New rural cooperative medical knowledge Q & A
1, what is the new rural cooperative medical system?
The new rural cooperative medical system is organized, guided and supported by the government, the farmers voluntarily participate in the individual, collective and government financing, with the main focus on the coordination of the major diseases of the farmers' medical mutual **** relief system.
2, the new rural cooperative medical care "new" in what way?
(a) there is government financial assistance and support, the government subsidizes 40 yuan per person per year (county by county according to the number of participants), individuals pay 10 yuan per year, individuals do not pay, the government does not subsidize. (b) The government set up a specialized agency for management, funds earmarked for special purposes, the management of the account does not see the money, the management of the money does not see the account, the management of the use of separate, closed operation, to ensure the safety of the funds. (C) hospitalization medical expenses can be reimbursed proportionally, and the establishment of family outpatient account, taking into account the reimbursement of outpatient medical expenses (8 yuan per person).
3. What is the significance of establishing the new rural cooperative medical system?
The new rural cooperative medical care is an important part of China's rural social security system, government funding, social welfare, mainly for farmers to establish a long-term, effective medical insurance system, so that farmers from the new rural cooperative medical care to get the benefits, reduce the economic burden of the farmers sick, and improve the health of farmers.
4, the new rural cooperative medical care can run for a long time?
The establishment of the new rural cooperative medical care is to establish and improve a long-term, effective adaptation to the rural farmers of the medical security system, is the government for the farmers to do a practical, good thing, the government not only to persist in the long term, but also to continue to summarize, improve, expand, and comprehensively promote, so that the farmers to get the practical medical protection.
5, who can participate in the new rural cooperative medical care?
All rural residents in the county with an agricultural household registration can participate in the new rural cooperative medical care, including migrant workers, business people and workers in the county's enterprises, county, township agencies, institutions in the temporary workers and private teachers in the agricultural household registration. In line with the principle of "the village can miss the household, the household does not miss the person", the implementation of a household a certificate system.
6, to participate in the new rural cooperative medical care why should all members of the household as a unit, all members of the family to participate?
Because the cooperative medical care has the nature of mutual **** relief, relying on everyone's money to help a small number of sick people, therefore, farmers are required to participate in the cooperative medical care on a household basis, the purpose is to avoid choosing to pay the fees of the personnel who are prone to get sick, and healthy people do not pay the fees of the situation.
7. What are the benefits of participating in the new rural cooperative medical care?
"The sky has its own way, and people have their own way of getting sick," is an old Chinese saying. It is inevitable that people will not get sick. If one person in a family gets a serious illness, the whole family may be dragged down, which will have an impact on production and life. When farmers participate in cooperative medical care, the first thing they do is to benefit personally. From the minimum standard, pay 10 yuan a year, if once you get sick, the maximum compensation can reach 20,000 yuan, which is 2,000 times of the personal payment. Secondly, the new rural cooperative medical care is supported by the government, which supports more than the individual farmer's contribution, and if the farmer does not participate, the government does not subsidize it. Furthermore, even if you do not get sick, it is the same as helping your folks and doing a good deed. If you get sick in the future, you still have a chance to be compensated, and if you don't get sick within two years you can also enjoy a free medical checkup.
8. Why should farmers fund their participation in rural cooperative medical care?
This is the nature of the cooperative medical care mutual **** relief decided. Enjoy the cooperative medical protection to bear the corresponding obligations, farmers themselves must participate. Only bear the corresponding obligations, in order to enjoy the right to receive government subsidies. In fact, the new rural cooperative medical care has embodied the government and collective financial support, but the government and collective funds are limited, only to let the majority of people to participate in, in order to expand the cooperative medical fund-raising capacity, give full play to the role of mutual assistance ****ji.
9, why pay once a year? And to pay within the specified time?
The new rural cooperative medical care for a period of one year, in the charging period did not participate in the cooperative medical care of farmers, can only participate in the next year. The purpose of this provision: is to timely and accurately count the number of participants, to facilitate the accurate accounting of cooperative medical funds. Because the normal operation of cooperative medical care is based on scientific calculations, to keep expenditure within the limits of revenues, to be able to absorb how much money, to determine how much compensation, and balance the books every year.
10, the county's new rural cooperative medical care how to fund? Government financial support funds can be guaranteed in place? Will the funds be misappropriated?
Farmers voluntarily pay 10.00 yuan per person per year, national, provincial, municipal and county financial subsidies of 40 yuan per person per year for participating farmers (the central 20 yuan, the provincial 15 yuan, the city of 2 yuan, the county of 3 yuan), *** counted 50.00 yuan per person per year, all of which are deposited into the county cooperative medical fund account, the formation of the county as a unit of the overall fund, dedicated to the participants of the hospitalization medical fee subsidies and outpatient The government is also responsible for the payment of hospitalization and outpatient medical fee subsidies for the participants.
The government's subsidized funds are disbursed on schedule after the number of participants is reported and verified, and the participation fund is not misappropriated.
11. What preferential policies does the government have for the Five Guaranteed Households and Special Hardship Households to participate in the New Rural Cooperative Medical Scheme?
Five-guaranteed households, the disabled, poor households in the second female sterilization households, military martyrs, the elderly over 80 years of age and other disadvantaged groups and the inclusion of the minimum subsistence guarantee line within the scope of the special hardship case, to participate in the new rural cooperative medical care of the individual part of the contribution funded by the County Civil Affairs Bureau.
12, school students have been insured, to participate in the new rural cooperative medical care?
Rural schoolchildren, including all primary and secondary school students, kindergarten children have participated in the insurance, but also with the household to participate in the new rural cooperative medical care, both benefit. Students from universities and colleges who have moved out of their hukou and are studying abroad are exempted from the program.
13. Why do I have to go to a designated medical institution for treatment in order to be reimbursed for the medical fee subsidy?
(1) In order to ensure the quality of medical services and the rights and interests of the participants. Must have certain conditions of the medical unit as a designated medical institutions, (2) to facilitate the management, to prevent people from impostor, take false bills reimbursement, set off the cooperative medical fund.
14. Can medical expenses be reimbursed across years?
No, because the validity of the cooperative medical certificate is limited to the year, the expiration of the farmers have to continue to pay the cooperative medical co-ordination fund to continue to be valid. The so-called inter-annualization is based on the date of issuance of medical bills. For those who have been hospitalized consecutively across the year, the farmers have to pay the cooperative medical fund in time before the expiration of the cooperative medical card.
15. Are office expenses paid out of the farmers' contributions?
No. The office expenses of the New Agricultural Cooperative Organization are included in the county budget and will not be withdrawn from the Cooperative Medical Fund. The money paid by the farmers and the money funded by the government as well as the interest should all be used for reimbursement to the sick farmers.
16, how to participate in cooperative medical care? What is the time limit for paying the cooperative medical fund?
Farmers voluntarily participate in cooperative medical care on a household basis, before November 30 each year, according to the standard of 10 yuan per person per year, to pay the next year's participation fee on a household basis, there are townships and townships to collect, register and fill in the Office of the cooperative management.
17, participating farmers to enjoy the cooperative medical subsidies time?
From January 1 to December 31 of the next year after the payment of fees for a cycle, participating farmers can enjoy the new rural cooperative medical treatment of medical fee compensation. For example, after paying the participation fee in 2007, the period from January 1, 2008 to December 31, 2008 will be the period for enjoying the cooperative medical care subsidy.
18. What is the use of the cooperative medical care fund paid by farmers themselves?
Participating farmers pay per person per year cooperative medical fund, of which 8 yuan to set up a family fund account, the remaining 2 yuan with the central and local government subsidies at all levels together *** with the composition of the county's rural cooperative medical fund, for farmers to reimbursement of major illnesses.
19, family account fund how to use?
The family account fund (8 yuan per person) is mainly used for the reimbursement of outpatient medical expenses of family members, with the principal and interest belonging to oneself and the balance being carried over to the next year for cumulative use, but cash cannot be withdrawn, and it cannot be offset against the participation fee payable by individuals in the following year.
20. How is the family account fund reimbursed?
Participating farmers in the designated medical institutions (county hospitals, township health centers, village health centers) incurred outpatient medical expenses, the patient first temporary payment, after the consultation with the "cooperative medical card", ID card (household register), the New Rural Cooperative special prescriptions and medical invoices to the township health centers to reimbursement of cooperation management section, but also can be accumulated over a period of time to reimbursement.
21. How is the cooperative medical fund used?
The fund is divided into a fund for major diseases, a risk reserve fund, and a health examination fund.
The Risk Reserve Fund is set at 12% of the Fund, and is used to prevent overdrafts of the Cooperative Medical Fund or to deal with emergencies in case of major accidents.
The health examination fund is drawn down at a rate of 2 yuan per capita, and is used for the health examinations of participating farmers who have not incurred outpatient or hospitalization expenses for two consecutive years.
The Major Disease Coordination Fund is the remaining portion of the fund in addition to the Risk Reserve Fund and the Health Examination Fund, which is mainly used for the compensation of hospitalized medical expenses of participating farmers.
22. What are the designated medical institutions in the county?
1) County People's Hospital, County Hospital of Traditional Chinese Medicine, County Maternal and Child Health Care Station, and health centers in each township.
2) The designated health center in the village of the participating farmers (outpatient treatment only).
23. What are the reimbursement standards for fixed-point medical institutions at all levels?
The starting line at the township level is 80 yuan, the reimbursement rate is 60%, and the ceiling line is 3,000 yuan; the starting line at the county level is 200 yuan, the reimbursement rate is 50%, and the ceiling line is 8,000 yuan;
the starting line at the city level is 800 yuan, the reimbursement rate is 35%, and the ceiling line is 10,000 yuan;
the starting line at the city level and above is 1,000 yuan, the reimbursement rate is 30%, and the ceiling line is 20000 yuan.
The total amount of reimbursement for medical expenses shall not exceed 20,000 yuan if a participating farmer is hospitalized several times in a year.
24. What kind of medical fee subsidies are available for hospitalization of participating farmers?
The scope of the subsidy is: bed fee, treatment fee, medicine fee, operation fee, laboratory fee, electrocardiogram, x-ray, ultrasound examination and other necessary examination fees.
25. How do I get the medical fee subsidy if I give birth within the program?
Participating farmers who are hospitalized for normal delivery within the plan will be reimbursed a fixed amount of RMB 150 per case for medical fees. If a cesarean section is chosen due to a difficult delivery, the hospitalization will be subsidized according to the reimbursement standard of the General Disease Coordination Fund. (If you are hospitalized for delivery, you should bring along a valid birth certificate)
26. What are the medical fees not reimbursed under the New Rural Cooperative?
The hospitalization subsidy fund is mainly used to subsidize the medical expenses incurred by participating farmers who are hospitalized due to illnesses. Not all medical expenses belong to the scope of reimbursement, and the medical expenses that are not reimbursed by the new type of rural cooperation in our county mainly include:
(1) the medical expenses of the people who do not participate in the cooperative medical care;
(2) the expenses of self-purchased medicines, heating expenses, utilities, out-of-hospital consultation fees, name and address, surgical surcharges, washing fees, meals, and other medical expenses. surgery surcharge, washing fee, meal fee, ambulance fee;
(3) assembly of prosthetic limbs, prosthetic teeth, prosthetic eyes, hearing aids, organ transplants, flap replacements and pacemakers, physical therapy equipment, cosmetic and plastic surgery fees and its sequelae of medical fees, infertility, sexually transmitted diseases and sexual dysfunction and abortion, induced abortion fees;
(4) injuries and disabilities due to fights and brawls, and drug addiction, alcoholism, suicide, homicide, self-inflicted injuries, traffic accidents, medical accidents, medical appraisals and industrial injuries and occupational diseases caused by labor export;
(5) medical expenses incurred for convalescence, rehabilitation, hospitalization in non-scheduled medical institutions and transferring to other hospitals for treatment without prior consent (except for emergency medical treatment and first aid);
(6) medical expenses incurred in unplanned hospital deliveries;
( (7) During the period of treatment, any medical expenses not related to the disease, medicine expenses in the prescription not belonging to the diagnosis, over-scope examination expenses, medicine expenses without doctor's prescription, false medicine expenses, medicines outside the catalog of Gansu Province's New Rural Cooperative;
(8) blood transfusion, albumin and nutritional tonic medicines.
(9) Other medical expenses, living service items and service facilities expenses which are not reimbursed by the cooperative medical care as stipulated by the county cooperative management office.
27. What regulations are violated by the participating farmers that will not be reimbursed or the subsidized medical fees have to be returned?
1) lending one's Cooperative Medical Care Certificate to others;
2) falsely altering the Cooperative Medical Care Certificate, receipts for medical fees and medical records, prescriptions, etc.;
3) unreasonably making a fuss over one's failure to comply with the provisions of the Cooperative Medical Care system, which results in failure to make reimbursement or affects the reimbursement of fees;
4) violating the provisions of the Cooperative Medical Care Management System. regulations.
28. What are the precautions to be taken when a participating farmer is hospitalized in the county?
Participating farmers who need medical consultation or hospitalization due to illness should present their cooperative medical card, ID card or hukou booklet at the designated hospital for consultation or hospitalization procedures (incomplete or unposted photos on the cooperative medical card should be submitted to the patient's recent registration photo in order to determine the identity of the patient). If you are hospitalized in a county hospital, bring your "cooperative medical card", household registration card (ID card), and hospitalization diagnosis to the county cooperative management office to issue a notice of hospitalization; if you are hospitalized in a township health center, for the convenience of the participating farmers, the staff of the cooperative management section of the township health center will do the work on your behalf.
29. How are hospitalized patients reimbursed for their medical expenses?
Participating farmers hospitalized in designated medical institutions due to illness, first pay a deposit for hospitalization procedures. During the hospitalization period, the "cooperative medical card" is temporarily kept by the designated medical institution. After the patient pays the hospitalization fees and is discharged from the hospital, he/she will be reimbursed by the cooperative medical card, ID card (hukou book), discharge certificate, duplicate prescription, detailed list of charges, cost settlement list and other relevant documents (accidental injuries caused by farm work must be issued with a letter of introduction from the village committee, which will be examined by the township cooperative administration office and stamped with an official stamp) in the cooperative administration section of the designated medical institution. Hospitalization subsidies.
30. How is the reimbursement method calculated?
(1) Minus the starting line. (2) Subtract the cost of medication outside the catalog. (3) Multiply the reimbursement rate. (4) Above the ceiling line is paid according to the ceiling line.
Calculation method=(total cost - non-reimbursable cost - starting line) x % reimbursement rate of the medical institution visited
31. How to transfer to other medical institutions?
Cooperative medicine patients who need to be transferred to a designated medical institution above the county level for hospitalization due to their condition, they should take the "Cooperative Medical Certificate", ID card or household booklet to be filled out by the treating physician of the designated medical institution at the county level in accordance with the requirements of the "Referral to the Hospital Approval Form", and then reported to the county co-management office for approval before being transferred to the hospital for treatment outside the hospital. Special circumstances, such as emergency and critical patients need to be transferred to the hospital in time for the formalities, you can first telephone (4428615) reported to the county co-management office, and then make up for the relevant procedures.
32. What kind of information should I bring with me when I am discharged from the hospital?
Diagnostic certificates of the attending hospitals, discharge summaries, copies of inpatient medical records (stamped with the official seal of the attending hospitals), cost settlement lists, detailed lists of charges, and approval forms for transferring to other hospitals.
33. What are the rules for transferring to other hospitals?
1) designated hospitals in Zhangye City: Zhangye People's Hospital, Zhangye Hospital of Traditional Chinese Medicine, Zhangye Maternal and Child Healthcare Station, Zhangye Red Cross Psychiatric Hospital;
2) Provincial-level and above hospitals must be non-profit hospitals.
34. How are medical expenses reimbursed for patients who are transferred to other hospitals?
Transferring a patient for medical treatment after discharge from the hospital with the relevant information to the county co-management office registration, fill out the transfer registration form, notice of consultation to the township hospital or transfer out of the designated medical institution co-management section of the settlement of reimbursement. If a person is directly hospitalized outside the county without the approval and registration of the county co-management office, his/her medical fees will not be reimbursed in principle.
35. What are the regulations on the use of medicines in the catalog during hospitalization?
When the designated medical institutions use medicines outside the basic medication catalog of cooperative medicine, the proportion of the medicines used by the designated medical institutions in townships shall not exceed 10% of the total cost of the medicines, and the proportion of the medicines used by the designated medical institutions at the county level shall not exceed 15%. When the use of drugs outside the catalog is required due to the condition of the patient, the consent of the participating patients must be obtained.
36, the county's rural cooperative medical fund management?
The county's rural cooperative medical fund to implement the financial, cooperative medical office, the bank tripartite joint management system, the financial management account, the joint management office management, the bank manages the money, mutual constraints, money account separation, closed operation, to ensure that the cooperative medical fund for the reimbursement of medical expenses of farmers.
37, the county's rural cooperative medical fund how to monitor?
The county set up by the county people's Congress, CPPCC, Commission for Discipline Inspection, Supervision, Price, Audit and other departments and participate in the cooperative medical supervision committee composed of representatives of farmers, every six months on the use of the cooperative medical fund and the management of the inspection and supervision; the county office of the new rural cooperative medical care will be regular reimbursement of the fund for the public to accept the supervision of the community; the auditing department of the fund regularly to carry out special audits of the use.
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38, what are the requirements for filling out the new cooperative medical certificate
"New rural cooperative medical certificate" should be stamped with a unified seal, fill in the content to be informative, unified and standardized number (10-digit), the photo posting is complete, and with the name of the person's identity card is consistent with the name of the person, and shall not be altered.
39, "new rural cooperative medical card" lost how to replace the card?
In the use of the process, the "cooperative medical card" shall not be transferred to the wrong, if lost or damaged, by the person to apply, the executive village committee introduced by the township co-management office audit, transferred to the county co-management office to replace.
40. How do migrant workers participate in cooperative medical care?
Outside workers to participate in the cooperative medical care in the place of domicile, hospitalized due to illness must be reported by phone, fax or letter to the county co-management office for the record, after discharge from the hospital with a certificate of discharge, a copy of medical records (stamped with the official seal of the hospital), hospitalization invoices, detailed list of costs and proof of employment, to the county co-management office review, transfer to the domicile of the health center for reimbursement of the subsidy procedures, if there are special circumstances If there are special circumstances, the next of kin can bring the relevant information to do the work on behalf of the family.
41. Can I get reimbursement in time? How much time can I get the reimbursement?
Yes, as long as the formalities are complete, it can usually be completed on the same day, and the reimbursement can be obtained after the completion of the formalities. If there are special circumstances that prevent you from being reimbursed on the same day, the staff will explain.
42、Faced with the new rural cooperative medical care what should we farmers do?
"The weight of life is more than a thousand pieces of gold", and human life is only once. The people pick up the wood and the flame is high. Farmers, let us *** with action, under the correct leadership of the new central government, with the ***, help each other, *** with the risk of major diseases, in the government's helping hand under the hand, with the majority of farmers of mutual help and love of the hand *** with the road to pave the way to health and happiness.
43, participate in the new rural cooperative medical system publicity song
Sunshine shines on the earth, the policy benefits ten thousand families. The new rural cooperative medical system is a guarantee of medical care.
Individuals pay less, the government makes up more, and the Civil Affairs Bureau subsidizes households with special difficulties.
Participating in the New Farmers' Cooperative Program, you will have subsidies for medical treatment, a lighter burden on your family, and health protection.
Listen to your fellow villagers, look at the ones who have received money, calculate the economic accounts, how are all cost-effective,
Early enrollment early benefit, not enrollment can not be supplemented, the policy is really good, we come to participate in the insurance.
44. New Rural Cooperative Funding Song
Spend three yuan a day to join the cooperative to protect your health, pay ten yuan individually, and the government will make up forty yuan.
Ten yuan, eight yuan, the family account deposit, the remaining two yuan, the big disease co-ordination fund.
Without illness, we can help others; with illness, we can help others; with cooperation and mutual assistance, we can guarantee medical care.
45, cooperative medical fund management propaganda song
Cooperative medical fund, health protection money, individuals do not pay money, the government will not make up.
The fund is set up as a special account, and its management and utilization are separated.
Please rest assured that the money will be used exclusively for the purpose, and the use of the fund will be publicized and monitored.
46, the participating farmers hospitalization publicity song
Selected points to see the doctor, bring all the documents, identity card, can not be missing.
Doctor's diagnosis, come to the Farmers' Cooperative Office, fill in the notification form, pay the deposit at the hospital,
Hospitalization to cure the disease, the prescription should be rewritten, the patient has to sign it, the cure is discharged from the hospital,
Payment of money to close the account, the bill to be settled, the hospital's cooperative management section, the reimbursement procedures.
47, the participating farmers hospitalization reimbursement rate publicity song
The township hospital, the proportion of 60, threshold fee of 80, the maximum reported 3,000.
County-level hospitals, the proportion is fifty, the threshold fee of two hundred, the maximum reported eight thousand.
Municipal hospitals live, the proportion is thirty-five, the threshold fee of eight hundred, the maximum reported ten thousand.
Provincial hospitals live, the proportion is thirty, the threshold fee of one thousand, the maximum reported twenty thousand.
How the reimbursement is calculated, the cost minus the threshold, minus the unreported, multiplied by the reimbursement ratio.
48、Participating farmers referral and transfer propaganda song
If you have a serious illness, you need to be transferred from one level to another, and the referral approval form should be filled out by the county hospital.
Coming to the Farmers' Cooperative Office, the approval procedures are completed, and the hospital is transferred to a fixed point for treatment of the disease.
When you are discharged from the hospital, you should bring five documents with you, a certificate of diagnosis and an invoice for settlement.
Discharge summary, full list of expenses, copies of medical records, hospital seal.
Bring all the information when you come, then go to the Agricultural Cooperation Office, fill out the notice, the health center reimbursement.
49, cooperative medical card use management publicity song
Cooperative medical card, stamped with a unified seal, photo posting full, name filled out.
The word is the same as ID card, don't change it, each family has a number, a **** ten digits.
After the reimbursement for medical treatment, the certificate book has a record. If the document is lost, go to the village committee,
open a letter of introduction, township audit, up to the Office of the co-management, come to the document replacement.
Extended reading: insurance how to buy, which is good, hand to teach you to avoid these insurance "pit"