General outpatient clinic: For those insured by urban employee medical insurance, the maximum payment limit of the overall pool fund is 300 yuan/person/month, including medication and diagnosis and treatment fees.

For urban and rural residents, the maximum payment limit of the overall fund for minors and school students is 1,000 yuan/person/year, and only medicine expenses can be reimbursed; for other people, the maximum payment limit of the overall fund is 600 yuan/person/year, and only medical expenses can be reimbursed.

Medication expenses can be reimbursed.

Outpatient designated chronic diseases (outpatient chronic diseases): For insured persons with the urban employee medical insurance type, the maximum payment limit of the overall pool fund is 200 yuan/disease type/month, and there is no rollover or accumulation.

The maximum payment limit of the overall fund for urban and rural residents is 50 yuan/disease/month. Deposit outpatient special items (mente): different diseases have different maximum payment limits. Insured persons can consult the Social Security Bureau or check the hospital’s social security announcement

information.

Hospitalization: Hospitalization has a deductible. Among urban employees, the deductible is 1,600 yuan for active employees and flexible employment personnel, and the deductible for retirees is 1,120 yuan. The annual cumulative maximum payment limit of the two collective funds is 445,500 yuan.

The maximum annual payment limit for critical illness subsidies is 222,700 yuan.

The minimum payment limit for urban and rural residents is 1,000 yuan, the annual cumulative maximum payment limit of the overall fund is 182,000 yuan, and the maximum annual payment limit of major disease subsidies is 120,000 to 180,000 yuan.

Medical expenses incurred by employees during hospitalization or emergency observation room stay above the deductible standard within a medical insurance year, as well as outpatient serious illness or home hospital bed medical expenses that are below the maximum payment limit, shall be paid by the overall fund according to the prescribed payment ratio.

Legal basis: "Decision on Establishing a Basic Medical Insurance System for Urban Employees" The minimum payment standard of the basic medical insurance pooling fund is controlled at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled at about 10% of the average annual salary of local employees.

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