of each month. All the approved applicants will be eligible for the related Medical Insurance standards from the following month. The Shanghai Medical Insurance Affairs Center will handle the details.

II. In the following cases related to hospitalization or emergency treatment, the medical expenses of the deductable of the Municipal Medical Insurance Fund shall be paid:

1. Group 1 subjects eligible for deductions

All working employees that have participated in the Basic Medical Insurance for Urban Employees in Shanghai, the eligible subjects are the low-income earners that have been assessed as losing the majority of their working ability by the Shanghai Labor Ability Assessment Center.

Applicable standards: Medical expenses shall be deducted by 50%.

Procedures: The eligible subject may bring their hospitalization expense receipt(s) to apply for a deduction in their closest district/county Medical Insurance Center.

2. Group 2 subjects eligible for deductions

For all families guaranteed a minimal life security in Shanghai, the subjects are those participants of the Basic Medical Insurance for Urban Employees (including those receiving the poverty subsidy given by the Civil Administration and have the social insurance relativity reserved by contract).

Applicable standards: Medical expenses shall be deducted by 85% to 92%.

Procedures: The same as group 1 above.

3. Group 3 subjects eligible for deductions

For all low-income employees, the subjects are those as having been assessed as losing full working ability by the Shanghai Labor Ability Assessment Center but can't keep the same Medical Insurance standards as before retirement due to their ineligible age.

Applicable standards: Medical expenses shall be deducted by 50%.

Procedures: The same as group 1 above.

III. In the following cases related to hospitalization or emergency treatment, the medical expenses at the private cost shall be deducted:

1. Group 1 subjects eligible for deductions

For all working employees that have participated in the Basic Medical Insurance for Urban Employees in Shanghai, the eligible subjects are the low-income earners that have been assessed as losing the majority of their working ability by the Shanghai Labor Ability Assessment Center.

2. Group 2 subjects eligible for deductions

For all families guaranteed a minimal life security in Shanghai, the subjects are those participants of the Basic Medical Insurance for Urban Employees (including those receiving the poverty subsidy given by the Civil Administration and have the social insurance relativity reserved by contract).

3. Group 3 subjects eligible for deductions

For all low-income employees, the subjects are those as having been assessed as losing full working ability by the Shanghai Labor Ability Assessment Center but can't keep the same Medical Insurance standards as before retirement due to their ineligible age.

4. Applicable standards

In the case of the incurred clinical or emergency treatment expense in the 2003 Medical Insurance Year is higher so as to fall into the co-paying sector, the balance between the part at the private cost of 2003 and the standard amount at the private cost of 2002 shall be deducted.

5. Procedures

In the case of an incurred clinical or emergency treatment expense is higher and therefore falls into the co-paying sector, the applicant may bring his/her medical expense receipt(s) to apply for a deduction in the nearby district/county Medical Insurance Center.