New Rural Cooperative Medical Care Reimbursement Procedure: After the insured person is discharged from the hospital, he or she must submit the hospitalization invoice, discharge record, expense list, referral certificate, and a copy of his or her ID card or household registration certificate signed or stamped by the patient to the township joint management office.
After review, they will be sent to the Municipal Agricultural Insurance Business Management Center.
"New Rural Cooperative Medical Care", the full name of New Rural Cooperative Medical Care, refers to a mutual medical aid and financial system for farmers organized, guided and supported by the government, with farmers voluntarily participating, with multi-party financing from individuals, collectives and the government, and focusing on overall planning of serious diseases.
The New Rural Cooperative Medical System is a mutual-aid and economical medical security system created by my country's farmers themselves. It plays an important role in ensuring farmers' access to basic health services and alleviating farmers' falling into poverty and returning to poverty due to illness.
The reimbursement scope of the New Rural Cooperative Medical System roughly includes three parts: outpatient compensation, hospitalization compensation and serious illness compensation.
The reimbursement scope of the new rural cooperative medical care is: the medicine expenses, examination fees, laboratory fees, surgery fees, treatment fees, nursing fees, etc. incurred by participants due to hospitalization in designated hospitals due to illness during the co-ordination period are within the reimbursement scope of urban employee medical insurance.
(i.e. effective medical expenses).
The new rural cooperative medical fund payment establishes a minimum payment standard and a maximum payment limit.
Hospitalization expenses below the hospital's annual minimum payment standard are paid by the individual.
If the minimum payment standard is reached within the same pooling period, hospitalization expenses incurred for two or more hospitalizations can be reimbursed cumulatively.
Hospitalization expenses that exceed the threshold are calculated in segments and reimbursed cumulatively. There is a maximum limit for cumulative reimbursement per person per year.
New rural cooperative medical reimbursement standards: outpatient compensation: 60% reimbursement for village clinics and village central clinics, a limit of 10 yuan for prescription drugs per visit, and a limit of 50 yuan for prescription drugs for temporary rehydration by doctors at the health center.
The town health center reimburses 40% of the fees for each visit, with a limit of 50 yuan for various examination fees and surgical fees, and a limit of 100 yuan for prescription drugs.
Secondary hospital reimbursement is 30%, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.
A tertiary hospital will reimburse 20% of the fees for visits, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.
The traditional Chinese medicine invoice attached to the prescription has a limit of 1 yuan per prescription.
The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.
Hospitalization compensation: Reimbursement scope: A. Medication expenses: auxiliary examinations: ECG, X-ray, film, laboratory tests, physical therapy, acupuncture, CT, MRI and other examination fees, with a limit of 200 yuan; surgery fee
(Refer to national standards, if the amount exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).
B. If an elderly person over 60 years old is hospitalized in a health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.
Reimbursement ratio: Town health center reimburses 60%; second-level hospitals reimburse 40%; third-level hospitals reimburse 30%.
Compensation for serious illness: Compensation from town risk fund: All inpatients who participate in cooperative medical care will be compensated in stages if their one-time or annual cumulative medical expenses exceed 5,000 yuan, that is, 65% will be compensated for 5,001-10,000 yuan, and 70% will be compensated for 10,001-18,000 yuan.
The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.
Special diseases reimbursed by the New Rural Cooperative Medical Fund include: chemotherapy and radiotherapy for malignant tumors; hemodialysis and peritoneal dialysis for severe uremia; anti-rejection treatment after tissue or organ transplantation; schizophrenia with mental decline; systemic erythema
Lupus (one of the complications of the heart, lungs, kidneys, liver and nervous system); aplastic anemia; anticoagulation therapy after cardiac surgery.
The remaining special diseases that can be reimbursed are subject to specific local policies.
Specific outpatient treatment for special diseases includes necessary supportive therapy and symptomatic treatment of systemic and local reactions during treatment. General auxiliary treatment is not included in the scope of reimbursement.