People's governments of towns, relevant departments of the municipal government, and administrative committees of development zones and new districts:
"Gaocheng 20 12 New Rural Cooperative Medical Scheme" has been approved by the municipal government and is hereby printed and distributed to you, please implement it carefully.
20 12 years 1 month 12 days
Gaocheng New Rural Cooperative Medical Scheme 20 12
According to "Hebei Province 20 12 New Rural Cooperative Medical System Compensation Scheme Basic Framework" and "Shijiazhuang City 20 12 New Rural Cooperative Medical System Compensation Scheme Basic Framework", combined with the actual situation, the compensation scheme of 20 12 New Rural Cooperative Medical System in our city is formulated.
First, the basic model
1. outpatient compensation: including general outpatient service, large outpatient service for special diseases and outpatient service for major diseases;
2. Hospitalization compensation: including general hospitalization, medical treatment for major diseases, maternity allowance for normal delivery and large medical expenses compensation for hospitalization.
Second, raise funds.
Individual farmers pay 50 yuan per person every year, and the central and local governments give subsidies to participating farmers according to 240 yuan per person every year. The financing standard is 290 yuan per farmer per year.
Three. allocation of funds
(1) outpatient fund
1, outpatient co-ordination fund: according to each participating farmer 40 yuan;
2. Large-sum outpatient fund for special diseases: included according to the 8 yuan of each participating farmer.
(two) the hospitalization fund
The overall hospitalization fund was established after deducting outpatient fund, general medical expenses and risk fund from the total amount raised in that year. The hospitalization fund is used to compensate farmers for general hospitalization, major diseases, normal delivery and large medical expenses.
(3) risk fund
According to the requirements of the salary framework of provincial offices, some funds were extracted from the raised funds to supplement them, and the scale of risk funds reached 10% of the total funds in that year.
(4) General medical expenses
General medical expenses are used for general outpatient compensation for township and village outpatient co-ordination and * * zero-difference sales. The extraction standard of general medical expenses is per farmer per year 16 yuan.
Fourth, compensation for medical expenses.
Compensation shall be made in accordance with the Catalogue of Drugs Reimbursed by the New Rural Cooperative Medical System in Hebei Province and the Compensation Provisions for Medical Treatment Projects of the New Rural Cooperative Medical System in Hebei Province (for Trial Implementation). Improve the level of protection for major diseases and diseases within the scope of fixed payment for single diseases.
Outpatient compensation
1, general outpatient fee compensation
(1) compensation range. (1) * * fee (limited to * * 20101in the corresponding level catalogue of villages and towns in Hebei Province); ② Material cost (disposable infusion set, syringe); (3) Medical technical inspection fees (B-ultrasound, electrocardiogram, X-ray and laboratory tests are limited to township-level designated medical institutions); ④ Treatment expenses (debridement and suture, dressing change, acupuncture, cupping, massage and scraping).
(2) Compensation standard. ① Compensation ratio: 45% of the medical expenses incurred by participating farmers in designated medical institutions at village level and 40% in designated medical institutions at township level. ② capping line: the daily compensation capping line of village-level designated medical institutions is 15 yuan, and that of township-level designated medical institutions is 20 yuan. The annual cumulative capping line of individual compensation is 200 yuan, which cannot be used by family members. (3) Participating farmers who hold cooperative medical cards can see a doctor at designated medical institutions in townships and villages.
(3) compensation method. (1) The medical expenses and examination expenses incurred in the outpatient service of the participating patients shall be directly compensated by the designated medical institutions according to the compensation standard, and the compensation voucher (expense receipt) shall be printed by the designated medical institutions and signed by the patients. ② Each designated medical institution shall submit the outpatient prescription, outpatient compensation voucher (expense receipt) and compensation summary table to the township joint management station for review at the specified time every month, and the township joint management station shall report it to Gaocheng joint management center for review at the specified time every month. After the audit, the compensation shall be paid in time according to the audited amount. The reimbursement of common diseases in outpatient department should be settled in real time, and the participating farmers shall not participate in the reimbursement after accumulation.
2. Large outpatient compensation for special diseases
Reply 1 Lou 20 12-03-28 09:52 Report | I also say a word.
Estuary110.228.139. * End-stage renal disease, malignant tumor radiotherapy and chemotherapy, leukemia, hemophilia and severe mental illness are compensated according to the compensation method for inpatients.
The diseases with large outpatient expenses for special diseases include: various heart diseases complicated with chronic heart failure, high risk of hypertension in the third stage and above, sequelae of cerebrovascular disease (with severe neurological, mental and limb dysfunction), chronic moderate and severe viral hepatitis (decompensated liver function), liver cirrhosis (decompensated liver function), diabetes (complicated with serious complications), end-stage renal disease, malignant tumor radiotherapy and chemotherapy, leukemia, hemophilia, aplastic anemia, rheumatoid arthritis (RA).
There is no deductible line for large-scale outpatient compensation for special diseases, and the reimbursement ratio is 60%, with an annual cap line of 2,000 yuan; The top line of using anti-rejection immunomodulators in aplastic anemia and organ transplantation is 30 thousand yuan; There are special provisions in accordance with the relevant documents.
Large outpatient compensation for special diseases is limited to designated medical institutions at Gaocheng city and township levels.
(2) Hospitalization compensation
1, general hospitalization (see table below)
Compensation Scheme for Hospitalization of New Rural Cooperative Medical System in Gaocheng City 20 12
Designated medical institution level
Deductible line (yuan)
Salary ratio (%)
Other township, county, city and provincial non-profit organizations.
100 300 800 1500 3500
85 78 68 55 50
(1) * * National list of essential drugs (equipped and used by primary medical and health institutions) and the list of non-essential drugs included in the management of essential drugs in Hebei Province, and Chinese patent medicines, Chinese herbal pieces, Chinese medicine diagnosis and treatment items, Chinese medicine preparations, etc. included in the reimbursement list of the new rural cooperative medical system. The proportion of hospitalization compensation increased by 5 percentage points.
(2) If the newborn is not within the payment time limit at birth, and its participating parents enjoy the treatment of the new rural cooperative medical system, the compensation expenses incurred shall be calculated with their parents. Newborns are exempt from the participation fee of the year, and the number of participants in the year is not counted, and the financial departments at all levels do not recover the subsidy funds.
(3) If the same farmer is hospitalized again in the same year, the deductible will be deducted again (except for patients with end-stage renal disease and malignant tumor who need to be hospitalized many times due to radiotherapy and chemotherapy).
(4) If the participating farmers are transferred from higher medical institutions to lower medical institutions for continuous hospitalization due to the same disease, the hospitalization deductible line of lower medical institutions shall not be deducted when calculating the hospitalization compensation expenses of lower medical institutions; If the hospitalization from a lower-level medical institution is transferred to a higher-level medical institution for continuous hospitalization, the deductible expenses of the lower-level medical institution shall be deducted from the deductible of the higher-level medical institution when calculating the hospitalization compensation expenses.
(5) Participating farmers can choose designated medical institutions in the county independently. In the designated medical institutions outside the county, the filing system is implemented. Within 3 days after hospitalization, you need to go through the filing formalities at Gaocheng New Rural Cooperative Medical Management Center, and bring relevant materials to the joint management center for reimbursement within 10 days after discharge.
(6) In any of the following circumstances, the new rural cooperative medical system shall compensate according to the compensation scheme of the actual payment part of the participating farmers:
The medical services received are subsidized by the special fund;
(2) The medical services received are reduced or exempted by medical institutions.
(7) The participating farmers are hospitalized in the administrative area of Shijiazhuang City, and the designated medical institutions that implement the "one card" management shall be based on the List of Designated Medical Institutions of New Rural Cooperative Medical System in Shijiazhuang City (20 1 1 version); Hospitalization outside the administrative area of Shijiazhuang City, government-run general hospitals at or above the second level can be reported, and the deductible and compensation ratio are implemented with reference to "other non-profit" medical institutions in the table.
2. Compensation for major diseases
Six major diseases, such as childhood leukemia and congenital heart disease, as well as major disease relief and protection diseases expanded by the state, shall be organized and implemented in accordance with the compensation scheme formulated by the provincial and municipal health administrative departments.
3, normal delivery hospital delivery allowance
Planned hospitalization for normal delivery, on the basis of the national hospital delivery subsidy project compensation, the new rural cooperative medical system will give subsidies according to the highest 200 yuan standard in each case.
(3) Top line
The top line is 80,000 yuan per year for each participating farmer, regardless of the level of medical institutions. The annual cumulative calculation (including hospitalization compensation, hospitalization childbirth subsidy, large outpatient compensation for special diseases and secondary compensation for hospitalization), hospitalization expenses for major diseases and large medical expenses for hospitalization are calculated separately.
(four) large medical expenses compensation for hospitalization
The compensation for large medical expenses for hospitalization is used to compensate according to a certain proportion after the hospitalization expenses reach a certain amount, mainly to reduce the burden of large medical expenses for participating farmers. Specific measures and plans shall be formulated separately.
(5) Secondary compensation
In order to make full and effective use of the cooperative medical care fund and ensure that the participating farmers benefit to the maximum extent, if the balance of the overall fund (including risk funds, the same below) in that year exceeds 15% or the accumulated balance of the overall fund over the years exceeds 25%, the second compensation will be made according to the balance.