2. Residents' medical insurance for serious illness: if the amount borne by individuals exceeds 1. 1.000 after hospitalization reimbursement, they can also be reimbursed for serious illness for the second time.
Rural clinics:
Reimbursement for medical treatment in village clinics and village center clinics is 60%, and the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan;
40% reimbursement for medical treatment in the town health center, the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drugs is 100 yuan;
Second-level hospitals will be reimbursed 30% for medical treatment, with each examination fee and operation fee limited to 50 yuan and prescription drug fee limited to 200 yuan;
Third-level hospitals will be reimbursed 20% for medical treatment. The examination fee and operation fee for each visit are limited to 50 yuan, and the prescription drug fee is limited to 200 yuan;
Chinese medicine invoice with prescription, each paste limit 1 yuan; The annual limit of outpatient compensation for town-level cooperative medical care is 5000 yuan [2].
The scope of reimbursement for hospitalization in rural areas:
Medical expenses: auxiliary examination: the examination expenses of electrocardiogram, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and MRI are limited to 200 yuan;
Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
serious illness
All inpatients who participate in cooperative medical care, whose medical expenses exceed 5,000 yuan at one time or cumulatively throughout the year, should be compensated by stages, that is, 500 1- 10000 yuan is 65%, and1-18000 yuan is 70%.
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.
exonerate
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 provisions of public medical care, and medical expenses that do not conform to family planning; Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, escort fee, nutrition fee, blood transfusion fee (except for family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ; Within the scope of reimbursement, beyond the limit.
Legal basis:
Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers
Article 43 Labor and social security, health administration, drug supervision and administration departments and social insurance agencies shall determine the designated medical institutions and pharmacies according to the Measures for the Administration of Designated Medical Institutions and Designated Drugstores, and in accordance with the principle of paying equal attention to Chinese and Western medicine, giving consideration to community, specialist and comprehensive medical institutions, and facilitating the insured to seek medical treatment, and announce them to the insured.
Article 44 With a personal account, patients can seek medical treatment and purchase medicines at any designated medical institution or pharmacy.
According to the provisions of the medical expenses paid by the overall fund, patients should go to designated medical institutions for medical treatment.
Forty-fifth medical expenses paid by the overall fund can be implemented in advance according to the principle of total control.
Social insurance agencies can regulate the number of prepaid pooling funds according to the quantity and quality of medical services provided by designated medical institutions and the protection of the legitimate medical rights and interests of the insured.