In 2025, in Baoji, Shaanxi, for dental expenses, there are some differences in reimbursement between the first - tier and second - tier medical insurance. For some dental treatment items like root canal treatment, cavity filling, etc., the reimbursement ratio for employees in the first - tier medical insurance (employee medical insurance) can reach 58% within the specified cost limit, while for residents in the second - tier medical insurance (urban and rural residents' medical insurance), the reimbursement ratio for some items may be 40% or lower, and the specific situation varies according to different hospitals and items. Here is a detailed comparison:
- Reimbursement scope:
- First - tier medical insurance: For employees, some oral outpatient single - disease treatments such as root canal treatment, cavity filling, severe periodontal disease treatment, impacted tooth extraction, and complex tooth extraction are within the reimbursement scope. In addition, for employees over 65 years old with natural loss of all teeth, there is a certain amount of reimbursement for full - mouth denture production.
- Second - tier medical insurance: For urban and rural residents, the scope of dental reimbursement is relatively narrower. Although some basic dental treatment items are also included, not all items that employees can be reimbursed for are covered. For example, the types of dental diseases and treatment items eligible for reimbursement in the outpatient single - disease reimbursement are less than those of employee medical insurance.
- Reimbursement ratio:
- First - tier medical insurance: As mentioned above, for the five oral outpatient single - disease treatments, the reimbursement ratio for employees is 58% within the specified cost limit. For some elderly - related dental benefits, such as full - mouth denture production for employees over 65 years old, there is a fixed amount of reimbursement.
- Second - tier medical insurance: For urban and rural residents, in the past, for the same five oral outpatient single - disease treatments, the reimbursement ratio was 40% within the specified cost limit. And there are relatively fewer preferential policies for special groups in terms of dental treatment compared to employee medical insurance.
- Limit and ceiling:
- First - tier medical insurance: Each reimbursement item usually has a specified cost limit. For example, for the five oral outpatient single - disease treatments, the reimbursement is within the specified cost limit. In addition, for some benefits like full - mouth denture production for the elderly, there is a fixed reimbursement amount (such as 880 yuan for employees over 65 years old).
- Second - tier medical insurance: There are also cost limits for reimbursement items, but they may be different from those of the first - tier medical insurance. And the overall ceiling for dental reimbursement in a year may be relatively lower than that of employee medical insurance.
In general, in 2025 in Baoji, Shaanxi, the first - tier medical insurance (employee medical insurance) has more advantages in dental reimbursement in terms of reimbursement scope, ratio, and limit compared to the second - tier medical insurance (urban and rural residents' medical insurance). However, specific reimbursement situations may vary depending on different hospitals and actual treatment situations. It is recommended that insured persons consult the local medical insurance department or the medical institution in advance for accurate information.