First, the proportion of reimbursement for outpatient service of the new rural cooperative medical system
1. The reimbursement rate of village clinics and health centers is 60%;
2. The reimbursement rate of town hospitals is 40%;
3. The proportion of stroke in secondary hospitals is 30%;
4. The reimbursement rate of tertiary hospitals is 20%;
5. The reimbursement limit for township-level cooperative medical clinics is 5000 yuan/year.
Second, the proportion of reimbursement for hospitalization of the new rural cooperative medical system
1. New EEG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, MRI and other auxiliary examination items were reimbursed to 200 yuan;
2. The operation expenses within the deductible line 1000 yuan shall be reimbursed according to the national standard, and those exceeding 1000 yuan shall be reimbursed according to 1000 yuan;
/kloc-hospitalization expenses and nursing expenses of the elderly over 0/0 can be reimbursed every day, with a limit of 200 yuan;
4. The reimbursement ratio of hospitals at all levels is: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
Third, the proportion of reimbursement for serious illness in the new rural cooperative medical system
1. The proportion of township and village subsidies for outpatient co-ordination increased to 65% and 75% respectively.
2. If the hospitalization expenses of first-class medical institutions are below 400 yuan, there is no deductible;
3. The subsidy ratio of secondary medical institutions will be increased to 75% ~ 80%;
4. Increase the subsidy ratio of tertiary medical institutions to 55%~60%.
5. The subsidy ratio of provincial tertiary medical institutions will be increased to 55%.
6. 70% of the quota for 8 serious diseases such as congenital heart disease in children, and 70% of the quota for 2 serious diseases such as lung cancer/kloc-0.
Four. Procedure:
1. I apply for and actively pay the cooperative medical fund.
2. The village committee shall review and submit the fund-raising roster and fund-raising bills to the town management station.
3. The town joint therapy office reviews the joint therapy funding form and applies for a visa to the county joint therapy center.
4. After verification by the county comprehensive management handling center, the visa, stamp, login and confirmation shall be processed.
Please consult the local authorities for details.
Verb (abbreviation for verb) reimbursement procedure
After the insured is discharged from the hospital, the hospitalization invoice, discharge record, expense list, referral certificate, a copy of my ID card or the household registration certificate signed or sealed by the patient shall be handed over to the township joint management office, and sent to the municipal agricultural insurance business management center after examination.
Matters needing attention about intransitive verbs
The following circumstances are not included in the reimbursement scope of the new rural cooperative medical system:
(a) the outpatient medical expenses of designated hospitals in non-co-ordination areas (except for outpatient treatment expenses for special diseases), and the expenses incurred by failing to seek medical treatment according to regulations and purchasing medicines by themselves;
(two) the cost of family planning measures and medical expenses in violation of the family planning policy;
(three) dental implants, orthodontics, optometry glasses, hearing AIDS, artificial organs, beauty therapy, cosmetic surgery, rehabilitation (such as qigong, massage, physical therapy, magnetic therapy, etc.). ), as well as various accompanying expenses, medical transportation expenses, home visits and other miscellaneous expenses during hospitalization;
(4) If there is a third party's liability, the medical expenses incurred due to personal injury, such as traffic accidents, medical accidents and work-related injuries, shall be borne by the third responsible person according to law.
(five) medical expenses caused by illegal acts such as suicide, self-mutilation, taking poison, taking drugs, fighting and other intentional acts of their families;
(six) medical expenses incurred during going abroad or staying in Hong Kong, Macao and Taiwan;
(seven) drugs and articles that are not reimbursed according to the medical insurance system for urban workers;
(eight) other expenses determined by the District Medical Management Committee.
Seven, rural cooperative medical reimbursement in different places in two cases:
1. The hospital has issued an immediate report. At this time, when the patient is admitted to the hospital, he can show his medical record book, ID card and referral approval form issued by the local agricultural association, and he can directly submit an expense account in the hospital;
2. If the hospital doesn't open an immediate report, the patient needs to go back to the local area for reimbursement.
(1) The patient was hospitalized in the hospital with the referral approval form issued by the Agricultural Association and stamped with the official seal of the hospital;
(2) When the patient is hospitalized, he will be reimbursed in full at his own expense. When he is discharged, he will bring the following information back to the local rural cooperative for reimbursement:
Discharge certificate, diagnosis certificate, invoice, general list of expenses, discharge medical records, etc.
Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law
Article 8 The medical expenses incurred by the insured in the agreed medical institutions shall be paid by the basic medical insurance fund in accordance with the provisions of the state if they meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.
2. What is the reimbursement ratio of Zhengzhou new rural cooperative medical system?
The reimbursement rate of Zhengzhou new rural cooperative medical system is 60%.
The new rural cooperative medical system (hereinafter referred to as the "new rural cooperative medical system") refers to the mutual medical assistance system for farmers, which is organized, guided and supported by the government, voluntarily participated by farmers, and jointly funded by individuals, collectives and the government. It takes the form of individual donations, collective support and government funding to raise funds.
On June 5438+ 10, 2002, China clearly proposed that governments at all levels should actively guide farmers to establish a new rural cooperative medical system with serious illness as the focus. In 2009, China made an important strategic plan to deepen the reform of the medical and health system, and established the position of the new rural cooperative medical system as the basic medical security system in rural areas. 20 15 65438+29 10, the State Health Planning Commission and the Ministry of Finance issued a notice on doing a good job in the new rural cooperative medical system in 20 15, proposing that the per capita subsidy standard of financial departments at all levels should be raised from 20 14 to 60 yuan and reach 380 yuan.
The "new rural cooperative medical system", the full name of the new rural cooperative medical system, refers to the medical mutual aid and economic system for farmers, which is organized, guided and supported by the government, with farmers participating voluntarily and jointly funded by individuals, collectives and the government. The new rural cooperative medical system is a medical security system created by farmers themselves in China, which has played an important role in ensuring farmers' access to basic health services, alleviating poverty caused by illness and returning to poverty due to illness. The reimbursement scope of the new rural cooperative medical system includes outpatient compensation, hospitalization compensation and serious illness compensation.
The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses).
Requirements for filling in reimbursement expenses:
1. The expense manager shall, in principle, go to the finance department for reimbursement procedures within 5 working days after the expense occurs, and special circumstances may be handled separately;
2. Cut off the corners of the original documents and paste them on the left side of the reverse side of the reimbursement form.
3. Fill in the contents of the reimbursement form truthfully with a blue or black pen and signature pen, such as reimbursement time, reimbursement person, expenses, document number, etc.
4. For purchasing business expenses, you must go to the warehouse with valid purchase requisition and invoice to go through the formalities of goods acceptance and warehousing, and attach the receipt form and direct requisition form to the reimbursement document;
5. For non-procurement administrative, office or other expenses, directly fill in the reimbursement documents.
Three, Zhengzhou City, the new rural cooperative medical reimbursement ratio
The reimbursement of the new rural cooperative medical system is carried out in proportion, generally floating around 20-85%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors. For example, it is clear that Class A drugs can enjoy full coverage, Class C drugs need to bear all the costs, and Class B drugs will report 80% and bear 20% of the costs. Description of rural medical insurance reimbursement: 1. Procedures and time limit for reimbursement of outpatient medical expenses: When attending outpatient clinics, participants must go to the designated medical institutions in their towns and villages and take the initiative to show their identity cards and medical cards. After the identity verification of medical institutions, the medical expenses incurred will be reported in real time through online credit cards in accordance with relevant regulations. The time limit for compensation is 65438+1 October1to 65438+February 3 1 every year. If it is overdue, it will be automatically abandoned and will not be carried forward to the next year. Second, the outpatient medical expenses compensation standard: the outpatient medical expenses that meet the compensation scope are compensated by 55%, and each person is capped at 30 yuan every day (the medical expenses of community health service stations are capped at 4 yuan and 26 yuan every day). The cumulative compensation limit per person per year is 450 yuan. Three. Procedures and time limit for reporting hospitalization expenses: When visiting a designated hospital in this city, participants must carry their ID card and the new rural cooperative medical card for hospitalization procedures. When leaving the hospital, the hospital will give a real-time report according to the relevant provisions of compensation. Hospitalization medical expenses incurred in hospitals at or above the first level outside the city, the participants to the new rural cooperative medical card, ID card, referral form, proof of work or visiting relatives and the list of medical expenses issued by the hospital, discharge summary, original medical invoices and other materials to the township finance office for preliminary examination, the city joint management office for examination and report. Time limit for compensation: 65438+ the following year1before October 30th. If the waiver is overdue, it will not be reimbursed. Cross-annual medical expenses are transferred to the next year. Fourth, the compensation standard for hospitalization medical expenses: deductible. Medical expenses that meet the scope of compensation every time, and medical expenses that meet the scope of compensation every time in hospital shall not be compensated if they do not exceed the deductible. Compensation ratio. Medical expenses above the deductible line that meet the scope of compensation. V. Report on medical expenses of special disease outpatient service: There is no deductible for special disease outpatient service compensation. After 80% of the medical expenses that meet the scope of compensation are converted, compensation will be made according to the compensation standard of hospitalization medical expenses in hospitals at the same level. Special disease types: malignant tumor (using anti-tumor drugs and radiotherapy), uremia (hemodialysis and peritoneal dialysis), severe diabetes (using insulin), leukemia, tuberculosis, chronic liver disease, lupus erythematosus, aplastic anemia, follow-up treatment of organ transplantation, hemophilia, myasthenia gravis, motor neuron disease and severe psychosis (using psychotropic drugs).
Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law
Article 8 The medical expenses incurred by the insured in the agreed medical institutions shall be paid by the basic medical insurance fund in accordance with the provisions of the state if they meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.