Shanghai has extended the validity of registration for serious-disease treatment under its basic medical insurance program from six months to one year. The new policy took effect on April 1, according to the Shanghai Municipal Medical Insurance Bureau.

Q: What has changed in Shanghai's serious-disease registration policy?

A: Starting April 1, each registration for serious-disease treatment under Shanghai's basic medical insurance program is valid for one year. Patients who need to continue treatment after the registration expires, or who wish to change their designated medical institution during the period, must complete a new registration or modification.

Q: Will current registrations be adjusted automatically?

A: Yes. For patients whose serious-disease registrations were still valid as of April 1, the original expiry date will be automatically extended by six months.

Q: What does Shanghai's serious-disease policy cover?

A: The policy mainly covers two categories under the basic medical insurance system.

The first is outpatient serious-disease coverage for employees. It applies to treatment for major illnesses including dialysis for severe uremia, anti-rejection treatment after kidney transplant, cancer treatment, and treatment for certain mental disorders. Under the policy, 85 percent of eligible outpatient expenses are covered by the pooled insurance fund for working employees, while retirees receive a 92 percent reimbursement rate.

The second is serious-disease insurance for urban and rural residents. It covers outpatient and inpatient treatment for the same four categories of diseases, as well as hemophilia and aplastic anemia for college students, and hemophilia for primary and secondary school students. After reimbursement under the basic medical insurance program, eligible medical expenses can be reimbursed by serious-disease insurance at 60 percent, or 65 percent for minimum-living-allowance recipients and members of low-income households.

Q: How can insured patients in Shanghai apply for serious-disease registration?

A: Insured patients who need treatment in Shanghai can complete serious-disease registration either at a qualified hospital or at medical insurance service windows at the municipal, district, or subdistrict levels. A qualified hospital will first issue an application form for outpatient serious-disease treatment based on treatment needs, after which the patient can proceed with registration. Only one qualified medical institution may be registered at a time for the same treatment category.

Q: What should Shanghai-insured patients do if they need eligible treatment outside the city?

A: They must first complete cross-provincial medical treatment filing and then apply for outpatient chronic and special disease registration for off-site treatment. Once both procedures are completed, they can receive direct settlement at the registered hospital using their social security card or medical insurance e-voucher without paying upfront. If direct settlement is not available because of a system failure or credential issue, they must pay first and then apply for manual reimbursement through Shanghai's medical insurance service agencies.

Q: Can people insured in other parts of China receive direct settlement for eligible treatment in Shanghai?

A: Yes. They may qualify for direct settlement if they complete the required filing and chronic-disease qualification procedures in their home region and choose a Shanghai hospital that supports cross-provincial direct settlement.

Q: How is reimbursement calculated for cross-provincial treatment?

A: Reimbursement follows the principle of "treatment-location catalog and home-location benefits". This means the scope of covered drugs and services is based on Shanghai's medical services catalog, while the patient's home insurance scheme determines reimbursement standards such as deductibles, reimbursement rates, and annual ceilings.