1. What is the reimbursement rate for hospitalization of the new rural cooperative medical system?
1, town hospital 60%, secondary hospital 40%, tertiary hospital 30%;
2. The operation expenses within 1 ,000 yuan shall be reimbursed according to national standards, and those exceeding 1 ,000 yuan shall be reimbursed according to1,000 yuan;
3. The hospitalization expenses and nursing expenses of the elderly over 60 can be reimbursed every day 10 yuan, and at most, 200 yuan can be reimbursed;
4, ECG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic vibration and other auxiliary examination items are reimbursed to 200 yuan at most.
Second, the proportion of reimbursement for serious illness in the new rural cooperative medical system
1, the proportion of overall subsidies for township and village clinics increased to 65% and 75% respectively;
2, a medical institution hospitalization expenses below 400 yuan, no deductible;
3, secondary medical institutions to increase the proportion of subsidies to 75% ~ 80%;
4, the proportion of tertiary medical institutions subsidies increased to 55% ~ 60%;
5, the proportion of provincial tertiary medical institutions subsidies increased to 55%;
6. Eight kinds of serious diseases, such as congenital heart disease in children, 70% of the subsidized diseases of the new rural cooperative medical system, 12 kinds of serious diseases, such as lung cancer, and 70% of the subsidized diseases of the new rural cooperative medical system.
Three, the new rural cooperative medical reimbursement need to prepare what materials?
The reimbursement of the new rural cooperative medical system is divided into outpatient reimbursement and hospitalization reimbursement, and the reimbursement materials related to special diseases are also different:
1, outpatient reimbursement data: outpatient invoice, cooperative medical certificate calendar (or medical record);
2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate calendar (or medical record), detailed list of expenses, discharge summary, and other relevant certificates;
3, outpatient special disease reimbursement information: outpatient invoices, special disease cooperative medical certificate calendar;
4. Information for handling special diseases: proposal for outpatient treatment of special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and two photos.
Legal basis:
Article 28 of the Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 26 of the Social Insurance Law
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.