In 2024, the outpatient co-ordination reimbursement limits in Chongqing vary depending on different types of insurance participation. For employees participating in the employee medical insurance through the unit or those with individual participation in Class II employee medical insurance, the annual payment limit for on-the-job employees is 3,000 yuan, and for retirees, it is 4,000 yuan. For those with individual participation in Class I employee medical insurance, the annual payment limit for on-the-job employees is 800 yuan, and for retirees, it is 1,200 yuan. For residents participating in the medical insurance, the annual reimbursement limit for Class I insured persons is 300 yuan per person, and for Class II insured persons, it is 500 yuan per person. Minors can be reimbursed according to the deductible standards and payment limits of secondary medical institutions when they seek outpatient treatment in tertiary children's hospitals or maternity and child health hospitals in the city. Here are the details:
- Employee Medical Insurance
- Annual Payment Limit:
- For employees participating in the employee medical insurance through the unit and those with individual participation in Class II employee medical insurance, the annual payment limit for on-the-job employees is 3,000 yuan, and for retirees, it is 4,000 yuan. For those with individual participation in Class I employee medical insurance, the annual payment limit for on-the-job employees is 800 yuan, and for retirees, it is 1,200 yuan.
- Reimbursement Proportion: The reimbursement proportion for policy - based medical expenses for on - the - job employees seeking outpatient treatment at designated medical institutions is 60% at secondary and below medical institutions and 50% at tertiary medical institutions. Retirees have an additional 10 - percentage - point increase on this basis.
- Deductible Standard: The deductible line for on - the - job employees is 200 yuan, and for retirees, it is 100 yuan.
- Resident Medical Insurance
- Annual Reimbursement Limit: The annual reimbursement limit for Class I insured persons is 300 yuan per person, and for Class II insured persons, it is 500 yuan per person.
- Reimbursement Proportion: For insured residents seeking outpatient treatment at secondary and below medical institutions in the city, the medical expenses within the policy - based scope are reimbursed by the medical insurance fund at a proportion of 40% at secondary medical institutions and 60% at primary and below medical institutions.
- Deductible Standard: The deductible standard for secondary medical institutions is 200 yuan, and there is no deductible standard for primary and below medical institutions. Minors can be reimbursed according to the deductible standards and payment limits of secondary medical institutions when they seek outpatient treatment in tertiary children's hospitals or maternity and child health hospitals in the city.
In conclusion, when seeking outpatient treatment in 2024 in Chongqing, employees and residents need to understand the corresponding outpatient co - ordination reimbursement limits, reimbursement proportions, and deductible standards according to their own insurance participation types to better enjoy medical insurance benefits.