In 2024, the medical insurance reimbursement policy for retirees in Hefei has several key highlights. For outpatient services, retirees enjoy higher reimbursement rates and annual payment limits compared to working employees. In terms of inpatient care, different levels of hospitals have their own set deductible standards and reimbursement ratios. Now, let's break it down in detail:
1. Outpatient Reimbursement
- Deductible Standard:
- For first - level (including undetermined - level) medical institutions, the deductible is 200 yuan.
- For second - level and third - level medical institutions, the deductible is 400 yuan.
- Reimbursement Ratio:
- In first - level medical institutions, retirees can be reimbursed at a rate of 70%, 10 percentage points higher than that of working employees.
- In second - level and third - level medical institutions, retirees' reimbursement rate is 60%, also 10 percentage points higher than that of working employees.
- Annual Payment Limit: The annual payment limit for retirees is 5000 yuan, which is 1000 yuan more than that of working employees. Additionally, the cost of purchasing drugs within the medical insurance catalog at designated retail pharmacies with prescriptions from designated medical institutions can be reimbursed according to the reimbursement standard of primary medical institutions, and the amount is included in the annual outpatient payment limit.
2. Outpatient Chronic and Special Disease Reimbursement
Retirees suffering from 74 types of chronic and special diseases uniformly regulated by the province can enjoy reimbursement treatment. The reimbursement ratio is similar to that of inpatient care, and each disease has a set annual reimbursement limit. The deductible standards for different levels of medical institutions are as follows:
- 200 yuan for first - level and below (including township health centers and community health service centers) medical institutions.
- 400 yuan for second - level medical institutions.
- 600 yuan for third - level medical institutions.
The reimbursement ratios are as follows:
- 97% in first - level and below medical institutions.
- 96% in second - level medical institutions.
- 95% in third - level medical institutions.
3. Inpatient Reimbursement
- Deductible Standard:
- 200 yuan for first - level medical institutions.
- 400 yuan for second - level medical institutions.
- 600 yuan for third - level medical institutions. For those hospitalized twice or more within a year, the deductible standard is halved from the second hospitalization.
- Reimbursement Ratio:
- 97% in first - level medical institutions.
- 96% in second - level medical institutions.
- 95% in third - level medical institutions.
- Annual Payment Limit: The annual payment limit for inpatient and outpatient treatment is 300,000 yuan.
4. Maternity Expenses (if applicable)
- For prenatal examination expenses before childbirth (including induced labor after 7 months), there is a fixed subsidy of 1000 yuan per person, which is paid in a lump sum when settling the in - hospital childbirth (induced labor) medical expenses.
- For normal delivery, assisted delivery, and cesarean section, the medical insurance fund payment limits are 3300 yuan, 3800 yuan, and 5300 yuan respectively. For multiple births, the payment limit of the medical insurance fund increases by 10% for each additional baby born.
It should be noted that the above policies are subject to the latest regulations of the Hefei Medical Insurance Bureau. When seeking medical treatment, retirees should understand the specific regulations of the medical insurance policy in advance and keep relevant medical documents for smooth reimbursement procedures.