In 2025, the medical insurance reimbursement policy in Rizhao City has several key highlights. The personal payment standard for urban and rural residents' basic medical insurance is 400 yuan per person, with 340 yuan for full-time school students (including children in nurseries). The centralized payment period is from September 1 to December 31, 2024, and those who pay on time can enjoy benefits from January 1, 2025. The reimbursement ratio for ordinary outpatient services has been increased to 65%, and the "two diseases" outpatient reimbursement ratio has been raised to 75%. There are also adjustments to the deductible line and maximum payment limit of critical illness insurance, and new regulations for continuous insured and non - continuously insured personnel. Now, let's break it down in detail:

1. Personal Payment Standard and Centralized Payment Period

• Payment Standard: The personal payment standard for urban and rural residents' basic medical insurance in 2025 is 400 yuan per person. For full - time school students (including children in nurseries) who pay as a whole with the school on an annual basis, it is 340 yuan per person.

• Centralized Payment Period: From September 1 to December 31, 2024. If you pay within this period, you can enjoy the medical insurance benefits of urban and rural residents from January 1, 2025.

2. Adjustment of Reimbursement Ratio

• Ordinary Outpatient Service: Since October 1, 2024, the reimbursement ratio for ordinary outpatient services of urban and rural residents has been increased from 50% to 65%, while the annual payment limit remains unchanged. For example, if you spend 100 yuan on an ordinary outpatient visit (meeting the reimbursement scope), you can be reimbursed 65 yuan.

• "Two Diseases" Outpatient Service: The "two diseases" refer to hypertension and diabetes. Since October 1, 2024, the reimbursement ratio for "two diseases" outpatient services has been increased from 70% to 75%, and the annual payment limit remains unchanged. For instance, if a patient with hypertension spends 200 yuan on relevant drugs (meeting the regulations), 150 yuan can be reimbursed.

3. Adjustment of Critical Illness Insurance

• Deductible Line: Since January 1, 2025, the deductible line for critical illness insurance for urban and rural residents in Rizhao City has been increased from 10,000 yuan to 12,000 yuan. That is to say, only when the self - paid part of the medical expenses exceeds 12,000 yuan can the critical illness insurance be triggered for reimbursement.

• Maximum Payment Limit Adjustment:

• For insured persons who have continuously participated in the resident medical insurance for 4 years, for each additional year of continuous participation and payment, the maximum payment limit of critical illness insurance (excluding special drugs for critical illness and drugs for rare diseases) will be increased by 3,000 yuan.

• For residents who have not used the medical insurance fund for reimbursement in the current year and participate in and pay for the insurance normally in the following year, the maximum payment limit of critical illness insurance in the following year will be increased by 3,000 yuan. However, the cumulative increase in the continuous insured incentive and the zero - reimbursement incentive shall not exceed 80,000 yuan.

4. Regulations for Continuous Insured and Non - continuously Insured Personnel

• Continuous Insured: Enjoy the above - mentioned preferential policies for continuous insured, such as the increase in the maximum payment limit of critical illness insurance.

• Non - continuously Insured: For those who do not pay within the centralized payment period of resident medical insurance or do not continuously participate in and pay for the insurance, a fixed treatment waiting period of 3 months will be set after payment. Among them, for those who do not continuously participate in and pay for the insurance, for each additional year of interruption, an additional 1 - month treatment waiting period will be added on the basis of the fixed waiting period. However, insured persons can repair the treatment waiting period by paying. For each additional year of payment, 1 - month treatment waiting period can be reduced (the fixed treatment waiting period remains unchanged). If there is a continuous interruption of payment for 4 years or more, the treatment waiting period (including the fixed treatment waiting period) after repair shall not be less than 6 months.

In general, the 2025 medical insurance reimbursement policy in Rizhao City is designed to better protect the medical needs of the people, with adjustments in payment standards, reimbursement ratios, and critical illness insurance policies. It is recommended that insured persons carefully understand the policy details to ensure that they can enjoy the corresponding medical insurance benefits.