In 2025, the reimbursement ratio of flexible employment medical insurance in Shaanxi Province is as follows:
- Outpatient reimbursement ratio:
- Deductible line: 200 yuan/year.
- Active employees: 70% in primary medical institutions, 60% in secondary medical institutions, and 50% in tertiary medical institutions.
- Retirees: 75% in primary medical institutions, 65% in secondary medical institutions, and 55% in tertiary medical institutions.
- Annual maximum payment limit: 2000 yuan for active employees and 2500 yuan for retirees.
- Outpatient special disease reimbursement: For 12 emergency diseases such as acute heart failure and severe trauma, outpatient expenses are reimbursed at 80% - 95%.
- Inpatient reimbursement ratio:
- Deductible line and segmented reimbursement:
- Tertiary special/primary hospitals: The first hospitalization deductible line in the year is 850 yuan, and 550 yuan for each subsequent time. For the amount above the deductible standard to 10,000 yuan, active employees are reimbursed at 88%, and retirees at 91%.
- Secondary hospitals: The first hospitalization deductible line in the year is 400 yuan, and 300 yuan for each subsequent time. For the amount above the deductible standard to 10,000 yuan, active employees are reimbursed at 90%, and retirees at 93%.
- Primary and community health institutions: The first hospitalization deductible line in the year is 200 yuan, and 150 yuan for each subsequent time. For the amount above the deductible standard to 10,000 yuan, active employees are reimbursed at 92%, and retirees at 95%.
- Maximum payment limit: For the amount from 50,000 yuan to 400,000 yuan, both active and retired employees are reimbursed at 95%.
It should be noted that the above standards are based on the 2025 policy. When actually applying for reimbursement, it is necessary to meet relevant regulations and procedures. Different regions may have some differences in implementation details. It is recommended to consult the local medical insurance department for specific information.