山西省人民政府办公厅关于印发山西省职工大额医疗费用补助办法的通知晋政办发〔2025〕38号

Core Viewpoint - The article outlines the implementation of the Shanxi Province Employee Major Medical Expense Subsidy Measures, aimed at reducing the medical expense burden on insured employees and enhancing the multi-level medical security system in the province [3][4]. Summary by Sections Introduction - The subsidy measures are established in accordance with various governmental documents to reform the medical insurance system and are intended to provide further protection for employees facing high medical expenses [4]. Scope of Subsidy - The subsidy applies to employees participating in the basic medical insurance, including retirees, but excludes those receiving civil servant medical subsidies [4][5]. Funding and Contribution - The funding for the subsidy will be jointly borne by employers and employees, with provisions for cases where employers cannot afford their share [5][6]. Payment Standards - The subsidy will cover medical expenses exceeding the maximum payment limit of the basic medical insurance, with a payment rate of 90% for eligible expenses within the defined limits [6][8]. Conditions for Eligibility - Eligibility for the subsidy aligns with the conditions for basic medical insurance, meaning those who do not qualify for the latter cannot receive the subsidy [6][7]. Management and Oversight - The funds for the subsidy will be managed separately from the basic medical insurance fund, with strict regulations to prevent misuse [6][7]. Implementation and Duration - The measures will be directly settled at designated medical institutions, and the program is set to take effect on January 1, 2026, with a validity of five years [7][8].