The new rural cooperative medical system in the province opened the medical insurance filing procedures in different places in the medical insurance bureau where the household registration is located. The registered hospital is Zhengzhou Hospital, and then you can take the medical insurance card to the medical insurance window of Zhengzhou Hospital or the hospital medical insurance office to activate it. The reimbursement rate of hospitalization expenses for users of the new rural cooperative medical system is 60%.
1. There are two kinds of hospitalization outside the county: one is living or working outside the county. If hospitalization requires reimbursement of the new rural cooperative medical system, it is necessary to get in touch with the county new rural cooperative medical system management department within 3 days after hospitalization and register for the record. In addition to hospitalization procedures, you need to provide proof of residence or work after discharge to be reimbursed;
2, from the county directly to the field to see a doctor, need to be hospitalized by the county medical institutions issued a referral certificate, with residence booklet, ID card, cooperative medical card to the county new rural cooperative medical system referral window for referral examination and approval procedures, and then to the selected hospital.
3. If you don't go directly to a foreign hospital in this county for treatment, you need to submit the hospital's diagnosis certificate (hospitalization certificate), household registration book (ID card) and cooperative medical certificate to the referral window of the new rural cooperative medical system in this county for approval within 3 days after hospitalization, so as to be reimbursed after discharge. Not according to the provisions of the referral or registration procedures, the new rural cooperative medical system will not be reimbursed.
4. The General Office of Henan Provincial Government recently issued the Implementation Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents. According to the requirements, Henan Province will promote the integration of urban residents' medical insurance and the new rural cooperative medical system in the whole province, and merge the management functions of the new rural cooperative medical system undertaken by the health and family planning department and the medical insurance management functions of urban residents undertaken by the human and social departments, which will be managed by the human and social departments.
5. After the implementation of the new policy, Henan Province will unify the minimum payment standard, reimbursement ratio and maximum payment limit of medical insurance for urban and rural residents. Within the scope of the policy, the proportion of hospitalization expenses is kept at about 75%, and the level of outpatient service security is gradually improved. The catalogue of medical insurance drugs and medical services for urban and rural residents will also be unified. After the integration, the actual per capita financing and individual contributions of urban and rural residents' medical insurance are not lower than the existing level.
When Zhengzhou is discharged from hospital, as long as you have the referral certificate, discharge certificate, new rural cooperative medical system certificate, medical bill invoice, ID card (or household registration book), you can get medical subsidy directly in the hospital. Qifubiaozhun for hospitalization of insured residents in 20021year: township 150 yuan (reimbursement rate is 70%~90% of reasonable expenses), county-level 400 yuan (reimbursement rate is 65%~85% of reasonable expenses), and city-level 600 yuan (reimbursement rate is 65%~75% of reasonable expenses). Municipal level III hospital 1200 yuan (reimbursement rate is 55%~75% of reasonable expenses), provincial level II and below hospital 600 yuan (reimbursement rate is 53%~72% of reasonable expenses), provincial level III hospital 2000 yuan (reimbursement rate is 50%~68% of reasonable expenses), and medical institutions outside the province 2000 yuan (reimbursement rate).
Detailed explanation of medical insurance reimbursement standards for urban and rural residents;
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 is 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.
40% reimbursement for medical treatment in the town health center, with the limit of examination fee and operation fee for each visit, and the limit of prescription drug fee 100 yuan.
The reimbursement for medical treatment in secondary hospitals is 30%, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
Third-level hospitals will be reimbursed 20%, with the examination fee and operation fee for each visit limited to 50 yuan and prescription drug fee limited to 200 yuan.
Chinese medicine invoice with prescription, limit 1 yuan. The annual compensation limit for rural cooperative medical clinics is 5000 yuan.
2, hospitalization compensation
Reimbursement scope:
First, the cost of drugs; Auxiliary examination: fees for ECG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic resonance, etc. Average 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 the town health center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
3. Compensation for serious illness
Compensation from town risk fund: if the medical expenses of inpatients participating in cooperative medical care exceed 5,000 yuan at one time or for the whole year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan is 65%, and10001-8000 yuan is 75%.
The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.
The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis for severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental retardation; Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery. Other special diseases that can be reimbursed shall be subject to local specific policies.
Specific outpatient treatment of special diseases includes necessary supportive treatment and symptomatic treatment of systemic and local reactions during treatment, while general adjuvant treatment is not included in the scope of reimbursement.
To sum up, the new rural cooperative medical system is mainly aimed at rural people; Patients will be reimbursed when they are hospitalized, and the scope of reimbursement is also specially stipulated in China, in order to better alleviate the economic pressure of patients. Therefore, you must consult clearly when reimbursing and protect your legitimate interests.
The new rural cooperative medical system in the province opened the medical insurance filing procedures in different places in the medical insurance bureau where the household registration is located. The registered hospital is Zhengzhou Hospital, and then you can take the medical insurance card to the medical insurance window of Zhengzhou Hospital or the hospital medical insurance office to activate it. The reimbursement rate of hospitalization expenses for users of the new rural cooperative medical system is 60%.
Where can I reimburse the illness I saw in Zhengzhou?
Can Zhengzhou big cities report the scope of rural medical insurance reimbursement?
The scope of reimbursement for rural medical insurance can be reimbursed in big cities in Zhengzhou.
Proportion of reimbursement for rural medical insurance:
1. Village clinics and village center clinics are reimbursed 60%, 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;
2. Reimbursement for hospitalization is 40%, and the examination fee and operation fee for each visit are limited to 50 yuan, and the prescription fee is limited to 100 yuan;
3. 30% reimbursement for medical treatment in secondary hospitals, with the limit of 50 yuan for examination fee and operation fee per visit and 200 yuan for prescription fee;
4. 20% reimbursement for medical treatment in tertiary hospitals, with the limit of 50 yuan for examination fee and operation fee per visit and 200 yuan for prescription fee;
5. Chinese medicine invoice with prescription, the limit is 1 yuan;
6. The annual compensation limit for rural cooperative medical clinics is 5,000 yuan; The proportion of reimbursement for hospitalization in rural medical insurance is 60% in town hospitals; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;
Reimbursement scope of rural medical insurance in Zhengzhou:
1. rural medical insurance outpatient reimbursement in village clinics, village center clinics, town health centers, secondary hospitals, tertiary hospitals, traditional Chinese medicine, town-level cooperative medical care and other medical institutions can be reimbursed according to a certain proportion.
2. The scope of reimbursement for hospitalization in rural medical insurance includes auxiliary examination expenses such as medicine expenses, electrocardiogram, X-ray fluoroscopy, filming and operation expenses.
3. The reimbursement scope of serious illness in rural medical insurance covers childhood leukemia, congenital heart disease in children, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, multidrug-resistant tuberculosis, AIDS opportunistic infection, lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction, cerebral infarction, hemophilia, type 2 diabetes, hyperthyroidism, cleft lip and palate, BH4 deficiency, etc.
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 to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.
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.
No, medical insurance reimbursement needs to be handled at the place of payment.
Reimbursement process of new rural cooperative medical system;
Information required for reimbursement:
1. Outpatient reimbursement information: outpatient invoice, cooperative medical certificate calendar (or medical record).
2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate (or medical record) calendar, detailed list of expenses, discharge summary and other relevant certificates.
3. Special disease outpatient reimbursement: invoices and calendars for special disease cooperative medical certificate outpatient service.
4. Information for handling special diseases: outpatient treatment proposal for special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and photos.
Reimbursement process:
1. The insured households prepare the required materials for reimbursement and submit them to the village (community) cooperative medical liaison, which will report them to the town cooperative medical liaison after review, and the town cooperative medical liaison will send them to the district agricultural medical office for reimbursement. Guide to reimbursement of new rural cooperative medical care.
2. Direct reimbursement by the hospital: When going through hospitalization procedures due to illness, you will issue a certificate of the new rural cooperative medical system to the hospital and directly participate in reimbursement.
Reimbursement can only be made at the place of payment, not in different places.
However, if the patient is referred to another place for treatment, the treatment fee can be reimbursed at the place of payment.