In 2025, the reimbursement ratio of employee medical insurance in Heze varies according to different situations. For inpatient reimbursement: in first - level hospitals, the reimbursement ratio for employees is 80% and 90% for retirees; in second - level hospitals, it is 85% for employees and 90% for retirees; in third - level hospitals, it is 80% for employees and 90% for retirees. For general outpatient clinics: the reimbursement ratio is 60%, and the annual individual maximum payment limit is 400 yuan. For special disease outpatient clinics: after a deductible of 400 yuan, it is reimbursed according to inpatient treatment, with a maximum annual reimbursement limit of 500,000 yuan, including 100,000 yuan for basic medical insurance and 400,000 yuan for large - amount assistance.
Here are the details:
- Inpatient reimbursement:
- First - level hospitals: The reimbursement ratio for employees is 80%, and for retirees, it is 90%. The first - time inpatient deductible is 300 yuan. If it is the second time, the deductible is halved to 150 yuan, and there is no deductible for the third time and subsequent times.
- Second - level hospitals: Employees can be reimbursed at a rate of 85%, and retirees at 90%. The first - time inpatient deductible is 700 yuan, the second - time deductible is 350 yuan, and there is no deductible for the third time and subsequent times.
- Third - level hospitals: The reimbursement ratio for employees is 80%, and for retirees, it is 90%. The first - time inpatient deductible is 1000 yuan, the second - time deductible is 500 yuan, and there is no deductible for the third time and subsequent times.
- General outpatient reimbursement:
- The reimbursement ratio is 60%. The deductible is calculated based on the level of medical institutions. For first - level hospitals, the annual deductible is 200 yuan; for second - level hospitals, it is 300 yuan; for third - level hospitals, it is 400 yuan. The annual maximum payment limit for in - service employees is 3500 yuan, and for retirees, it is 4500 yuan. For the part exceeding the annual maximum payment limit of the overall planning fund, it is paid by the large - amount medical subsidy fund, with a payment limit of 1000 yuan.
- Special disease outpatient reimbursement:
- The deductible is 700 yuan, and the reimbursement ratio is 87%. For severe mental disorders, there is no deductible, and the reimbursement ratio is 87%. For uremia dialysis treatment, tissue or organ transplantation (anti - rejection treatment), and hemophilia, there is no deductible. Except for fully self - paid expenses, they are included in the overall planning, and the reimbursement ratio is 90%.
- The maximum payment limit for hospitalization and outpatient treatment of special diseases is combined. In a medical year, the maximum payment limit is 130,000 yuan. For the part of employees' hospitalization expenses that exceeds the maximum payment limit of basic medical insurance and meets the regulations of medical insurance, it is reimbursed by the large - amount medical expense subsidy at a ratio of 90%, with a maximum payment limit of 420,000 yuan.
It should be noted that the above is based on the current Heze employee medical insurance policy. When actually reimbursing, it is subject to the medical insurance catalog and the regulations of medical institutions at the time of medical treatment.
