In 2025, the outpatient reimbursement amount for flexible employment medical insurance in Jinan, Shandong is divided into two main aspects: ordinary outpatient co - ordination and outpatient chronic and special diseases.

Ordinary Outpatient Co - ordination

1. Payment Standards for In - service Employees

• For treatment in tertiary - level designated medical institutions, the annual deductible is 800 yuan, the co - ordination payment ratio is 60%, and the maximum annual payment limit is 6000 yuan.

• For secondary - level designated medical institutions, the annual deductible is 400 yuan, and the co - ordination payment ratio is 70%.

• For primary - level designated medical institutions and designated community health service institutions, the annual deductible is 200 yuan, and the co - ordination payment ratio is 80%.

2. Payment Standards for Retired Employees

• The co - ordination payment ratio for retired employees is 5 percentage points higher than that of in - service employees. For example, in tertiary - level hospitals, the payment ratio is 65%, in secondary - level hospitals, it is 75%, and in primary - level and community health service institutions, it is 85%.

• The annual payment limit for retired employees in ordinary outpatient co - ordination is increased to 7000 yuan.

3. Free Medicines

• For employees participating in the insurance who settle at designated community health service institutions through ordinary outpatient co - ordination, basic medicines for treating hypertension (Captopril Tablets, Nifedipine Tablets, Aspirin Enteric - coated Tablets, Hydrochlorothiazide Tablets), basic medicines for treating diabetes (Metformin Tablets, Glipizide Tablets), and medicines for treating coronary heart disease (Isosorbide Dinitrate Tablets) are provided free of charge. The cumulative amount of free medicines within a medical year does not exceed 240 yuan. The part exceeding this amount will be reimbursed in accordance with the regulations of ordinary outpatient co - ordination.

Outpatient Chronic and Special Diseases

1. Disease Types

• The basic disease types of outpatient chronic and special diseases are divided into two categories. Category I includes malignant tumor outpatient treatment, uremia dialysis treatment, tissue or organ transplantation (anti - rejection treatment), severe mental disorders, other mental disorders, outpatient treatment of benign nervous system tumors, leukemia, etc. Category II includes a series of chronic diseases such as myelodysplastic syndrome, hemophilia, aplastic anemia, etc.

2. Deductible and Reimbursement Ratio

• For Category I diseases, there is no deductible.

• For Category II diseases, the deductible standards vary according to different - level medical institutions. The deductible for provincial (ministerial) - level tertiary - level designated medical institutions is 800 yuan/year, for other tertiary - level designated medical institutions is 600 yuan/year, for secondary and primary - level designated medical institutions is 300 yuan/year, and for designated community health service institutions is 0 yuan/year. It should be noted that the deductible standard for designated traditional Chinese medicine comprehensive hospitals within this co - ordination area is reduced by 20%.

• The reimbursement ratio for outpatient chronic and special diseases: within a medical year, for in - service employees, the reimbursement ratio for expenses from the deductible to 10,000 yuan in tertiary - level hospitals is 85%, from 10,000 to 400,000 yuan is 88%, and from 400,000 to 600,000 yuan is 90%. In secondary and below - level hospitals, the reimbursement ratio for expenses from the deductible to 10,000 yuan is 90%, from 10,000 to 400,000 yuan is 93%, and from 400,000 to 600,000 yuan is 90%. For retired employees, the reimbursement ratio is relatively higher. For example, in tertiary - level hospitals, the reimbursement ratio for expenses from the deductible to 10,000 yuan is 88%, from 10,000 to 400,000 yuan is 91%, and in secondary and below - level hospitals, the reimbursement ratio for expenses from the deductible to 10,000 yuan is 93%, from 10,000 to 400,000 yuan is 96%.

• After the basic medical insurance and other reimbursements as required, for the part of the individual's cumulative burden of compliant medical expenses exceeding 6000 yuan, a secondary payment will be given. The reimbursement ratio for the part of 6000 - 200,000 yuan is 80%, and for the part above 200,000 yuan is 90%, with no upper limit.

In general, the outpatient reimbursement policy for flexible employment medical insurance in Jinan in 2025 comprehensively considers different medical needs of in - service and retired employees, as well as different disease types, aiming to provide better medical security for flexible employment groups. When seeking medical treatment, it is recommended that insured persons understand relevant policies in advance, choose appropriate medical institutions, and keep relevant medical receipts to ensure smooth reimbursement.