Legal analysis: 1, outpatient reimbursement
(1) village health clinics and village center health clinic visit reimbursement 60%, each visit prescription drug fee limit of 10 yuan, health center doctors temporary rehydration prescription drug fee limit of 50 yuan.
(2) Township health centers will be reimbursed 40% of the cost of each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.
(3) Secondary hospitals will be reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.
(4) Tertiary hospitals will reimburse 20% of the cost, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs.
(5) Chinese medicine invoices with prescription attached are limited to RMB 1 yuan per sticker.
(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.
2. Hospitalization Compensation
(1) Reimbursement Scope:
A. Pharmaceutical Fees: Auxiliary Examinations: Limit of 200 RMB for each examination fee such as EKG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, MR*** vibration, etc.; Surgical Fees (with reference to the national standard, reimbursement for fees in excess of 1,000 RMB will be made in accordance with the limit of 1,000 RMB).
B, the elderly over 60 years of age hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) Reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.
3. Chronic Diseases
Cirrhosis 4400 yuan, chronic active hepatitis 3200 yuan, tuberculosis 1800 yuan, hypertension 3000 yuan, coronary heart disease 3000 yuan, cerebrovascular accident sequelae 3600 yuan, diabetes mellitus 3600 yuan, necrosis of the femoral head 2600 yuan, ankylosing spondylitis 4000 yuan, hyperthyroidism 1000 yuan, rheumatoid arthritis 3200 yuan. Rheumatoid arthritis 3200 RMB. Various types of malignant tumors, chronic renal failure, organ transplantation, aplastic anemia, myasthenia gravis, systemic lupus erythematosus, severe mental illness, seven types of temporary indefinite limit.
Legal basis: "Chinese People's **** and State Social Insurance Law"
Article 2 The State establishes a social insurance system of basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance and other social insurance systems, to protect the citizens' rights to material assistance from the State and society in old age, illness, industrial injury, unemployment and maternity in accordance with the law.
Article 26 The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.
Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue shall be paid from the basic medical insurance fund in accordance with the state regulations.