First, the scope of reimbursement for rural cooperative medical care:
Farmers who participate in the new rural cooperative medical care are hospitalized due to illness, and can get compensation for the expenses including medicine, bed fee, operation fee, disposal fee, infusion fee, oxygen delivery fee, routine imaging examination (A-ultrasound, B-ultrasound, electrocardiogram and X-ray) and routine laboratory tests (blood, urine and feces) during hospitalization.
Second, the reimbursement ratio:
The deductible line and the capping line are set up for hospitalization medical expenses compensation. The deductible standard is 5 yuan, a town health center, 2 yuan, a county-level hospital in the county, and 5 yuan, a hospital outside the county; The top line is 2, yuan, that is, the total hospitalization expenses paid by the new rural cooperative medical fund for each person within one year does not exceed 2, yuan. Each hospitalization of farmers participating in the new rural cooperative medical system is within the scope of reimbursement, and the part below the deductible line is borne by individuals, and the medical expenses exceeding the deductible line are compensated in proportion from the hospitalization medical fund of the new rural cooperative medical system: < P > (1) Hospitalization in town health centers and designated medical institutions below them, and hospitalization expenses above 5 yuan are reimbursed at the rate of 6%.
(2) hospitalization in designated medical institutions at the county level, with hospitalization expenses ranging from 21 yuan to 5, yuan (including 5, yuan), will be reimbursed at 4%; 51 yuan to 1 yuan (including 1 yuan), according to the proportion of 5% reimbursement; More than 1 yuan, according to the proportion of 6% reimbursement.
(3) hospitalization in designated medical institutions outside the county, with hospitalization expenses ranging from 51 yuan to 5, yuan (including 5, yuan), will be reimbursed at the rate of 3%; 51 yuan to 1 yuan (including 1 yuan), according to the proportion of 4% reimbursement; More than 1 yuan, according to the proportion of 5% reimbursement.
if the hospitalization medical expenses exceed the compensation capping line, the county joint management office will appropriately give a second subsidy from the serious illness subsidy of cooperative medical care after the year-end unified audit.
III. Reimbursement process:
At the end of medical treatment, medical records, medical expense statement, Shayang County New Rural Cooperative Medical Certificate, ID card or household registration book are used to apply for reimbursement to the town joint management office or the joint management department of county-level medical institutions, and after being audited by the town joint management office or the joint management department of county-level medical institutions, the service medical institutions will compensate them immediately.
Fourth, consultation telephone number:
Ask the village committee cadres, the township cooperative medical service office and the county joint management office first. The specific business is in the township cooperative medical office.
V. Full text reference:
Implementation measures of the new rural cooperative medical system in Shayang County (for Trial Implementation)
----------------. The provincial government's "Decision on Further Strengthening Rural Health Work" (E Fa [25] No.5), according to the "Pilot Work Plan of New Rural Cooperative Medical System in Hubei Province" (E Zheng Ban Fa [23] No.72), combined with the actual situation of this county, these implementation measures are formulated.
article 2 the new rural cooperative medical system is a medical mutual aid and economic system organized, guided and supported by the government, financed by individuals, collectives and the government, with serious illness as the main concern and farmers voluntarily participating.
article 3 the purpose of developing the new rural cooperative medical system is to improve the health level of rural residents, solve the problem of "poverty caused by illness and returning to poverty due to illness" and realize the goal of building a well-off society in an all-round way.
Article 4 Farmers who have registered permanent residence in agricultural registered permanent residence can participate in the new rural cooperative medical system. Participating farmers must take households as the unit and implement the system of one household and one certificate.
article 5 the new rural cooperative medical system is "county-run, county-town-run". Manage inpatient medical fund and health check-up fund by county, and manage outpatient medical fund by town.
Chapter II Organization
Article 6 A new rural cooperative medical management committee (hereinafter referred to as the county cooperative medical management committee) shall be established in the county to be responsible for the organization, coordination, management and guidance of the new rural cooperative medical system in the county. County Health Bureau is the competent department of new rural cooperative medical service in the county.
the county and town set up the new rural cooperative medical management Committee office (hereinafter referred to as the joint management office), which is the agency of the new rural cooperative medical system and is responsible for the business management and daily work of the new rural cooperative medical system within its jurisdiction. County-level designated medical institutions set up a new rural cooperative medical management department (referred to as the joint management department), and accept the leadership and management of the county joint management office. Administrative villages set up new rural cooperative medical care management groups.
township governments and village committees are responsible for assisting in the fund-raising, publicity, organization, supervision and management of the local new rural cooperative medical system.
article 7 the county joint management office is a public institution with 5 approved posts, and its office is located in the county health bureau. The town joint management office is entrusted by the county joint management office, with 2 staff in each stable post, and the office is located in the town health center, with separate management and vertical management. County, town joint management office staff from the county financial support personnel and health system financial balance support personnel in open recruitment, merit-based, town joint management office staff to implement off-site appointment. County-level medical institutions and management personnel to implement the appointment system. The wages and working expenses of the staff of the county joint management office and the full-time staff of the town joint management office are uniformly included in the fiscal budget by the county government.
Article 8 The main responsibilities of the county and town joint management office and the village management team:
The main responsibilities of the county joint management office:
(1) Seriously implement the relevant policies of the new rural cooperative medical system and be responsible for the organization and coordination of the new rural cooperative medical system in the county.
(2) formulate relevant supporting management measures.
(3) assist relevant departments to raise and manage the new rural cooperative medical fund.
(4) to formulate the annual work plan of the new rural cooperative medical system and the budget and final accounts of the fund.
(5) supervise the write-off of medical expenses in the county, and be responsible for the write-off of hospitalization medical expenses outside the county according to regulations.
(6) making cards, certificates, forms and books related to the new rural cooperative medical system.
(7) provide consulting services for participants in the new rural cooperative medical system.
(eight) responsible for the training and assessment of the town's new rural cooperative medical management personnel, and investigate and deal with violations of the provisions of the new rural cooperative medical system.
(9) Establish and improve the information system of the new rural cooperative medical system in this county, collect, sort out, analyze, evaluate and report the information of the new rural cooperative medical system in time, and do a good job in the management of the documents and files of the new rural cooperative medical system.
(1) to be responsible for the qualification examination and confirmation of the designated medical institutions of the new rural cooperative medical system, and supervise the service quality of the designated medical institutions. Review the relevant outpatient and inpatient information reported by all designated medical institutions.
(11) report the work to the county management committee on a regular basis and carry out other tasks assigned by superiors.
main responsibilities of the town joint management office:
(1) to be responsible for the organization and coordination of the new rural cooperative medical system in this town.
(2) assist relevant departments to raise and manage the new rural cooperative medical fund.
(3) Establish and improve the archives of the new rural cooperative medical system, and fill in, issue and manage cooperative medical certificates.
(4) to be responsible for the audit and reimbursement of outpatient medical expenses, conduct a preliminary examination of the reimbursement credentials of inpatient medical expenses, and write them off according to regulations.
(5) sign an agreement with farmers on the new rural cooperative medical system, establish health records, and provide farmers with policy consultation services on the new rural cooperative medical system.
(6) report and publish the income and expenditure of the new rural cooperative medical fund in this area.
(7) training and assessment of village managers.
(8) Implement other tasks assigned by superiors.
main responsibilities of the village management team:
(1) to carry out propaganda work and assist in collecting the new rural cooperative medical fund.
(2) supervise the service behavior of village health institutions and the villagers' medical treatment behavior.
(3) publicize the compensation for medical expenses of local farmers.
(4) Assist in organizing farmers to participate in physical examination and establish health records.
Article 9 Departments of county health, finance, auditing, supervision, public security, civil affairs, agriculture, development and reform, drug administration, radio and television, price, personnel and labor, social security, poverty relief office, credit union, etc. shall conscientiously perform their respective duties and do a good job in the new rural cooperative medical system according to relevant regulations.
tenth counties set up a new rural cooperative medical supervision Committee to supervise the use and management of the new rural cooperative medical fund and the health services of designated medical institutions. The supervision committee consists of the heads of the county people's congress, CPPCC, Commission for Discipline Inspection, supervision, auditing, price and other relevant departments, some NPC deputies, CPPCC members and farmers' representatives participating in the new rural cooperative medical system, among which the proportion of farmers' representatives is not less than 2%.
chapter iii fund raising
article 11 the new rural cooperative medical care fund is mainly composed of three parts: voluntary payment by individual farmers, local financial subsidies and central financial transfer payments.
(a) farmers who participate in the new rural cooperative medical system pay 15 yuan every year.
(2) The local finance subsidizes 15 yuan every year according to the number of people participating in the new rural cooperative medical system, including provincial financial subsidies to 1 yuan and county-level financial subsidies to 5 yuan.
(3) The special transfer payment funds from the central government will subsidize 2 yuan every year according to the number of people participating in the new rural cooperative medical system.
article 12 farmers from poor households with poor certificates in rural areas shall participate in the new rural cooperative medical system, and their individual contributions shall be paid by the civil affairs department from the relief funds. Rural five-guarantee households participate in the new rural cooperative medical system, and their individual contributions are partly solved from the financial transfer payment funds for each five-guarantee household in 8 yuan after the tax and fee reform.
thirteenth collective economic organizations, social organizations and individuals to support the funding of the new rural cooperative medical system by the county joint management office unified reception.
article 14 the new rural cooperative medical fund paid by individual farmers shall be collected by the town finance office and transferred to the special account of the new rural cooperative medical fund in time.
article 15 the deadline for individuals to pay the new rural cooperative medical care fund at the end of December each year can be paid in advance, but it is not allowed to make overdue payment, nor can it be required to return the paid new rural cooperative medical care fund. The county joint management office shall, jointly with the town joint management office, establish an outpatient family account for the farmers who pay the new rural cooperative medical fund, and issue the Shayang County New Rural Cooperative Medical Certificate.
article 16 farmers participate in the new rural cooperative medical system to resist the risk of diseases and fulfill the obligation of payment.
Chapter IV Subsidies for Medical Expenses
Article 17 Farmers who participate in the new rural cooperative medical system can get compensation for outpatient medical expenses in 1 yuan every year, and the compensation will be credited to the outpatient family account.
article 18 farmers who participate in the new rural cooperative medical system are hospitalized due to illness, and can be compensated for the expenses including medicine, bed fees, operation fees, disposal fees, infusion fees, oxygen delivery fees, routine imaging examinations (A-ultrasound, B-ultrasound, electrocardiogram and X-ray) and routine laboratory tests (blood, urine and feces) during hospitalization. The compensation for hospitalization medical expenses shall be set up with deductible line and capping line. The deductible standard is 5 yuan, a town health center, 2 yuan, a county-level hospital in the county, and 5 yuan, a hospital outside the county; The top line is 2, yuan, that is, the total hospitalization expenses paid by the new rural cooperative medical fund for each person within one year does not exceed 2, yuan. Each hospitalization of farmers participating in the new rural cooperative medical system is within the scope of reimbursement, and the part below the deductible line is borne by individuals, and the medical expenses exceeding the deductible line are compensated in proportion from the hospitalization medical fund of the new rural cooperative medical system: < P > (1) Hospitalization in town health centers and designated medical institutions below them, and hospitalization expenses above 5 yuan are reimbursed at the rate of 6%.
(2) hospitalization in designated medical institutions at the county level, with hospitalization expenses ranging from 21 yuan to 5, yuan (including 5, yuan), will be reimbursed at 4%; 51 yuan to 1 yuan (including 1 yuan), according to the proportion of 5% reimbursement; More than 1 yuan, according to the proportion of 6% reimbursement.
(3) hospitalization in designated medical institutions outside the county, with hospitalization expenses ranging from 51 yuan to 5, yuan (including 5, yuan), will be reimbursed at the rate of 3%; 51 yuan to 1 yuan (including 1 yuan), according to the proportion of 4% reimbursement; More than 1 yuan, according to the proportion of 5% reimbursement.
if the hospitalization medical expenses exceed the compensation capping line, the county joint management office will appropriately give a second subsidy from the serious illness subsidy of cooperative medical care after the year-end unified audit.
according to the actual situation, the county joint management Committee can make appropriate adjustments to the reimbursement ratio.
Article 19 Pregnant women who participate in the new rural cooperative medical system give birth within the planned scope, and each person will be given a fixed subsidy to 8 yuan for hospitalization delivery expenses, and those who have obstetric complications will be included in the scope of hospitalization compensation.
Article 2 Compensation Measures for New Rural Cooperative Medical System:
(1) Medical expenses incurred in outpatient clinics are treated in designated village clinics and town health centers, and the patients receive compensation directly with the Shayang County New Rural Cooperative Medical System Certificate; In the county-level designated medical institutions, the patients will return to the village clinic for reimbursement with the medical expense invoice. Every household's annual report (nuclear) sales outpatient medical expenses shall not exceed the balance of family account. If there is a balance at the end of the year, it can be transferred to the next year to continue to use, but it shall not be offset against the new rural cooperative medical expenses payable by individuals in the next year, nor shall it be refunded in cash.
(2) The medical expenses incurred in hospitalization in designated medical institutions shall be paid first and then compensated. At the end of medical treatment, the patient shall apply for reimbursement with medical records, medical expense statement, Shayang County New Rural Cooperative Medical Card, ID card or household registration book to the town joint management office or the joint management department of county-level medical institutions, and after being audited by the town joint management office or the joint management department of county-level medical institutions, the service medical institutions will immediately compensate.
(3) When working outside the county, staying temporarily or visiting relatives, they need to be hospitalized due to illness. In principle, they will go back to the designated medical institutions in the county for treatment. For the medical expenses incurred in hospitalization in different places due to rescue, the medical doctor will go to the county joint management office for review with the diagnosis certificate of the medical institution, the copy of the hospital medical record, the list of medical expenses and the formal receipt, and the county joint management office will reduce the reimbursement ratio by 1% according to the provisions of Item 3 of Article 18 of these Measures.
(4) the medical expenses incurred when the county joint management office approves to be transferred to the county for hospitalization shall be directly compensated by the patient with the diagnosis certificate of the medical institution, the copy of the medical record, the duplicate prescription, the list of medical expenses, the formal receipt and the Shayang County New Rural Cooperative Medical Care Certificate, ID card or household registration book, with reference to the provisions of Item 3 of Article 18 of these Measures.
(5) During hospitalization, in addition to the expenses of routine imaging examination (A-ultrasound, B-ultrasound, electrocardiogram and X-ray) and routine laboratory tests (blood, urine and feces), when other examinations and tests are needed due to illness, the approval system shall be implemented. The expenses incurred below 2 yuan (including 2 yuan) shall be compensated according to the proportion of hospitalization compensation; More than 2 yuan, according to 2 yuan into the scope of hospitalization compensation.
Article 21 All hospitalization expenses of participants in the new rural cooperative medical system shall be filled out by the medical institution that accepts the medical treatment, and signed by the patient himself or his family members for confirmation. No compensation will be given for medical expenses that have not been signed by the patient himself or his family.
Article 22 The following situations do not belong to the compensation scope of the new rural cooperative medical system:
(1) Medical expenses incurred in fighting, alcoholism, taking poison, self-mutilation, suicide, traffic accidents, etc. <