I. Participants in the new rural cooperative medical care, with the cooperative medical card and ID card to the designated medical institutions in this jurisdiction, to enjoy the corresponding subsidies.
Second, the fixed-point medical institutions are limited to technical and equipment conditions, can not diagnose and treat the patient, the hospital agreed, and issued a certificate, and reported to the district cooperative medical office for the record.
Three, special emergency patients to the medical institutions outside the region to rescue hospitalized, with the first aid certificate, within five days to the District Office of Rural Cooperative Medical Care to fill in the relevant procedures, otherwise no subsidies.
Four, participate in the cooperative medical farmers, on business trips abroad, working and other hospitalized due to illness, must be in the local cooperative medical designated medical institutions (not carried out in the local public health care institutions), and within five days of the District Cooperative Medical Office to get in touch with the registration, after discharge, with a copy of the prescription, hospitalization one-day list, diagnosis, bills, copies of medical records and cooperative medical card to the district of the new type of medical care. and the cooperative medical certificate to the district new rural cooperative medical office for examination, otherwise, no subsidy will be given.
V. Participants in the new rural cooperative medical care, tuberculosis, AIDS must be in accordance with the "Henan Province, tuberculosis management of the implementation of the rules" and other relevant provisions of the implementation.
Sixth, unauthorized private medical institutions outside the region, no subsidies.
Seven, all levels and types of designated medical institutions must be registered in accordance with the scope of diagnosis and treatment and according to their own technical equipment and conditions of diagnosis and treatment of patients, is strictly prohibited from forcibly accepting patients. The result of medical accidents or medical disputes, in addition to handling in accordance with the "Regulations on the Treatment of Medical Accidents", the parties and the person in charge will be given economic and administrative penalties.
From October 1 this year, Henan will fully launch the new rural cooperative big disease insurance policy. The new rural cooperative insurance policy, also known as the second reimbursement of major illnesses, according to the policy, in addition to the normal new rural cooperative reimbursement, after January 1 this year, sick farmers can also be reimbursed for the second reimbursement, the second reimbursement starting line of 15,000 yuan, the annual compensation ceiling of 300,000 yuan.
At present, the General Office of the provincial government has issued the "New Rural Cooperative Medical Insurance Implementation Program (Trial)" (hereinafter referred to as the "Program") to all areas, and urged the implementation.
The second reimbursement compensation ratio is divided into three grades, the lowest is 50%
August 7, 71-year-old Ms. Huang was discharged from the hospital because of inflammatory bowel disease and emergency hospitalization, she spent 65,000 yuan in the hospital, the New Rural Cooperative Medicine reimbursement, she also paid 35,000 yuan out of pocket. Fortunately, she caught up with the province's soon-to-be-implemented major disease insurance policy.
"The province's major disease insurance policy was officially implemented from Oct. 1, but eligible participating farmers from Jan. 1 to Sept. 30 this year can also enjoy the policy." Dai Nengguang, a researcher at the Rural Health Division of the Provincial Health and Family Planning Commission, said.
Taking Ms. Huang as an example, after the approval of the NPC reimbursement, her out-of-pocket 35,000 yuan of the cost of the compliant costs of 30,000 yuan, at which time her second NPC reimbursement will be (30,000 yuan - 15,000 yuan) × 50 percent = 7,500 yuan.
Taking another example, Mr. Liu, a 78-year-old lung cancer patient, was hospitalized*** at a cost of 400,000 yuan, and paid 200,000 yuan out of his own pocket after removing the reimbursement from the New Farmers' Cooperative Medical Scheme (NFCM). After verifying that the compliant cost among the 200,000 yuan cost was 150,000 yuan, his secondary reimbursement amount was then (50,000 yuan - 15,000 yuan) × 50% + 50,000 yuan × 55% + 50,000 yuan × 65% = 77,500 yuan.
Additionally, the new rural cooperative disease reimbursement can only reimburse the "compliant expenses", which are tentatively defined as the out-of-pocket medical expenses within the scope of the basic drug catalog and basic diagnostic and therapeutic item catalog of the new rural cooperative.
Where is the money coming from to pay no more money, paid by the new rural cooperative fund
"Participating farmers do not need to pay additional money, the new rural cooperative insurance funds by the new rural cooperative fund." Wang Yaoping, director of the Rural Health Work Department of the Provincial Health and Family Planning Commission, said that the funding standard is based on the per capita net income of rural residents in the previous year as the basis for differential funding, and that in the future, the level of funding for the major disease insurance will be gradually increased in accordance with the level of funding of the New Rural Cooperative Fund and the fund's payment situation.
According to Dai Nengguang, in 2014, the province's financing standards are divided into three grades of 16 yuan, 15 yuan and 14 yuan, "the financing level of high income cities is also high, such as Zhengzhou City is 16 yuan per person, Zhoukou City is 14 yuan per person."
However, although the financing level of each prefecture and city is different, the reimbursement rate enjoyed by the people is the same.
Reimbursement method before 2015, all the implementation of instant settlement
"Before 2015, all the implementation of instant settlement." Dai Nengguang introduction, instant settlement is that the patient is discharged from the hospital settlement, at present, the province **** 295 medical institutions to realize the cross-regional "instant settlement".
In the province outside the medical or provincial non-instant settlement patients, with a valid ID, a copy of the referral certificate and the new rural cooperative hospitalization compensation bill to participate in the commercial insurance agency designated service outlets for the new rural cooperative insurance compensation procedures, the commercial insurance agency service outlets through the provincial new rural cooperative management information system for the settlement of compensation costs for the participating patients.
The Provincial Health and Family Planning Commission requires that commercial insurance agencies set up at least one service outlet in each co-ordination area to provide settlement services for out-of-province hospitalized and in-province non-instant settlement patients, and may also station business personnel in each co-ordination area to provide "one-stop" settlement services.
Graduated major disease insurance
For 2014, the starting line for major disease insurance is 15,000 yuan, and reimbursement is made in three grades:
The portion of 15,000 to 50,000 yuan (including 50,000 yuan) is compensated at a rate of 50%
The portion of 50,000 yuan to 100,000 yuan (including 100,000 yuan) is compensated at a rate of 55%, and the portion of
100,000 yuan The portion above is compensated at 65%, and the compensation ceiling is 300,000 yuan in a year.
You are likely to encounter these situations ......
What about hospitalization outside the province?
Self-payment part of a 60% discount and then reimbursement in accordance with the regulations
Mr. Cai has been working in Beijing for many years, and has brought his parents from his hometown in rural Nanyang to Beijing. In June this year, because of a sudden cerebral infarction, Mr. Cai's father was hospitalized in a hospital in Beijing, before and after spending 90,000 yuan, in addition to the reimbursement of the New Farmers' Cooperative, Mr. Cai's father also out of pocket 60,000 yuan. Mr. Cai questioned, his father is hospitalized outside the province, can enjoy the second reimbursement?
"You can, but the standard is different." Dai Nengguang introduced, hospitalized outside the province of the enrolled patients, by the new rural cooperative compensation for 60% of its out-of-pocket medical expenses are considered compliant out-of-pocket medical expenses included in the scope of compensation for major medical insurance.
Taking Mr. Cai's father as an example, because his family paid 60,000 yuan out-of-pocket, his compliant medical expenses were 60,000 yuan x 60 percent = 36,000 yuan. Using this calculation, his secondary reimbursement money would be ($36,000 - $15,000) x 50 percent = $10,500 yuan.
What about multiple hospitalizations?
Only the starting line is deducted once in a year
Mr. Gao was hospitalized three times in a year this year due to gastrointestinal problems. For such a patient who has been hospitalized several times in a year, what is the provision for secondary reimbursement under the New Farmers' Cooperative?
The program stipulates that during the year, patients (including those who have been hospitalized several times) will only be deducted once from the starting line of the New Farmers' Cooperative insurance for major illnesses, and that the out-of-pocket medical expenses above the starting line will only be reimbursed once by the insurance for major illnesses, and that the remaining expenses of the current time will not be repeated in the calculation of reimbursement.
Taking Mr. Gao as an example, for the first hospitalization, after deducting the reimbursement from the New Rural Comprehensive Medical Insurance (NRMI), his out-of-pocket expenses were 10,000 yuan; for the second time it was 7,000 yuan, and for the third time it was 15,000 yuan, so the second reimbursement for Mr. Gao was (10,000+0.7 million yuan+15,000 yuan-15,000 yuan)×50%=0.85 million yuan.
The NPC major disease insurance is aligned with the NPC operating year, which starts on January 1 and ends on December 31 each year. In case of a single hospitalization across the year and the compliant out-of-pocket medical expenses exceed the starting line, the compensation policy of the major disease insurance in the year of discharge will be implemented.
Will major medical insurance bring about difficult and expensive visits?
Reporter Li Xiaomin intern Qiu Sijie
With the protection of major medical insurance, will people pile up in big hospitals, resulting in new difficulties in seeing a doctor? Will medical institutions increase prices, resulting in a new expensive to see a doctor? In this regard, the provincial Health and Family Planning Commission, Director of Rural Health Work Wang Yaoping revealed that, at present, supporting policies are being developed, will also be formally implemented from October 1st.
A question: small diseases will pile up big hospitals? A: common diseases will be implemented "fixed compensation"
Knowing that the full promotion of the new rural cooperative insurance policy, has been concerned about the policy of the new rural cooperative Mr. Huang, a citizen of Zhengzhou, the first reaction is: will not stimulate more people flocked to the big hospitals?
"We also took this into consideration when formulating the policy, so we are working on supporting policies." Wang Yaoping said that in order to guide patients with common and frequent diseases to stay at the grass-roots level, and to prevent people from blindly referring to the hospital after the launch of the major disease insurance, the province will realize the fixed compensation for common diseases, and the out-of-pocket medical expenses for the fixed-compensation diseases will not be included in the scope of coverage of the major disease insurance.
"Fixed compensation is a kind of disease reimbursement when a price, in which level of hospitals are reimbursed so much, the use of economic leverage to guide patients with common diseases in the primary health care institutions, to guide the reasonable diversion of patients." Wang Yaoping said, at present, the provincial health and family planning commission is organizing experts on some common diseases, frequent diseases to investigate, the first batch of common diseases fixed compensation list proposed 30.
The second question: what about going to a large hospital without a referral? A: the new rural cooperative reimbursement rate will be reduced by 20%
Wang has been working in the clinical Mr. Wang often run into such patients, some of the diseases obviously county hospitals can be treated, but because of the distrust, some patients will give up the "small" to "big". At present, for not issued a referral certificate directly to the municipal and above the designated medical institutions hospitalized patients, the province's new rural cooperative in the reimbursement will be automatically reduced by 10%.
"After October 1 this year, the reimbursement ratio for hospitalization expenses will be automatically adjusted from the current 10% reduction to a 20% reduction." Wang Yaoping said this is to strictly referral procedures, reasonably guide and triage participating hospitalized people, and gradually establish a hierarchical diagnosis and treatment system.
At the same time, for those who are hospitalized directly in municipal and above designated medical institutions without going through the required referral approval procedures, the province requires that 80 percent of their current hospitalization compliance out-of-pocket medical expenses be included in the compensation scope of the major disease insurance.
Three questions: medical institutions will take the opportunity to increase prices? A: a number of regulatory control costs unreasonable rise
For the people, a hidden worry is that with the support of the major medical insurance, individual medical institutions will not take advantage of this price increases.
"We will also introduce a series of policies to control and prevent." Wang Yaoping introduced, for example, sub (daily) average hospitalization cost growth, the actual hospitalization compensation ratio, the proportion of out-of-catalog drug costs, the proportion of Class A drugs, the proportion of out-of-catalog diagnostic and treatment costs, the proportion of consumables costs as the main indicators of cost growth control of medical institutions, regular statistical notification and public disclosure to the community, and to effectively control the medical costs of irrational rise.
At the same time, he mentioned, the province will also promote the Yiyang, Xixian new rural cooperative by disease grouping classification (A, B, C path) payment method. In the province's all coordinated areas of county and township-level designated medical institutions to fully promote, and further standardize the behavior of medical services, control the unreasonable rise in medical costs.
Four Q: What about the participating farmers in the three pilot cities? A: 2016 years ago, all into the provincial level
In fact, the new rural cooperative big disease insurance from 2013, the province's Zhengzhou, Xinxiang, Luoyang three cities, has tasted, these three municipalities to implement municipal coordination. It is understood that, at present, Zhengzhou's major medical insurance starting line for 20,000 yuan, Xinxiang 30,000 yuan, Luoyang 20,000 yuan, the three cities of major medical insurance reimbursement of the proportion of 50 percent.
According to the "Implementation Plan of Major Disease Insurance for New Rural Cooperative Medical Care in Henan Province (Trial)," the three cities will continue to implement municipal-level coordination in 2014 and gradually converge with the provincial-level coordination program, with all of them being included in the provincial-level coordination by 2016.
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