1, and the reimbursement rate of town hospitals is 60%;

2. The reimbursement rate of secondary hospitals is 40%;

3. The reimbursement rate of tertiary hospitals is 30%;

4, the town-level cooperative medical outpatient reimbursement limit of 5000 yuan/year;

5. Reimbursement of supplementary inspection items to 200 yuan;

6. If the deductible line of operation fee is less than 1000 yuan, it shall be reimbursed according to the national standard;

7. The hospitalization expenses and nursing expenses can be reimbursed every day 10 yuan, with the limit of 200 yuan;

8, a medical institution hospitalization expenses below 400 yuan, no deductible;

9, secondary medical institutions to increase the proportion of subsidies to 75%-80%;

10, and the subsidy ratio of tertiary medical institutions will be increased to 55%-60%;

1 1, and the subsidy ratio of provincial tertiary medical institutions increased to 55%;

12, 70% places for children with congenital heart diseases and 70% places for diseases such as lung cancer.

Cooperative medical reimbursement process:

1, the patient sees a doctor in the designated hospital of cooperative medical care and presents the certificate of cooperative medical care;

2, the hospital according to the patient's condition and treatment needs, provide corresponding medical services;

3, after the treatment, the hospital issued a detailed list of expenses, and indicate the reimbursable items and expenses;

4, patients or their families will cost list and related documents submitted to the cooperative medical management department;

5. The cooperative medical management department shall review the authenticity and compliance of the expense list and certification materials;

6. After examination and approval, calculate the reimbursement amount according to the reimbursement ratio and regulations of cooperative medical care;

7. The cooperative medical management department will transfer the reimbursement to the bank account designated by the patient or pay it to the patient in other ways.

To sum up, the reimbursement policy of Yantai cooperative medical care stipulates the reimbursement ratio of different levels of medical institutions, outpatient and inpatient treatment limits, and fixed subsidies for specific diseases, of which the reimbursement ratio of town hospitals is 60%, that of secondary hospitals is 40%, and that of tertiary hospitals is 30%. The reimbursement rate of secondary and tertiary medical institutions has increased, and a higher proportion of fixed subsidies have been given to children with congenital heart diseases.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.