Compensation standard for serious illness of new rural cooperative medical system

Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%. Medical expenses: ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic resonance and other inspection expenses. , limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). 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.

Legal analysis

Rural residents who participate in the new rural cooperative medical system in our city and newborns who enjoy the treatment of the new rural cooperative medical system with their participating parents meet one of the following three conditions. Included in the scope of medical assistance for serious illness in rural areas: 1. Children with leukemia (0- 14 years old), children with congenital heart disease (0- 14 years old), end-stage renal disease, breast cancer, cervical cancer, severe mental illness, multidrug-resistant tuberculosis, opportunistic infection of AIDS, lung cancer and esophageal cancer who participated in the first visit or attending visit. For 22 major diseases such as acute myocardial infarction, cerebral infarction, hemophilia, type I diabetes, hyperthyroidism, cleft lip and palate, BH4 deficiency, and critical pregnant women, after reimbursement by the new rural cooperative medical system, the personal expenses in the reimbursement policy of the new rural cooperative medical system accumulated more than 3,000 yuan (including 3,000 yuan) and personal expenses outside the policy (natural year, the same below). 2. In addition to the above-mentioned 22 major diseases, the annual hospitalization and serious illness outpatient medical expenses of rural residents, after reimbursement by the new rural cooperative medical system, the annual accumulated personal expenses within the reimbursement policy of the new rural cooperative medical system are more than 20,000 yuan (including 20,000 yuan), and the annual accumulated personal expenses outside the policy are more than 40,000 yuan (including 40,000 yuan). 3. The expenses outside the reimbursement policy of the new rural cooperative medical system are set as the upper limit of the total medical expenses, and the expenses outside the designated medical institutions of the first-level new rural cooperative medical system are 10% (including 10%, the same below), the designated medical institutions of the second-level new rural cooperative medical system are 20%, and the designated medical institutions of the municipal new rural cooperative medical system and the designated medical institutions outside the city are 30%.

legal ground

People's Republic of China (PRC) Social Insurance Law Article 24 The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.