In 2025, the second - reimbursement ratio of critical illness insurance in Jiangsu varies depending on different situations. Generally, for some specific conditions, the reimbursement ratio can reach up to 70% or more in certain expense segments. For example, for some high - cost diseases, when the personal - burdened medical expenses reach a certain amount, the reimbursement ratio can be relatively high.
- For "Jiangsu Yihuibao 1" (Basic Version)
- Responsibility One: In - scope Medical Expenses within the Medical Insurance Payment Range
- For non - past - medical - history people: If the personal - burdened expenses within the medical insurance payment range are within 100,000 yuan, the reimbursement ratio is 50%; for the part of expenses exceeding 100,000 yuan minus the deductible amount (14,600 yuan in 2025), the reimbursement ratio is 77%.
- For people with past medical history: If the personal - burdened expenses within the medical insurance payment range are within 100,000 yuan, the reimbursement ratio is 25%; for the part of expenses exceeding 100,000 yuan minus the deductible amount (14,600 yuan in 2025), the reimbursement ratio is 38.5%.
- Responsibility Two: Out - of - scope Drugs and High - value Medical Consumables Expenses of Basic Medical Insurance
- For non - past - medical - history people: If the expenses for drugs and high - value medical consumables are within 100,000 yuan, the reimbursement ratio is 60% (55% + 5% additional for continuous enrollment); for the part of expenses exceeding 100,000 yuan minus the deductible amount (20,000 yuan in 2025), the reimbursement ratio is 72% (67% + 5% additional for continuous enrollment).
- For people with past medical history: If the expenses for drugs and high - value medical consumables are within 100,000 yuan, the reimbursement ratio is 30% (27.5% + 2.5% additional for continuous enrollment); for the part of expenses exceeding 100,000 yuan minus the deductible amount (20,000 yuan in 2025), the reimbursement ratio is 36% (33.5% + 2.5% additional for continuous enrollment).
- Some Local Regulations in Different Cities
- Nanjing:
- The starting standard for critical illness insurance is set at about 50% of the per - capita disposable income of urban residents in the previous year (currently tentatively set at 20,000 yuan). For the part above the starting standard, it is "calculated in segments and paid in an accumulative manner", without setting a maximum payment limit. Specifically, for the part above 20,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below), the payment ratio is 60%; for the part from 40,000 yuan to 60,000 yuan, the payment ratio is 65%; for the part from 60,000 yuan to 80,000 yuan, the payment ratio is 70%; for the part from 80,000 yuan to 100,000 yuan, the payment ratio is 75%; for the part above 100,000 yuan, the payment ratio is 80%.
- For eligible disadvantaged people, the starting standard for critical illness insurance is reduced by 50% (now 10,000 yuan), and the reimbursement ratio for each expense segment is increased by 5%.
- Suzhou:
- For insured employees, for some major diseases, the reimbursement ratio has reached or exceeded 90%. For example, for policy - scope expenses such as uremia dialysis, anti - rejection drug treatment after organ transplantation, and chemotherapy and radiotherapy for malignant tumors, if the cumulative amount is within 40,000 yuan (including 40,000 yuan), it is paid by the basic medical insurance pooling fund at a ratio of 90%; for the part from 40,000 yuan to 100,000 yuan (including 100,000 yuan), it is paid by the basic medical insurance pooling fund at a ratio of 95%. For the part of hospitalization and outpatient specific - item medical expenses that meet the regulations and exceed 100,000 yuan in the settlement year, it is paid by the large - amount medical expense social mutual - aid fund at a ratio of 95%, with individuals bearing 5%.
- For urban and rural medical insurance participants, for policy - scope expenses such as uremia dialysis, chemotherapy and radiotherapy for malignant tumors, and anti - rejection drug treatment after organ transplantation, if the amount is within 100,000 yuan, it is paid by the resident medical insurance fund at a ratio of 90%.
- Yancheng:
- The starting line for critical illness insurance remains at 14,000 yuan (7,000 yuan for disadvantaged people) in 2024. It is reimbursed in segments according to the ratio. From the starting line to 100,000 yuan (including 100,000 yuan), the reimbursement ratio is 60%; from 100,000 yuan to 200,000 yuan (including 200,000 yuan), the reimbursement ratio is 70%; above 200,000 yuan, the reimbursement ratio is 80%. The reimbursement ratios for disadvantaged people are correspondingly increased by 10 percentage points.
It should be noted that the specific second - reimbursement ratio of critical illness insurance in Jiangsu may vary due to different insurance types (such as urban employee medical insurance, urban and rural resident medical insurance), different regions, and different reimbursement item scopes. It is recommended that you consult the local medical insurance department or relevant insurance agencies for the most accurate and up - to - date information.
