First, can the new rural insurance be used in hospitals in different places?
1。 Reimbursement scope: It conforms to the reimbursement scope stipulated by the new rural cooperative medical system, and even the expenses incurred in emergency, outpatient and hospitalization during medical treatment in different places can be applied for reimbursement.
2。 Reimbursement ratio:
Outpatient reimbursement
(1) The reimbursement rate for general outpatient service is 50%, and the annual reimbursement for each person is capped in 80 yuan.
(2) Outpatient observation can be reimbursed up to 1 1,000 yuan per day.
(3) The reimbursement rate for outpatient serious illness is 50%, and patients with liver cirrhosis, sequelae of cerebral thrombosis and cerebral hemorrhage, rheumatoid arthritis (active stage), femoral head necrosis, hypertension with complications, diabetes, pulmonary heart disease, systemic lupus erythematosus, aplastic anemia, organ or tissue transplantation anti-rejection treatment, leukemia, severe mental illness, congenital adrenal hyperplasia and congenital hypothyroidism are reimbursed 654.38 million yuan per person per year. Patients with malignant tumor, uremia and hemophilia are reimbursed 30,000 yuan per person per year.
Second, hospitalization reimbursement
(1) 200 yuan, the deductible line for hospitalization reimbursement at township level (level 1), with the reimbursement ratio of 85%.
(2) 500 yuan, the deductible line for hospitalization reimbursement of county-level (secondary) designated medical institutions, the reimbursement ratio is 70%.
(3) The deductible line for hospitalization reimbursement of municipal (tertiary) designated medical institutions is 700 yuan, and the reimbursement ratio is 55%.
(4) The deductible line for hospitalization reimbursement in provincial (tertiary) designated medical institutions is 1000 yuan, and the reimbursement ratio is 50%.
(5) With the consent of the county-level new rural cooperative medical management institution, the unified reimbursement deductible line is 1 1,000 yuan, the reimbursement ratio is 40%, and the guaranteed reimbursement ratio is 20%.
(6) The reimbursement rate of drugs, Chinese herbal pieces and non-drug and non-surgical therapies such as acupuncture, massage, cupping and scrapping in the list of essential drugs is increased by 10% on the basis of the original reimbursement rate. The deductible lines of Dezhou City, county-level Chinese medicine hospitals and maternal and child health hospitals were reduced by 200 yuan, and the compensation ratio was increased by 5% on the basis of the original reimbursement ratio.
(7) Proportion of reimbursement for hospitalization expenses of 20 major diseases such as childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, AIDS opportunistic infection, multidrug-resistant tuberculosis, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer and rectal cancer in designated medical institutions at the municipal and provincial levels.
(eight) accidental injuries caused by their own reasons, in addition to the "Shandong Province, the new rural cooperative medical treatment project directory" will not be reimbursed, unified hospitalization.
First, the rural medical insurance hospitalization reimbursement process
Rural medical insurance is a part of social security in China, and the agricultural population in China accounts for 6.5% of the total population.
3。 9 1%, rural medical insurance, which can make farmers enjoy the benefits of rural medical insurance, is also an important part of social security and one of the important links of China's economic construction.
Participating farmers can choose different hospitals for medical treatment, generally taking the principle of proximity, and the reimbursement ratio of different hospitals is also different. Generally, the reimbursement rate of inpatients is relatively large, which can be divided into chronic diseases, special diseases and accidental injuries. Different reimbursement rates can be adopted to avoid poverty and anti-poverty due to illness to a certain extent.
1, chronic disease reimbursement process
Patients need to bring their household registration book, joint treatment certificate, special chronic disease certificate, outpatient medical records, and outpatient fee invoices of public hospitals to the county new rural cooperative medical service center for reimbursement.
2, county hospital reimbursement process
With the cooperative medical certificate, ID card and household registration book, the patient will go through the admission examination and registration formalities in the general treatment department of the hospital within 24 hours after admission, and then go through the reimbursement formalities in the general treatment department of the hospital with the hospital medical record, settlement invoice, diagnosis certificate, daily list and other related materials after discharge.
3, outpatient reimbursement process as a whole
Patients with cooperative medical certificate go to township hospitals and village clinics, and go through reimbursement procedures in the joint therapy department with outpatient prescription and machine-made outpatient fee invoice. After seeing a doctor in the clinic and signing the reimbursement registration form and other related materials, you can directly apply for reimbursement and only pay part of the expenses paid by the individual.
4, outside the county medical reimbursement process
(1) When participating patients are transferred to hospitals outside the county, county-level designated medical institutions (county hospitals, 5702 hospitals, and Wugong Affiliated Hospital of Xi 'an Medical College) must issue a transfer approval form, and make technical referral registration in the county joint therapy office, and the proportion of unapproved reimbursement will be reduced by 30%.
(2) After the participating patients are discharged from the county, they need to ask the hospital for: hospitalization settlement invoice, hospitalization expense list, diagnosis certificate and copy of medical records (all the above four items are stamped with the official seal of the medical unit).
Second, how to reimburse rural medical insurance for hospitalization in different places?
The specific process is as follows:
The reimbursement process of rural medical insurance in different places
1. Generally, you should tell the doctor to copy the materials when you leave the hospital. The materials are sent to the medical record room and can only be copied after filing, which takes one to two weeks.
2. The staff should carefully input all the expenses incurred by the patient in the hospital into the computer in order to get the compensation amount of the patient. For the safety of the fund, an audit is needed, so more time is needed to get compensation outside the county.
Generally speaking, banks have no right to refuse to withdraw money. Of course, some agricultural insurance centers in counties and cities have cashiers who pay money specially.
I hope the above content can help you. If in doubt, please consult a professional lawyer.
Legal basis:
Article 64 of People's Republic of China (PRC) Social Insurance Law
Social insurance funds include basic endowment insurance fund, basic medical insurance fund, industrial injury insurance fund, unemployment insurance fund and maternity insurance fund. In addition to the basic medical insurance fund and maternity insurance fund combined accounting, other social insurance funds are accounted for separately according to social insurance types. Social insurance funds implement a unified accounting system throughout the country. The social insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it. The basic old-age insurance fund will gradually implement national overall planning, and other social insurance funds will gradually implement provincial overall planning. The specific time and steps shall be stipulated by the State Council.