Measures for the implementation of the new rural cooperative medical system in Tonglu County
Chapter IV Repayment
Fifteenth in line with the provisions of rural cooperative medical care for farmers' outpatient and inpatient medical expenses, the scope of reimbursement shall refer to the relevant provisions of the basic medical insurance for urban workers. Those who meet the requirements of the three catalogues of the relevant provisions of the basic medical insurance for urban employees in our county can be included in the reimbursement scope of the new rural cooperative medical system.
The expenses incurred by participants who meet the provisions of the Interim Measures for the Basic Medical Insurance for Urban Workers in Tonglu County shall be reimbursed according to the proportion of Class A drugs.
Article 16 Provisions on itemized accounting, reimbursement rate and upper limit amount. In 2007, 80 yuan formulated the following per capita funding standards:
1, the reimbursement proportion of medical institutions at all levels shall be calculated by segments.
Total reimbursement ratio of medical expenses in medical institutions at all levels
(yuan) community health service institutions, county-level medical institutions and medical institutions outside the county.
0- 1000 10%00
100 1-200025% 15%5%
200 1-500035%25% 15%
500 1- 1000045%35%25%
1000 1-2000055%45%35%
200065438+65%55%45% 0 yuan.
2. The maximum annual reimbursement amount is 50,000 yuan.
3. The above-mentioned medical expenses are all audited expenses that meet the scope of reimbursement.
Seventeenth establish a strict step-by-step referral system and designated medical system to encourage on-site diagnosis and treatment.
Eighteenth designated medical institutions in the county through the computer network to implement zero-based instant credit card reimbursement management, participants must hold a card for medical treatment. Participants who fail to get a medical card for personal reasons shall be deemed to have waived their rights.
In the special circumstances of medical treatment in designated medical institutions and non-designated medical institutions outside the county, the participating farmers shall apply to the township (street) management institution where the household registration is located. After the preliminary examination by the township (street) management organization, if it belongs to emergency or burn cases, it shall be reported to the county social security office for reimbursement, and other cases shall be reported to the county joint medical office for research and decision.
Nineteenth new rural cooperative medical expenses reimbursement to participate in the annual calculation, when the settlement.