The latest reimbursement ratio and scope of rural cooperative medical insurance;
1, outpatient and emergency medical expenses: The medical expenses that meet the requirements of basic medical insurance for employees in the current year (65438+ 10/kloc-0+February 3 1) totaled more than 2,000 yuan.
2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.
3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.
4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.
5, hospitalization, medical insurance paid for 20 years, can enjoy medical insurance reimbursement after retirement.
Outpatient reimbursement standard
1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.
2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan.
3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.
4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 0 yuan, prescription drug fee limit 200 yuan.
5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan.
6, the township cooperative medical outpatient compensation limit is 5000 yuan.
Reimbursement standard for serious illness
1, compensation from town risk fund: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or within one year, that is, 500 1- 10000 yuan is 65%,10001-/kloc-.
2. The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is1.654.38+0.000 million yuan. Rural cooperative medical care is a medical security system created by farmers themselves in China, which can greatly alleviate poverty caused by illness and play a great role in returning to poverty due to illness.
So can rural cooperative medical care be supplemented? You can't make up the payment. The rural cooperative medical system will be paid from June 165438+ 10 to February 65438+February, and it will take effect in June 65438+ 10/the following year. Even if it is made up the next year, it will not take effect, so the rural cooperative medical system can't make up the money.
Hospitalization reimbursement standard
1, drug cost: auxiliary examination: 200 yuan for ECG, X-ray fluoroscopy, photography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
2. The elderly over 60 years old are treated in urban hospitals, and the daily compensation for treatment and nursing expenses is 10 yuan, with the limit of 200 yuan.
Outpatient expenses reimbursement procedures:
When farmers participating in the new rural cooperative medical system go to designated medical institutions at township and village levels with cooperative medical certificates and cards, the designated medical institutions directly reduce the outpatient compensation expenses, and the remaining part after deducting the outpatient compensation expenses from the total outpatient medical expenses shall be settled by the insured farmers in cash. When the insured farmers suffer from chronic diseases or major diseases in the outpatient clinics of designated medical institutions in provinces, cities and districts, the medical expenses incurred shall be settled by the insured farmers in cash, reported to the district joint management office for examination after the preliminary examination by the township joint management office, and the funds advanced by the new rural cooperative medical institutions shall be recorded by the township hospitals where the household registration is located after examination, and then directly transferred to the special account of the designated medical institutions of the new rural cooperative medical system after examination and approval by the district joint management office.
Procedures for reimbursement of hospitalization expenses:
Insured farmers who are hospitalized in the designated medical institutions in the city shall go through hospitalization procedures by paying a certain amount of deposit in advance with the cooperative medical certificate, card and household registration book, and only settle the self-funded part when they leave the hospital, and the compensation part shall be paid in advance by the designated medical institutions. To the new rural cooperative medical institutions at the provincial level, it is necessary to issue a transfer certificate in the relevant hospital. To see a doctor in a designated medical institution of the new rural cooperative medical system outside the province, a transfer certificate must be issued in a designated medical institution at the provincial level.
If the participants who are absent from class or go to school are hospitalized due to illness or give birth in hospital, they should choose the public designated medical institutions established by the local designated medical institutions of the new rural cooperative medical system to be hospitalized, and entrust their relatives or others within 7 days from the date of hospitalization, and go to the township health centers where the household registration is located to handle the referral procedures by the hospitalization certificate (or fax copy) of the designated medical institutions. Within 20 days after discharge, the diagnosis certificate, discharge certificate, invoice, expense list (original) and pathological copy will be provided to the township joint management office where the household registration is located. If the formula is not less than 15 days in the open column of township government affairs, the township health center will enter the new rural cooperative medical system for compensation.
For participating patients hospitalized in designated medical institutions outside the city, the expenses above 10000 yuan must be checked and verified by the district, the senior management class and the hospital where they are located, and the reimbursement can be publicized only if they meet the reimbursement conditions of the new rural cooperative medical system. The medical expenses incurred afterwards will not be compensated for the participating patients who have not gone through the referral procedures according to the relevant provisions of the new rural cooperative medical system.