In 2025, the reimbursement ratio of Chongqing's employee medical insurance varies depending on factors such as the level of medical institutions, the identity of insured persons (active employees or retirees), and different payment levels. Here are the details:
- Inpatient Reimbursement:
- Active Employees: For first - level medical institutions, the deductible line is 200 yuan, and the reimbursement ratio for in - scope expenses is 90%. For second - level medical institutions, the deductible line is 440 yuan, and the reimbursement ratio is 87%. For third - level medical institutions, the deductible line is 880 yuan, and the reimbursement ratio is 85%.
- Retirees: The deductible standard is the same as that of active employees. The reimbursement ratio for in - scope expenses is 95%.
- Annual Limit of Basic Medical Insurance Co - ordination: The annual limit of basic medical insurance co - ordination payment is 47,000 yuan.
- Outpatient Reimbursement:
- General Outpatient:
- Active Employees: For those participating in the first - level payment, the annual limit is 800 yuan; for those participating in the second - level payment, the annual limit is 3,000 yuan. The reimbursement ratio for expenses in second - level and below medical institutions is 60%, and for third - level medical institutions is 50%.
- Retirees: For those participating in the first - level payment, the annual limit is 1,200 yuan; for those participating in the second - level payment, the annual limit is 4,000 yuan. The reimbursement ratio for expenses in second - level and below medical institutions is 70%, and for third - level medical institutions is 60%.
- Special Outpatient Diseases: For the first - level insured employees, there are 4 types of special outpatient diseases. For the second - level insured employees and those insured through the unit, there are currently 25 types of special outpatient diseases. For 3 types of special diseases, including chemotherapy, radiotherapy, and analgesic treatment for advanced cancer patients, dialysis treatment for patients with renal failure, and anti - rejection drug treatment after organ transplantation, the reimbursement ratio is 90% (after the reimbursement amount exceeds 37,000 yuan, it is 100%). For other special diseases, the reimbursement ratio is 80%. The deductible line is 200 yuan for first - level medical institutions, 440 yuan for second - level medical institutions, and 880 yuan for third - level medical institutions, and the annual reimbursement limit is shared with inpatient reimbursement.
- Large - amount Medical Insurance: After the 47,000 - yuan reimbursement of basic co - ordination is completed, the reimbursement ratio for in - scope expenses is 100%, and the annual payment limit is 500,000 yuan.
- Active Employees: The deductible line is 200 yuan/year. The reimbursement ratio for in - scope expenses in second - level and below medical institutions is 60%, and for third - level medical institutions is 50%.
- Retirees: The deductible line is 100 yuan/year. The reimbursement ratio for in - scope expenses in second - level and below medical institutions is 70%, and for third - level medical institutions is 60%.
It should be noted that specific reimbursement details may be subject to local medical insurance policies and regulations. When seeking medical treatment, it is recommended that insured persons understand relevant regulations in advance to ensure smooth reimbursement.