Xiamen's health insurance reimbursement policy is differentiated according to individual status and medical expenses. Outpatient reimbursement for active employees starts at 1,800 yuan, with 50% reimbursement for the excess, and a maximum of 20,000 yuan for large outpatient medical expenses. For hospitalization, the starting line for the first hospitalization is RMB 1,300, and the starting line for each subsequent hospitalization is RMB 650. The maximum payment limit for hospitalization expenses from the basic medical insurance co-ordination fund is 70,000 yuan during the year.
For retirees, under the age of 70, the reimbursement rate for medical expenses above 1,300 yuan is 70 percent, with the portion in excess calculated according to the above rules for active workers. And for retirees over 70 years old, the reimbursement rate is raised to 80 percent. The reimbursement rate for hospitalization is related to the hospital level: in a tertiary hospital, for expenses between 1,300 yuan and 30,000 yuan, the employee pays 15% and is reimbursed 85%; for expenses between 30,000 yuan and 40,000 yuan, the employee pays 10% and is reimbursed 90%; and for the portion of the expenses exceeding 40,000 yuan and up to 70,000 yuan, the employee pays 5%, and the remaining 95% is reimbursed by the medical insurance. For expenses below the starting standard, the retiree is personally responsible for the full amount, and the remaining reimbursement rate is 60 percent of the active employee.
Overall, the details of Xiamen's medical insurance reimbursement depend on the status of the individual, the amount of medical expenses, and the level of the hospital visited, ensuring varying degrees of medical coverage.