The "new rural cooperative medical system", the full name of the new rural cooperative medical system, refers to the medical mutual aid and economic assistance system for farmers organized, guided and supported by the government, in which farmers voluntarily participate and individuals, collectives and the government jointly raise funds. The serious illness insurance of the new rural cooperative medical system (NCMS) is a policy to further compensate the high medical expenses of seriously ill patients on the basis of basic medical security.
* * NCMS critical illness insurance policy
It is understood that the scope of medical reimbursement for residents participating in the new rural cooperative medical system in Hunan Province has been clarified.
A few days ago, the leading group for the coordination of new rural cooperative medical care in Hunan Province issued a clear opinion: under normal circumstances, the first-level and below medical institutions (generally township hospitals) are not less than 75%, and the second-level medical institutions are not less than 60%; No less than 45% of tertiary medical institutions. According to the latest policy, the Provincial Health Department publicly promised to implement nine measures to benefit the people, including comprehensively promoting the new rural cooperative medical system for 32 diseases and major diseases. The policy stipulates that the reimbursement rate is over 80%, which is a powerful measure to expand the reimbursement scope of Hunan new rural cooperative medical system and improve the reimbursement rate of Hunan new rural cooperative medical system. Specifically, comprehensively promote the new rural cooperative medical system for 32 major diseases such as childhood leukemia, and the policy stipulates that the reimbursement rate is over 80%. What is the reimbursement ratio of Hunan new rural cooperative medical system? It is understood that the deductible line for hospitalization expenses compensation: in general, township hospitals do not exceed 100 yuan, county hospitals do not exceed 300 yuan, municipal hospitals do not exceed 500 yuan, and provincial hospitals do not exceed 700 yuan. Top line: According to the accumulated annual hospitalization compensation of the new rural cooperative medical system, it is not less than 30,000 yuan in principle.
Reimbursement scope of new rural cooperative medical system
(1) The medical expenses incurred by participating farmers in outpatient service and hospitalization in designated medical institutions in the local area and approved hospitalization in medical institutions outside the local area, except for the items that are not compensated or compensated at a limited price as determined in the Compensation Provisions for New Rural Cooperative Medical Care Projects in Hebei Province, shall be implemented according to the Medical Service Project Specification and Service Price in Hebei Province (for Trial Implementation) and reimbursed according to the standards stipulated in the New Rural Cooperative Medical Care System in Taocheng District.
(two) the following items are not included in the scope of reimbursement of the new rural cooperative medical system.
1, service item
(1) Registration fee (including special outpatient service and specialist outpatient service registration fee), outpatient service and inpatient medical record fee;
(2) Visiting fees, self-invited consultation fees, external expert operation fees, roll call operation fees, examination, treatment, operation acceleration fees, special medical service fees, escort fees, packed bed fees, nursing fees, high-priced bed fees (exceeding the minimum bed fees), and family bed fees;
(3) Transportation expenses for medical treatment and referral and ambulance expenses;
(4) Food (nutrition) expenses, daily necessities expenses, washing expenses, decocting expenses, heating expenses, air conditioning expenses, TV expenses, telephone expenses, etc. ;
(5) Blood transfusion fee (including whole blood, blood components and blood products);
(6) medical projects (including new projects, new technologies, new instruments, new materials, etc.). ) beyond the scope of "Hebei Province medical service project specification and service price (Trial)";
(7) medical institutions to carry out diagnosis and treatment projects without the approval of the price and health departments.
2. Non-disease diagnosis and treatment projects
(1) all kinds of fitness, beauty, hairdressing, bodybuilding, weight loss, weight gain, etc.
(2) non-functional cosmetic surgery and orthopedic surgery;
(3) Dental inlay (including dental implantation), tooth cleaning, tooth deformity correction and its complications.
(4) Assemble artificial eyes, wigs, artificial limbs, etc.
(5) Optometry glasses (including contact lenses), etc.
3, preventive health care projects
(1) Expenses for diagnosis and treatment of vaccination, preventive medication, preventive injection, screening and treatment of general diseases and their complications;
(2) Medical expenses for maternal and child health care and its complications;
(3) Premarital examination and diagnosis of hereditary diseases of pregnancy;
(4) Health massage, pedicure, hydrotherapy, physiotherapy, dietotherapy, qigong medical treatment, etc. ;
(five) all kinds of health examination (including going abroad, leaving the country) and medical consultation (including health consultation and psychological consultation) carried out by using the new rural cooperative medical system as a whole fund for serious illness;
(6) Various disease prevention and control projects supported by special funds, such as tuberculosis prevention, AIDS prevention, schistosomiasis prevention, endemic disease prevention, etc. ;
(7) the national free treatment of diseases, as well as the fee reduction and exemption of treatment projects.
4, medical care, rehabilitation equipment and supplies
Various massage, magnetic therapy, examination, laboratory test and treatment instruments and supplies for personal health care and rehabilitation, including hearing AIDS, orthoses, tractors, crutches, wheelchairs, massagers, magnetic therapy supplies, back protectors, waist protectors, bowl protectors, knee protectors, sphygmomanometer, blood sugar detectors, etc.
* * Reimbursement scope of serious illness insurance
5, treatment project
(1) The organ source or tissue source of various organ or tissue transplants;
(2) vision correction and rehabilitation. ;
(3) Music therapy (except mental patients), health nutrition therapy, magnetic therapy and other auxiliary treatment projects;
(4) Sexual dysfunction, diagnosis and treatment of male and female infertility, non-pathological termination of pregnancy, non-pathological caesarean section, etc.
(5) the cost of diagnosis and treatment of family planning and its complications and sequelae.
6. No compensation.
(1) Work-related injuries, fights, traffic accidents, criminal accidents, alcoholism, drug abuse, taking poison, quitting smoking, detoxification, self-injury, self-mutilation, suicide and medical accidents.
(2) Unplanned family planning (including natural delivery and pathological delivery).
(3) Medical expenses incurred in going abroad and going to Hong Kong, Macao and Taiwan.
(4) all kinds of medical technical appraisal, judicial appraisal, industrial injury and disability appraisal, family planning disabled children appraisal, etc.
(5) All expenses incurred from the second day of the discharge notice for patients who refuse to leave the hospital because of not following the doctor's advice.
(6) Expenses incurred in the hospital.
Reimbursement ratio of rural cooperative medical insurance
The serious illness insurance of the new rural cooperative medical system is an institutional arrangement to further guarantee the high medical expenses of the seriously ill people on the basis of the basic medical security of the new rural cooperative medical system. Its basic principle is to introduce commercial insurance institutions to undertake serious illness insurance, and give full play to the synergistic effect of the basic medical insurance and serious illness insurance of the new rural cooperative medical system. Serious illness insurance shall be co-ordinated at the city and state levels, with unified fund management, unified security policies and unified organization and implementation.
Urban Case 1: How much is the reimbursement for major diseases of rural cooperative medical care in Shijiazhuang?
After the participating farmers suffered from serious illness and incurred high medical expenses, they were compensated by the new rural cooperative medical system according to regulations, and the annual cumulative burden of compliance medical expenses exceeded 13000 yuan, which was included in the compensation scope of the new rural cooperative medical system serious illness insurance according to certain standards. The following items are not included in the scope of compensation for serious illness insurance of the new rural cooperative medical system:
(a) drug purchase and outpatient expenses in pharmacies (except for end-stage renal disease);
(2) Being hospitalized in a non-designated medical institution without the approval of the county-level new rural cooperative medical management center where the household registration is located;
(3) Work-related injuries, fights, traffic accidents, medical accidents, criminal offences, self-injury, self-mutilation, suicide, drug abuse, alcoholism, smoking cessation and drug rehabilitation, etc. ;
(4) The organ source and tissue source of various organ and tissue transplants;
(five) exceeding the price of medical services stipulated by the provincial price department;
(six) large-scale examination, diagnosis and treatment without the permission and access of the administrative department of health;
(seven) beauty, bodybuilding projects and non-functional cosmetic surgery, orthopedic surgery and other non-disease treatment projects;
(eight) artificial organs and internal materials, beyond the "Hebei Province, the new rural cooperative medical compensation and reimbursement project regulations" limited price;
(nine) drugs that are beyond the scope of medical chemicals in the new rural cooperative medical system in Hebei Province and the People's Republic of China (PRC) Pharmacopoeia;
(ten) due to irresistible natural factors, the expenses of urgent, dangerous and serious patients.
City Case 2: How much is the reimbursement for major diseases of rural cooperative medical care in Henan Province?
1. deductible line, compensation ratio and capping line. The critical illness insurance deductible line is 10000 yuan, and the part of 10000 yuan (including 50000 yuan) is compensated by 50%, the part of 50000 yuan and 65438+ ten thousand yuan (including 65438+ ten thousand yuan) is compensated by 55%, and the part above 65438+ ten thousand yuan is compensated by 65%. The compensation cap line of that year was 300,000 yuan. For the participating patients hospitalized outside the province, 60% of their out-of-pocket expenses are regarded as compliance out-of-pocket expenses, which are included in the compensation scope of serious illness insurance after compensation by the new rural cooperative medical system. During the year, the participating patients (including hospitalized patients for many times) only pay the deductible line of NCMS serious illness insurance once. The compliant out-of-pocket medical expenses above the deductible line only participate in the compensation of serious illness insurance once, and the remaining expenses do not participate in the compensation calculation repeatedly.
2. Insurance year. The major illness insurance of the new rural cooperative medical system is the same as that of the new rural cooperative medical system, from 10 in October to 1 in February. If the annual single hospitalization and compliance self-paid medical expenses exceed the deductible line, it shall be implemented according to the annual serious illness insurance compensation policy.
Start time. The serious illness insurance of the new rural cooperative medical system (NCMS) will be fully launched on 20 18 10 1. The out-of-pocket medical expenses incurred during the period from 20 18 1 to September 30 shall be included in the compensation scope of the new rural cooperative medical system according to the regulations, and hospitalized patients may go through the compensation procedures at the service outlets of commercial insurance institutions in the participating places. In 20 18, Zhengzhou, Xinxiang and Luoyang continued to implement municipal overall planning, and all of them were included in the provincial overall planning scope before 20 18.
The above is the knowledge about the reimbursement scope of NCMS serious illness insurance. I hope it helps you. If you have any questions, you can contact a lawyer to answer them.