Rural cooperative medical insurance refers to the system of mutual medical assistance and economic assistance for farmers, which is organized, guided and supported by the government, voluntarily participated by farmers and jointly funded by individuals, collectives and the government. Take individual contributions, collective support and government funding to raise funds.
Reimbursement of rural cooperative medical insurance:
1, outpatient compensation:
(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 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: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 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 the 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, serious illness compensation:
(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 throughout the year should 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.
Three levels of new rural medical insurance;
The first layer is rural cooperative insurance. The local agricultural population is 269,000. Districts, towns, villages and individual farmers raise 326 yuan every year. Participating farmers can get 50% ~ 80% compensation for hospitalization in district and town medical institutions, and 40% compensation for outpatient service, of which the maximum capping line for serious illness can reach 200,000 yuan.
The second layer is accident insurance. After solving the disease problem, after consultation with the commercial insurance company, each farmer pays 10 yuan, and the financing and management are undertaken by the rural cooperative. Participating farmers can get a maximum compensation of 60,000 yuan for accidental injuries.
The third level is medical assistance to the poor. There are more than 5000 poor people in Xiangcheng District. There is no threshold for their participation except government compensation. After the medical expenses incurred by individuals, the poverty alleviation fund will bear 90%, and individuals will only pay 10%.