New Rural Cooperative Medical System reimbursement scope

Medicine expenses, examination fees, laboratory fees, surgery fees, treatment fees, and nursing care expenses incurred by participants due to hospitalization in designated hospitals due to illness during the planning period Expenses and other expenses that are within the reimbursement scope of urban employee medical insurance (that is, 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.

Reimbursement standards

Outpatient compensation

Village clinics and village center clinics are reimbursed 60%, with a limit of 10 yuan for prescription drugs per visit. Doctors at the health center The prescription drug fee for temporary rehydration is limited to 50 yuan.

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.

The reimbursement for visits to secondary hospitals 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.

Tertiary hospitals are reimbursed 20%, 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

Scope of reimbursement:

A. Medication expenses: auxiliary examinations: ECG, X-ray, radiography, laboratory tests, physical therapy, acupuncture , CT, MRI and other examination fees, the limit is 200 yuan; the operation fee (refer to the national standard, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

B. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, 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%.

Critical illness compensation

Town risk fund compensation: All inpatients participating in cooperative medical care whose one-time or annual cumulative medical expenses exceed 5,000 yuan will be compensated in stages, that is, 5,001-10,000 The compensation is 65% for RMB 10,001-18,000 Yuan, and the compensation is 70% for RMB 10,001-18,000.

The annual compensation limit 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 accompanied by mental decline; systemic lupus erythematosus (with one of the complications of the heart, lungs, kidneys, liver and nervous system); aplastic anemia; anticoagulant 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.

Reimbursement procedure

After the insured person is discharged from the hospital, he or she will submit the hospitalization invoice, discharge record, expense list, transfer certificate and a copy of his or her ID card signed or stamped by the patient himself or herself. Household registration certificates must be paid to the township joint management office and sent to the Municipal Rural Insurance Business Management Center after review.

Reimbursement procedures for hospitalization

1. Information provided by myself 1. Copy of household register (or ID card); 2. Rural Cooperative Medical Cooperative Copy (that is, personal medical record); 3. Hospitalization Diagnosis certificate; 4. Discharge summary; 5. List of hospitalization expenses; 6. Hospital invoice.

2. Go to the Rural Cooperative Cooperative Cooperative Office window for reimbursement

3. If the mother and baby are bundled to participate, a copy of the parents’ ID cards and a copy of the baby’s birth certificate are required.

"New Rural Cooperative Medical Care" Outpatient Coordination Reimbursement Procedure

1. Materials provided by myself 1. Rural Cooperative Medical Care Copy (that is, personal medical record); 2. Second-generation personal ID card; 3. , outpatient invoice.

2. Go to the Rural Cooperative Cooperative Office window to handle reimbursement procedures.