According to the latest data, during the period from July 1 2023 to June 30, 2024, the maximum annual payment limit of Shenzhen's first-level medical insurance pooling fund shall not exceed 5% of the average annual salary of employees in the previous year. The current standard is 7778 yuan. However, the annual maximum payment limit of general outpatient medical expenses in hospitals above the second level and specialized hospitals does not exceed 2.5% of the average annual salary of employees in this city in the previous year, that is, 3889 yuan.
This means that in a medical insurance year, the insured person goes to the general outpatient clinic for medical treatment, and the overall fund can reimburse him for medical expenses of up to 7778 yuan. However, if you seek medical treatment in a general outpatient department of a secondary hospital or a specialized hospital, the annual maximum reimbursement limit of the overall fund will be reduced to 3,889 yuan. It should be noted that these limits do not include the use of personal account balance, and the use limit of personal account is independent.
To sum up, the annual use limit of Shenzhen's first-class medical insurance pooling fund is 7778 yuan for general outpatient service and 3889 yuan for general outpatient service in secondary hospitals and specialized hospitals. The payment limit of the overall medical insurance fund shall be adjusted by the municipal government according to the level of economic and social development, the income and expenditure of the medical insurance fund and the price of medical services.
Legal basis:
Measures of Shenzhen Municipality on Medical Security
Article 4
The medical insurance system should follow the principles of combining fairness with efficiency, corresponding rights and obligations, and adapting the level of security to the development level of social productive forces.