The reimbursement scope of Jiangsu new rural cooperative medical system includes treatment fee, medicine fee, examination fee, laboratory fee, operation fee and hospitalization fee. Insured people only need to be hospitalized in designated hospitals in Jiangsu, and then submit materials to relevant departments to get reimbursement for the new rural cooperative medical system.

First, outpatient compensation

1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.

2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan.

3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan.

6, the township cooperative medical outpatient compensation limit is 5000 yuan.

Second, hospitalization reimbursement

60% reimbursement for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

Third, the proportion of reimbursement for serious illness compensation

1, compensation from town risk fund: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or within one year, that is, 500 1- 10000 yuan is 65%,10001-/kloc-.

2. The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is1.654.38+0.000 million yuan.

Fourth, the scope of hospitalization reimbursement

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 Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

Reimbursement scope of Jiangsu new rural cooperative medical insurance

1. Bed fee: the highest in township hospitals 1 1 yuan/day, and the highest in hospitals above the municipal level 15 yuan/day.

2. Drug expenses: The Catalogue of Essential Drugs for New Rural Cooperative Medical System in Jiangsu Province shall be implemented, and drugs outside the catalogue shall not be reimbursed.

3. Inspection fee: maximum 600 yuan.

4. Treatment expenses: According to the actual calculation in 300 yuan, 50% of the part above 300 yuan is included in the reimbursement scope.

5. Operating expenses: calculated according to the charging standard approved by the price department.

6. Blood transfusion expenses: The blood transfusion expenses (limited to 500 yuan) incurred in the rescue of critical illness or operation are included in the reimbursement scope, and other blood transfusion expenses are not reimbursed.

7. Material cost: up to 2000 yuan. (Items that are not reimbursed according to the provisions of medical insurance for urban workers are not included in the scope of reimbursement)

Provisions on referral of new rural cooperative medical insurance in Jiangsu Province

1, if transferred to a municipal hospital for hospitalization, 90% will be included in the reportable medical expenses;

2, to the hospital outside the city, according to 80% included in the reportable medical expenses;

3, hospitalized in military hospitals and for-profit hospitals, according to 60% of the reportable medical expenses;

4, no transfer certificate according to 60% included in the reportable medical expenses.

legal ground

People's Republic of China (PRC) social insurance law

Article 2 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 in case of old age, illness, industrial injury, unemployment and maternity.

Seventeenth individuals who participate in the basic old-age insurance, due to illness or non-work-related death, their survivors can receive funeral grants and pensions; Persons who have completely lost their ability to work due to illness or non-work-related disability before reaching the statutory retirement age can receive disability allowance. The required funds are paid from the basic old-age insurance fund.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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.