The new rural cooperative medical insurance is first of all a family unit to join the New Rural Cooperative Medical Insurance, the population of the cooperative medical book must be the same as the hukou; then the New Rural Cooperative Medical Insurance is only for the relief of the major illnesses, for the workplace injuries, alcoholism, traffic accidents, fights and assaults, family planning, suicide self-inflicted injuries, and so on, will not be reimbursed.
I. Scope of Settlement
1. Bed charge: up to 11 yuan/day for township health centers, 15 yuan/day for city and above city hospitals.
2. Drug fees: the implementation of the "Hebei Province New Rural Cooperative Medical Care Basic Drug Catalog", all drugs outside the catalog will not be reimbursed.
3. Examination fee: maximum 600 RMB.
4. Treatment fee: within 300 RMB, calculated according to the actual situation; the part above 300 RMB is included in the reimbursement at 50%.
5. Surgical fee: calculated according to the fee standard approved by the price department.
6. Blood transfusion fee: blood transfusion fee incurred in critical disease rescue or surgery (limited to 500 yuan) is included in the scope of reimbursement, while other blood transfusion fees are not reimbursed.
7. Material costs: maximum limit of 2,000 yuan. (Items that are not reimbursable under urban workers' medical insurance are not included in the scope of reimbursement)
II. Referral Regulations
1. 90% of the reimbursable medical fees will be included in the calculation of the inpatient treatment for those who have been referred to municipal hospitals in the city;
2. 80% of the reimbursable medical fees will be included in the calculation of the inpatient treatment for those who have been referred to out-of-town hospitals;
3. For hospitalization in military hospitals and for-profit hospitals, 60% of the medical fees will be included in the calculation;
4. 60% of the medical fees will be included in the calculation if there is no certificate of hospital transfer.
Three, the settlement ratio
After verification of the reportable medical expenses section by section (35% - 70%) of the settlement amount of compensation, per person per year, the annual amount of compensation for a cumulative maximum of 20,000 yuan.
Four, the settlement process
Participants discharged from the hospital, the patient's own signature or seal of the hospital invoice, discharge records, cost lists, referral certificates and a copy of my ID card or proof of domicile to the township co-management office, after review and centralized unified sent to the municipal agricultural insurance business management center.
V. Related Matters
1. The insurance period of 2005 is from January 1 to December 31, 2005, during which the hospitalized medical expenses of the insured persons can be settled, and all the outpatient medical expenses will not be reimbursed.
2. All medical expenses for the current year must be settled by the end of February of the following year, after which no reimbursement will be made.
3. Hospitalization expenses without discharge records, cost lists or medical orders will not be reimbursed; medical expenses not recorded in the cost lists or medical orders, as well as diagnostic and therapeutic items not reimbursed under the provisions of the Urban Employees' Medical Insurance, will not be included in the scope of reimbursement.
4. The original invoices must be provided for the reimbursement of all medical expenses, and the medical expenses for more than one hospitalization within a year must be settled in several times on a proportional basis, and shall not be added up.
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