In 2025, the medical insurance reimbursement policy in Shaanxi Province has been adjusted and optimized in many aspects, aiming to provide more comprehensive and convenient medical security for the people. Here is a detailed introduction to the main contents of the policy:

1. Basic Medical Insurance for Urban and Rural Residents

• Payment Standard: In 2025, the personal payment standard for urban and rural residents' medical insurance in Shaanxi Province is 400 yuan per person per year, and the government subsidy standard is not less than 670 yuan per person per year.

• Payment Time: The centralized payment period is from September to December 20, 2024. If you pay within this period, the treatment enjoyment period is from January 1 to December 31, 2025.

• Reimbursement Policy

• Outpatient Reimbursement: There is no deductible line for outpatient services in all coordinated areas. The payment ratio for fixed - point village clinics, community health service stations and outpatient departments is 60% - 70%, 50% - 60% for first - level fixed - point hospitals, township health centers and community health service centers, and 50% for second - level fixed - point hospitals (included in the payment scope in some coordinated areas). The annual maximum payment limit is 100 - 200 yuan, and the specific standard is implemented in accordance with the relevant regulations of each coordinated area.

• Outpatient Chronic and Special Diseases: Diseases such as hypertension, diabetes, mental illness, outpatient treatment of malignant tumors, anti - rejection treatment after organ transplantation, and dialysis have been included in the scope of outpatient chronic and special diseases uniformly managed and regulated in the province. It is implemented on an annual basis, and the treatment cycle is a natural year. The treatment standard for each disease is set by each coordinated area. The payment scope includes inspection, testing, drugs, treatment, special materials and other medical expenses related to the disease that meet the basic medical insurance drug list, diagnosis and treatment project scope, medical service facility scope and payment standards. The special drug guarantee is implemented in accordance with relevant policies.

• Inpatient Reimbursement: The reimbursement ratio for inpatient services in medical institutions within the province or for those who have undergone cross - provincial medical treatment after filing for off - site medical treatment is determined according to the hospital level and whether it is cross - provincial. Generally, the higher the hospital level, the lower the reimbursement ratio. For example, in some areas, the reimbursement ratio for first - level hospitals may be around 80%, 70% for second - level hospitals, and 60% for third - level hospitals.

2. Employee Basic Medical Insurance

• Payment Standard: The employer pays 6.5% (including 0.5% of maternity insurance), and the individual pays 2%. In addition, each person pays 300 yuan per year for the major illness co - ordination fund, with the unit paying 200 yuan and the individual paying 100 yuan.

• Reimbursement Policy

• Outpatient Reimbursement: The annual deductible line for outpatient co - ordination is 200 yuan. The reimbursement ratio for third - level hospitals is 50% for on - the - job employees and 55% for retirees; 60% for on - the - job employees and 65% for retirees in second - level hospitals; 70% for on - the - job employees and 75% for retirees in first - level hospitals. The annual limit is 800 yuan per on - the - job employee per year and 1000 yuan per retiree per year.

• Inpatient Reimbursement: The reimbursement ratio for third - level hospitals is 90% for on - the - job employees and 92% for retirees; 92% for on - the - job employees and 94% for retirees in second - level hospitals; 94% for on - the - job employees and 96% for retirees in first - level hospitals. The deductible line for third - level hospitals is 2000 yuan, 1000 yuan for second - level hospitals, and 500 yuan for first - level hospitals.

3. Other Highlights of the Policy

• Special Drug Management: Shaanxi Province has included 252 drugs in the special drug management scope. The out - of - pocket ratio for urban and rural residents is not more than 20% for these drugs, and the payment ratio within the policy scope is not less than 60%. After the basic medical insurance payment, the remaining expenses can be included in the scope of urban and rural residents' major illness insurance payment.

• Support for Fertility: Some ovulation - promoting drugs such as bromocriptine, triptorelin, and clomiphene have been included in the co - ordination fund payment scope. Thirteen treatment - related assisted reproduction medical service projects such as "egg retrieval" have been included in the basic medical insurance and work - related injury insurance fund payment scope.

• Medical Assistance: For different types of assistance objects, there are different subsidy standards. For example, for Class I assistance objects (such as extremely poor people and orphans), there is no deductible line for inpatient assistance, and the reimbursement ratio is 100%; for Class II assistance objects (such as subsistence allowance recipients), there is no deductible line for inpatient assistance, and the reimbursement ratio is 70%.

In general, the medical insurance reimbursement policy in Shaanxi Province in 2025 has made a series of adjustments and improvements in terms of payment standards, reimbursement ratios, and scope of protection, aiming to better meet the medical needs of the people and reduce the burden of medical expenses. It is recommended that the public pay attention to the relevant policies in a timely manner and understand the specific procedures and regulations for medical insurance reimbursement to ensure that they can enjoy the corresponding medical security benefits.