1, 60% for treatment in village clinics and village center clinics, 40% for treatment in town health centers, 30% for treatment in secondary hospitals and 20% for treatment in tertiary hospitals. Traditional Chinese medicine invoice with prescription, the limit is 1 yuan. The annual compensation limit for rural cooperative medical clinics is 5000 yuan.
2. Proportion of reimbursement for hospitalization compensation: 60% for reimbursement in town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Serious illness compensation town risk fund compensation: All inpatients who participate in cooperative medical care 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%,1001-.
Medical insurance reimbursement materials:
1, ID card;
2. Social security card;
3. Leave invoices for hospitalization expenses;
4, the original hospitalization expenses summary list;
5. The first page of medical records;
6. Discharge summary;
7. Cost summary table;
8. Expense receipt;
9, door (emergency) medical records and inspection reports (emergency);
10, pathological examination report;
1 1, operation record;
12, long-term and temporary orders;
13, other required information.
Not covered by medical insurance reimbursement:
1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;
2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;
5, within the scope of reimbursement, beyond the limit.
To sum up, the reimbursement rate of the new rural cooperative medical system is 20% to 60% of the expenses. Residents can apply for reimbursement with outpatient invoices, diagnosis certificates and expense lists from designated hospitals. Serious illness medical insurance, more than 50 thousand, the new rural cooperative medical system reimbursement 40%.
Legal basis:
Article 26 of People's Republic of China (PRC) Social Insurance Law
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. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.