1. outpatient compensation: 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 doctors in health centers is 50 yuan. 40% reimbursement for medical treatment in the town health center, the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drugs is 100 yuan;
2. Hospitalization compensation: the scope of reimbursement includes medical expenses, auxiliary examinations, electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, magnetic resonance imaging and other examination expenses. Operation expenses refer to national standards, and those exceeding 1 1,000 yuan will be reimbursed 1 1,000 yuan;
3. Compensation for serious illness: If the medical expenses of hospitalized patients who participate in the cooperative medical system exceed 5,000 yuan at one time or in the whole year, they should be compensated by stages, that is, 500 1- 10000 yuan is 65%, and 1000 18000 yuan is 70%.
Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC).
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.