In 2025, the reimbursement ratio of flexible employment medical insurance in Nujiang, Yunnan, varies depending on different situations. In general, for hospitalization expenses within the scope of regulations, the reimbursement ratio in first - level hospitals can reach up to 65% for some special groups (such as students/children and those over 70 years old), and for other age - stage urban and rural residents, it is up to 60%; in second - level hospitals, the reimbursement ratio for special groups can reach up to 60% (students/children) or 55% (those over 70 years old), and for other age - stage urban and rural residents, it is 55%; in third - level hospitals, the reimbursement ratio for special groups can reach up to 55% (students/children) or 50% (those over 70 years old), and for other age - stage urban and rural residents, it is 50% [2]. Additionally, for expenses exceeding the maximum payment limit of the basic medical insurance (80,000 yuan), the serious illness supplementary medical insurance will be activated, with a unified reimbursement ratio of 90% and a maximum additional reimbursement of 250,000 yuan [2].
Here are the details:
- Hospitalization reimbursement by hospital level
- First - level hospitals:
- For students or children, as well as those over 70 years old, the maximum reimbursement ratio can reach 65% within a settlement year [2].
- For other age - stage urban and rural residents, the maximum reimbursement ratio is 60% within a settlement year [2].
- Second - level hospitals:
- For students or children, the maximum reimbursement ratio can reach 60% within a settlement year [2].
- For those over 70 years old, the maximum reimbursement ratio is 55% within a settlement year [2].
- For other age - stage urban and rural residents, the maximum reimbursement ratio is 55% within a settlement year [2].
- Third - level hospitals:
- For students or children, the maximum reimbursement ratio can reach 55% within a settlement year [2].
- For those over 70 years old, the maximum reimbursement ratio is 50% within a settlement year [2].
- For other age - stage urban and rural residents, the maximum reimbursement ratio is 50% within a settlement year [2].
- Serious illness insurance:
- When the medical expenses exceed the maximum payment limit of the basic medical insurance (80,000 yuan in Nujiang), the serious illness supplementary medical insurance will take effect. The reimbursement ratio for hospitalization expenses is uniformly increased to 90%, and the maximum additional reimbursement amount is 250,000 yuan [2].
- Since 2025, for insured persons who have continuously participated in the resident medical insurance for 4 years, for each additional year of continuous payment thereafter, the maximum payment limit of the serious illness insurance will be increased by 4,000 yuan per year [2,3].
- Influence of special groups:
- For special groups such as the extremely poor, the minimum - living - guarantee recipients, and eligible anti - poverty monitoring objects, the individual payment of the resident medical insurance will be classified and subsidized as required [3]. But there is currently no information indicating that this directly affects the reimbursement ratio. However, it reduces their financial burden of participating in insurance.
It should be noted that the above - mentioned reimbursement ratios are applicable to medical expenses within the scope of the three catalogs (drug catalog, diagnosis and treatment service item, and service setting standard) stipulated by the state and the province [2]. To obtain the most accurate and up - to - date information on the reimbursement ratio of flexible employment medical insurance in Nujiang, it is recommended to consult the local social security department or medical insurance agency.
