In life, farmers have been facing the problem of difficult and expensive medical treatment. In order to better help farmers solve this problem and reduce the economic pressure brought by farmers' illness, the state has also introduced a new rural cooperative medical system policy.

First, the new rural cooperative medical insurance reimbursement ratio

For the reimbursement of major diseases of the new rural cooperative medical system, the reimbursement ratio will be different according to different hospital grades. Except for the medical expenses exceeding the maximum payment limit of the basic medical pooling fund, the reimbursement ratio will be different according to the different scope of medical expenses. General medical expenses below 0-40 thousand yuan can be reimbursed 85%; Medical expenses below 40,000-80,000 yuan can be reimbursed by 90%; Medical expenses above 80,000 yuan can be reimbursed by 95%, and the maximum payment limit for each medical year is 6.5438+0.5 million yuan. Among them, the reimbursement ratio in different medical institutions is:

1, the proportion of overall subsidies for township and village clinics increased to 65% and 75% respectively.

2. The cost of hospitalization in a first-class medical institution is below 400 yuan, and there is no deductible standard. The subsidy ratio of secondary medical institutions will be increased to 75%-80%; The proportion of hospitalization expenses subsidies in tertiary hospitals can be increased to 55%-60%; The proportion of hospitalization expenses paid by provincial tertiary medical institutions has increased to 55%.

3. There are 8 serious diseases in children, such as congenital heart disease, leukemia and phenylketonuria, and the proportion of subsidized diseases in the new rural cooperative medical system is 70%; Lung cancer, esophageal cancer, cervical cancer and other serious diseases 12 years, the proportion of subsidized diseases of the new rural cooperative medical system will reach 70%.

Second, the new rural cooperative medical reimbursement time to account

At the end of the first year, the new rural cooperative fund-raising will take effect in the second year 1 month 1 day, which means that hospitalization after this date can be reimbursed. If 1 month 1 was hospitalized before, 1 month 1 was discharged in the future, you need to look at your daily list. 1 month 1 future expenses can be reported, but previous expenses cannot be reimbursed.

Third, the new rural cooperative medical reimbursement process

1. Patients who have participated in the new rural cooperative medical system can submit claims directly by swiping their cards at the designated medical institutions of township-level general outpatient clinics in the region with their valid certificates and medical cards, and be hospitalized in the designated medical institutions in the region and outside the region, and can submit claims directly when they are discharged.

2. Insured patients are hospitalized in secondary and above public hospitals outside the city. Within 3 months after discharge, the insured or their families will submit the original medical expense invoice, detailed list of hospitalization expenses, discharge summary, outpatient medical record, medical card, patient ID card, household registration book and agent ID card to the new rural cooperative medical system window of the district administrative service center for reimbursement of medical expenses.

3. Special disease outpatient reimbursement can apply to the new rural cooperative medical management center with the cases, relevant examinations, laboratory tests, medical institutions' certificates and the approval form for outpatient treatment of special diseases of the new rural cooperative medical system issued by the designated medical institutions at or above the second level. After examination and approval, outpatient medical expenses can be included in the scope of reimbursement of the new rural cooperative medical fund, and can be reimbursed annually according to the hospitalization reimbursement standard.

4. After being discharged from hospital due to accidental injury, the hospitalized patients shall submit the confirmation certificate of the cause of accidental injury and the medical records of the hospital with the signature and seal of the village (residence) where the household registration is located. Those who cannot provide valid certificates and records will not be accepted. Once it is investigated and audited by the new rural cooperative medical system, it will be reimbursed once it is true. If the responsibility is the responsibility of a third party, it will not be reimbursed. I hope that the above reimbursement ratio, reimbursement arrival time and reimbursement process of the new rural cooperative medical system will be helpful.

Legal objectivity:

Article 2 of the Social Insurance Law

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

Article 24

The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.