The reimbursement ratio of rural medical insurance in Chongqing is as follows:
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
Medical expenses: ECG, X-ray fluoroscopy, photography, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic resonance and other examination expenses 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 the town health center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan. 60% reimbursement for town hospitals; 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 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.
Content not covered by reimbursement:
(1) Self-seeking medical treatment (no designated hospital or referral form), self-purchasing drugs, drugs that cannot be reimbursed according to the regulations on free medical care, and medical expenses that do not conform to family planning;
(2) Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, escort fee, nutrition fee, blood transfusion fee (except for family blood donors, which shall be reimbursed according to relevant regulations), heating and cooling fee, ambulance fee, special nursing fee, etc.
(three) medical expenses for car accidents, fights, suicides, alcoholism, work-related injuries 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.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.