On October 10th, the Shanxi Provincial Health Insurance Bureau announced a significant update regarding health insurance coverage for reproductive health services. In collaboration with the Shanxi Provincial Department of Finance and the Shanxi Provincial Health Commission, they issued a notice titled “Inclusion of Certain Therapeutic Assisted Reproductive Technology Projects in the Basic Medical Insurance Payment Scope.” This new policy is set to take effect on October 1, 2024, and will incorporate 13 types of therapeutic reproductive health services into the state’s health insurance coverage, applying uniformly across the province.
The notice specifies that Shanxi will include procedures such as “egg retrieval” among the 13 assisted reproductive technology services covered by health insurance. Of these, four are classified as Category A projects, while nine fall under Category B, with a personal co-payment rate of 10% for Category B services.
Additionally, the notice outlines that insured individuals receiving these 13 assisted reproductive technology services at designated medical institutions approved by the health department within the province will have their outpatient treatment costs reimbursed through a direct payment method by the health insurance fund. There will be no minimum payment threshold; instead, the employee insurance and resident insurance funds will cover 70% and 60% of the costs, respectively. For treatments conducted outside the province, compliant expenses will be reimbursed at 60% for employee insurance and 50% for resident insurance.
Moreover, the policy stipulates that each insured individual can claim coverage for each project no more than three times. Any other eligible medical expenses incurred during treatment will be processed according to existing regulations.
Finally, the notice emphasizes the importance of interdepartmental collaboration in Shanxi to ensure the safe and effective use of health insurance funds.
