1. Outpatient compensation: (1) 60% reimbursement for visits to village clinics and village center clinics, with the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers in 50 yuan. (2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan. (3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan. (4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. (5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan. (6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.
2, hospitalization compensation
(1) Reimbursement scope: A. Drug expenses: supplementary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance, etc. 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Compensation for serious illness
(1) town risk fund compensation: all inpatients who participate in the cooperative medical system whose medical expenses exceed 5,000 yuan at one time or for the whole year shall be compensated by stages, that is, 500 1- 10000 yuan is 65%,10001-/. The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.
Reimbursement procedure of new rural cooperative medical system
1. Outpatient reimbursement: Farmers participating in the new rural cooperative medical system are directly reimbursed by designated medical institutions.
2. Hospitalization in the district: When the hospitalized patients are discharged from the hospital, they will immediately submit their reimbursement to the designated hospital with the cooperative medical certificate, ID card or household registration book, discharge certificate and detailed list of hospitalization expenses.
3. Hospitalization expenses outside the district and outside the city: After discharge 15 days, submit the cooperative medical certificate, ID card or household registration book (original and photocopy), copy of the case (stamped with the seal of the hospital), full charge bill, diagnosis certificate and medical expense list to the district new rural cooperative medical management center for review and reimbursement.
4. When participating farmers who participate in commercial insurance are hospitalized, they should go to the new rural cooperative medical management center for examination and approval with cooperative medical certificate, household registration book or ID card, diagnosis certificate, original and photocopy of commercial insurance policy and original and photocopy of hospitalization bill, and the designated medical institutions should go through the exemption procedures when they are hospitalized, and provide them to the commercial department for relevant procedures.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.