山西省医疗保障局 山西省财政厅 国家税务总局山西省税务局关于做好2025年城乡居民基本医疗保障工作的通知

Core Viewpoint - The notification outlines the strategies and measures for enhancing the basic medical insurance system for urban and rural residents in Shanxi Province for the year 2025, focusing on increasing financial support, improving insurance coverage, and ensuring effective management and service delivery [1][2][3]. Group 1: Funding and Financial Support - The per capita financial subsidy for residents' medical insurance will increase by 30 yuan, reaching 700 yuan in 2025, with the central government covering 60% to 80% of the costs depending on the county's classification [1]. - The personal payment standard for 2026 is set at 400 yuan per person per year, with local financial departments required to allocate sufficient funds by October 31 [1]. Group 2: Enhancing Comprehensive Insurance Capacity - The basic medical insurance will cover hospitalization and outpatient services, maintaining a payment ratio of around 70% for eligible expenses, and will include maternity medical expenses under outpatient coverage [2]. - The big illness insurance will be funded through basic medical insurance contributions, with a focus on maintaining a balance between funding and expenditure to prevent risks to the insurance fund [2]. Group 3: Strengthening Medical Assistance - The medical assistance program will continue to support low-income and poverty-stricken populations, with a subsidy standard of 280 yuan per person per year for those at risk of falling back into poverty [3]. - A multi-tiered medical security system will be promoted, encouraging the development of commercial health insurance and charitable donations to meet diverse public needs [3][4]. Group 4: Enrollment and Payment Management - The plan emphasizes universal coverage, targeting key demographics such as students and migrant populations, with specific policies for newborns and students in higher education [5]. - The enrollment period for residents will be from late October 2025 to February 25, 2026, with immediate benefits for those who pay by the end of 2025 [5]. Group 5: Improving Management and Service Levels - There will be a focus on budget management for the insurance fund, with measures to enhance the efficiency of payment processes and prevent fraudulent activities [6]. - The notification calls for improved collaboration among various departments to ensure effective implementation of medical insurance policies and to raise public awareness [7].