The highest reimbursement rate for general outpatient medical insurance in Nanjing is 50%, and the highest reimbursement rate for employees is 70%. First, the proportion of reimbursement for general outpatient service.

Proportion of reimbursement for residents' general outpatient service

1. In a natural year, the expenses of "residents" clinics within 200 yuan shall be borne by individuals, 60% of the expenses between 200 and 900 yuan shall be paid in community hospitals and 50% in other hospitals;

2, residents over the age of 80, 65% in the community hospital fund, 55% in other hospital funds, 900 yuan above the cost borne by individuals.

3. "Students and children" pay 60% of the medical expenses in the outpatient department of community hospital 0-400 yuan;

4, in other hospitals, the fund pays 50%, and the expenses above 400 yuan are borne by individuals.

Note: The outpatient expenses incurred by insured residents in other places shall be borne by individuals, and the fund will not subsidize them.

Second, the proportion of outpatient serious illness reimbursement

(A) the proportion of outpatient serious illness reimbursement

1, 50% of the portion from 20,000 yuan to 40,000 yuan;

2, more than 40 thousand yuan to 60 thousand yuan, pay 55%;

3, 60 thousand yuan to 80 thousand yuan, pay 60%;

4, more than 80 thousand yuan to 6.5438 million yuan, pay 65%;

56,5438+70% for the part above 10,000 yuan.

6, "students and children" fund to pay 85%.

(2) The proportion of reimbursement for serious illness in outpatient service.

1, if it exceeds 20,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below), 60% will be paid;

2, 40 thousand yuan to 60 thousand yuan, pay 65%;

3, 60 thousand yuan to 80 thousand yuan, pay 70%;

4, more than 80 thousand yuan to 6.5438 million yuan, pay 75%;

5. RMB 65,438+10,000 Yuan, with 80% paid.

Third, "resident" hemophilia.

According to light, medium and heavy classification, the fund payment limits are 65,438+0,000,50,000 and 65,438+0,000 respectively, and the proportion of fund payment within the limits is 80%.

Fourth, the proportion of reimbursement for serious illness in hospital.

Proportion of hospitalization reimbursement for serious illness among residents

1, the minimum threshold of "residents" is 1000, 500 and 300 yuan respectively, and the proportion of fund payment is 65%, 85% and 90% respectively;

2. The minimum threshold for "students and children" is 500, 400 and 300 yuan in tertiary, secondary and primary hospitals respectively, and the proportion of fund payment is 80%, 90% and 95% respectively.