The reimbursement scope and proportion of rural medical insurance in Yunnan Province
1. Outpatient compensation:
(1) 6% of the medical treatment in village clinics and village center clinics is reimbursed, and the prescription drug fee for each visit is limited to 1 yuan, and the prescription drug fee for temporary rehydration for doctors in health centers is limited to 5 yuan.
(2) 4% reimbursement for medical treatment in town health centers, with the limit of each examination fee and operation fee in 5 yuan and the limit of prescription drug fee in 1 yuan.
(3) 3% reimbursement for medical treatment in secondary hospitals, with the limit of each examination fee and operation fee in 5 yuan and the limit of prescription drug fee in 2 yuan.
(4) tertiary hospitals will be reimbursed 2%, with the limit of each examination fee and operation fee in 5 yuan and the limit of prescription drug fee in 2 yuan.
(5) The invoice of traditional Chinese medicine is attached with a prescription with a limit of 1 yuan per paste.
(6) The annual compensation limit of township-level cooperative medical outpatient service is 5, yuan.
2. Hospitalization compensation
(1) Reimbursement scope:
A. Medicine expenses: auxiliary examination: 2 yuan for examination expenses such as ECG, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Operation expenses (refer to national standards, and those exceeding 1 yuan will be reimbursed by 1 yuan).
B, the elderly over 6 years old are hospitalized in Xingta Town Health Center, and the treatment and nursing expenses are compensated to 1 yuan every day, with a limit of 2 yuan.
(2) reimbursement rate: 6% for town hospitals; 4% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 3%.
reimbursement ratio of medical insurance in Yunnan province in p>217
3. Compensation for serious illness
(1) Compensation of town risk fund: All inpatients who participate in rural cooperative medical insurance should report medical expenses of more than 5, yuan at one time or in a year, that is, 65% compensation for 5,1-1, yuan and 7% compensation for 1,1-18, yuan.
(2) The annual compensation limit for hospitalization and uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy in town-level cooperative medical system is 11, yuan.
Q&A on rural medical insurance in Yunnan Province
Q: My parents now live in rural Anhui Province and have participated in the new rural medical insurance. Is there a cap on the reimbursement amount of this insurance? What is the maximum amount that can be reported? In addition, I want to buy them another serious illness medical insurance now. Will there be any conflict in the reimbursement of this insurance in the future?
If you see a doctor in a hospital in this province, can the reimbursement rate reach 5%? In addition, there is only one medical bill. If you apply for rural medical insurance, is there any way to apply for serious illness medical insurance from an insurance company?
a: the maximum cap of the new rural cooperative medical system is 4, yuan per year, and the reimbursement ratio is 8% for township hospitals except the deductible line, followed by 6% at the county level and 45% at the provincial level, which does not conflict with other commercial insurance. Please keep copies of all the materials and ask the new rural cooperative medical system office that received your materials to affix their official seals to reimburse commercial insurance.
Tips for Rural Medical Insurance in Yunnan Province
Compared with the system started in 27, the new version of the List of Medicines for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance in Anhui Province released in 21 has reached 2,422 kinds of medicines of Class A and Class B, which is more than 3 kinds more than the previous version of the List of Medicines. At the same time, the scope of medical insurance fund payment has gradually expanded, and the scope of prescribed diseases for outpatient serious diseases and chronic diseases has been increasing.
in addition, by doing a good job in the transfer and connection of medical insurance relations and the settlement service of medical treatment in different places, Yunnan Province focuses on solving the transfer and connection of rural medical insurance relations in Anhui Province, which flows between urban and rural areas, so as to realize the smooth transfer and connection of medical insurance relations between different systems and different regions. Through the cooperation of medical insurance management and the docking of handling services with the "Yangtze River Delta" region, the settlement method of medical treatment in different places will be continuously improved, so that the insured in our province can better enjoy the medical insurance treatment in different places.
in p>215, Yunnan province continued to implement the basic medical insurance system for urban residents, a livelihood project, and improved the reimbursement of medical insurance. In order to help the insured residents further understand the residents' medical insurance policies, master the relevant procedures such as enrollment, medical treatment and reimbursement, so as to better enjoy the government's policy of benefiting the people, the Yunnan Provincial Bureau of Human Resources and Social Security recently announced the treatment and reimbursement policies for residents' medical insurance in 215-216.
treatment of insured persons in Yunnan Province
During the period from October 1st of this year to September 3th of the following year, insured persons can enjoy the following treatment with medical insurance card, social security card and ID card (insured persons under the age of 18 can rely on household registration book, hereinafter referred to as "valid certificate"):
① hospitalization reimbursement treatment; ② special disease outpatient treatment; ③ general outpatient treatment; ⑤ subsidy treatment for assembly of assistive devices for the disabled
.
hospitalization in a secondary hospital:
8% of the expenses within the scope of medical insurance exceeding 4 yuan (Qifubiaozhun) will be reimbursed;
hospitalization in tertiary hospitals:
7% of the expenses within the scope of medical insurance exceeding 6 yuan (Qifubiaozhun) will be reimbursed;
hospitalization in different places (transfer to hospital and emergency treatment in different places):
5% of the expenses within the scope of medical insurance exceeding 6 yuan (Qifubiaozhun) will be reimbursed.
See the following table for details of hospitalization qifubiaozhun and fund payment ratio:
qifubiaozhun for ordinary residents in medical institutions (threshold fee) and qifubiaozhun for students, children and residents under the age of 18 (reimbursement ratio)
637% in tertiary hospitals
428% in secondary hospitals
219% in primary hospitals <
2. The use of Class B drugs and diagnosis and treatment items requires individuals to pay a certain fee first.
●2. Outpatient treatment of special diseases in Yunnan Province
The insured persons suffer from coronary heart disease, hypertension phase III, diabetes, psychosis, cirrhosis, malignant tumor, renal dialysis, kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia, hemophilia, breast cancer (endocrine therapy), hepatolenticular degeneration, chronic heart failure, chronic renal insufficiency and thyroid function. Prostate cancer (endocrine therapy), bladder tumor (perfusion therapy), liver transplantation, hematopoietic stem cell transplantation, rehabilitation therapy, chronic hepatitis B (antiviral therapy), cerebral palsy and other 27 diseases, after the application is confirmed, enjoy 6% to 8% reimbursement treatment under the monthly limit.
●3. General outpatient treatment in Yunnan Province
The overall fund will pay 5% of the medical expenses incurred by the insured residents in the outpatient service of the community health service center (the general outpatient service in hospitals designated by other residents does not enjoy this treatment). The maximum reimbursement limit for single medical expenses is 4 yuan. The maximum reimbursement limit in one year is 16 yuan, among which, the maximum reimbursement limit for insured residents over 6 years old for men and over 55 years old for women is 24 yuan. There is no disease limitation for reimbursement of general outpatient service, and medical expenses are settled directly in community health service center.
●4. Subsidy treatment of birth expenses in Yunnan Province
Insured residents who meet the family planning policy will be given a subsidy of 1,2 yuan for 6 yuan and cesarean section if they give birth naturally (including assisted delivery).
●5. Subsidies for the disabled in Yunnan Province to assemble assistive devices
Disabled people with disability certificates and hearing-impaired children under 7 years old among the insured residents will be given subsidies for assembling lower limb prostheses and equipped with hearing AIDS in designated institutions for assembling assistive devices for the disabled. Every five years, a subsidy of 2, yuan will be given to ordinary thigh prostheses, 1 yuan for calf prostheses and 2,4 yuan for hearing AIDS for hearing-impaired children under 7 years old.
Instructions for medical insurance reimbursement in Yunnan Province
●1. Local hospitalization
Insured personnel should seek medical treatment in designated medical institutions, go through medical insurance hospitalization procedures in hospitals with valid certificates, and directly reimburse and settle the medical expenses incurred when they leave the hospital. If you don't go to a designated hospital for medical treatment or go through medical insurance hospitalization procedures in the hospital, the medical expenses incurred will not be reimbursed.
●2. Application for outpatient treatment of special diseases
Insured personnel fill in the Application Form for Outpatient Treatment of Special Diseases of Basic Medical Insurance for Urban Residents in Yunnan Province, and submit the relevant medical records and medical examination reports in the near future to the Special Diseases Appraisal Office of Yunnan Medical Insurance Center, which will organize medical insurance experts to conduct appraisal, and issue the Outpatient Treatment Card for Special Diseases if it meets the requirements, and enjoy the outpatient treatment of special diseases with the card. Identification is organized every three months.
●3. Procedures for medical treatment in different places
If the diseases of the insured are difficult to be diagnosed in tertiary hospitals (including specialized hospitals) or there is no treatment, they can apply for transfer to different places for hospitalization. Transfer from different places must fill in the Application Form for Transfer from Different Places, and after the opinions are signed by the designated hospitals above Grade III in Yunnan Province, they will be transferred to different places for treatment after being reported to the medical insurance agency in Yunnan Province for examination and filing.
if an insured person has sudden illness in a different place and really needs hospitalization, he should be hospitalized in a local designated medical institution and call the medical insurance center for filing within 3 days after admission.
The medical expenses for transfer and emergency treatment in different places shall be paid by individuals first. Within one month after discharge, bring the transfer approval form, detailed list of hospitalization expenses, invoice documents, discharge summary and valid documents to the medical insurance center for reimbursement and settlement.
●4. Apply for maternity allowance
Within one month after birth, report to the medical insurance management center with valid documents, birth certificate, medical invoice, detailed list of expenses and discharge summary.
●5. reimbursement for neonatal congenital diseases
if a newborn suffers from congenital diseases such as congenital heart disease and goes through the insurance formalities within three months from the date of birth, it will enjoy the medical insurance benefits of residents from the date of birth. Hospitalization medical expenses due to congenital diseases shall be reported to the medical insurance management center within 3 days after discharge with valid documents, hospitalization invoices, detailed list of expenses and discharge summary.
treatment of medical insurance for serious illness
For medical expenses incurred by the insured in hospital due to illness, the insured can enjoy treatment of medical insurance for serious illness and be reimbursed at the rate of 5%-8% for the part exceeding the deductible of 2, yuan within the policy scope. The specific segmentation ratio is:
within the policy scope, the individual pays more than 2, yuan, and the segmentation reimbursement ratio is
~ 5, yuan (inclusive) 5%
5, yuan ~ 1, yuan (inclusive) 6%
1, yuan ~ 3, yuan (inclusive) 7%
3, yuan (exclusive).