8 participants in hospital medical expenses subsidies paid in accordance with the following provisions:
① The hospitalization expenses of patients are limited by single disease, and the scope of drug subsidies is calculated and paid with reference to the basic drug list of new rural cooperative medical care in Hunan Province. The deductible line and subsidy standard of hospitals at all levels are as follows: the deductible line of township hospitals (health centers) and county mental hospitals is 100 yuan, and the subsidy is 50%; The deductible line of county traditional Chinese medicine hospital and county maternity hospital is 200 yuan, and the subsidy ratio is 40%; 300 yuan, the deductible line of the Second People's Hospital of the county, with a subsidy ratio of 40%; County People's Hospital deductible line 300 yuan, the subsidy ratio is 35%; The deductible line of downtown hospital 1000 yuan, and the subsidy ratio is 30%; The deductible line of provincial hospitals (Grade III A hospitals) is 1500 yuan, and the subsidy ratio is 25%.
(2) large medical expenses limit reimbursement, that is, each person's medical expenses subsidy does not exceed 4,000 yuan, and the annual cumulative amount does not exceed 6,000 yuan. Under special circumstances, an application is made by the patient, and the township joint management station or the joint management department of the managed medical institution submits a written report to the county joint management office, which may be appropriately relaxed with the approval of the county cooperative medical care coordination management committee, but the annual cumulative amount shall not exceed1.20 thousand yuan. During the start of the project, tuberculosis patients who meet the conditions for free treatment of tuberculosis will be diagnosed and treated according to the provisions of the project county, and all hospitalized tuberculosis patients will be subsidized according to these measures.
(3) Families participating in the cooperative medical system, who do not enjoy the annual hospitalization subsidy, can go to their town or designated cooperative medical institutions for one-person free routine physical examination. Physical examination items include blood pressure, pulse, internal medicine, surgery, facial features and other physical examinations; According to the physical condition, you can choose one of blood routine, urine routine, chest X-ray, electrocardiogram and hepatitis B surface antigen detection. The medical examination fee shall be subsidized to the hospital, and the subsidy standard shall be stipulated separately.
(4) Who participated in the cooperative medical care, the implementation of outpatient fixed subsidies, 5 yuan subsidy per person per year (not to individual contributions).
9, the participants in the county designated medical institutions hospitalization medical expenses subsidies to implement the principle of "pay first". Participants need to be hospitalized. With the "Anhua County New Rural Cooperative Medical Certificate", patient ID card (or household registration book) and village committee certificate, go to the designated hospital for admission procedures (emergency patients can complete the relevant procedures after admission, and the village committee certificate will be kept by the designated hospital for inspection). When leaving the hospital, apply for payment of hospitalization subsidy at the rural cooperative medical subsidy window set up by medical institutions. The designated hospital handling personnel shall examine and approve the subsidy amount according to the deductible line, subsidy proportion and capping line, and pay it immediately.
10, in the "instant subsidy" of designated medical institutions, the maximum approval authority for the payment of hospitalization medical expenses in township hospitals (health centers) does not exceed 1000 yuan, and the county-level hospitals do not exceed 2000 yuan. If the amount exceeds the above-mentioned provisions, the personnel in charge of the designated hospital shall submit the patient's medical record, expense list and other related materials to the county joint management office for examination and approval, and pay in the original designated hospital within one week.
1 1, the designated medical institutions in the county should report to the county joint management office the monthly and annual reports on the payment of hospitalization medical expenses subsidies that occurred in the designated medical institutions last month and last year.
12, township designated medical institutions in the first half of each month in the unit posting last month's cooperative medical subsidies. The published contents include name, age, gender, detailed address, illness, hospitalization expenses, subsidy payment amount, etc.
13. The subsidy for hospitalization expenses of cooperative medical care in designated medical institutions shall be audited and settled once a month by the handling personnel in the county joint management office.
14. When the handling personnel of the designated medical institutions in the county go to the county joint management office to review and settle the paid subsidy payment fees, they should provide the accurate name and detailed address of the head of the household, the patient's complete hospitalization medical records, the expense list, the original hospitalization bill (returned to the designated medical institutions after the hospitalization medical records are reviewed), the hospitalization expense subsidy application form signed by the hospitalized patients, and affix the official seal of the designated medical institutions.
15. The subsidy for hospitalization expenses provided by designated medical institutions to the county joint management office must be complete and true, otherwise it will not be confirmed.
16. The non-annual settlement system shall be implemented for all participants' hospitalization medical expenses subsidies.
17. Designated medical institutions and handling personnel must be familiar with the Catalogue of Essential Drugs of New Rural Cooperative Medical System in Hunan Province, the Catalogue of Hospitalized Diseases of New Rural Cooperative Medical System in Hunan Province and their exclusions. In case of subsidy errors, the designated medical institutions shall bear corresponding responsibilities.
18. Participants were hospitalized in medical institutions outside the county. Within two months after discharge, you must hold your cooperative medical certificate, head of household and ID card (or household registration book), disease certificate, expense list and hospitalization invoice to the county joint management office to receive hospitalization medical expenses subsidy. Overdue and incomplete procedures, the county joint management office will not apply for subsidies.
19. When the designated medical institutions apply for hospitalization expenses subsidies, they should keep the original hospitalization expenses documents and related materials. At the same time, if participants in commercial insurance need original bills and related materials, designated medical institutions can provide them to participants, but copies of the original bills and related materials should be kept. The copy should be signed by the person in charge of the agency, the person in charge of the medical institution and the patient himself.
20. The subsidy standard for hospital delivery of the participating objects is flat delivery per case in 200 yuan, and the hospital delivery is paid by the designated medical institutions in the county; Newborns who did not participate in that year will not be subsidized for medical expenses. Pathological obstetrics that meet the indications of cesarean section and have prenatal, intrapartum and postpartum complications shall be implemented according to the subsidy standard of hospitalization medical expenses, but they shall not enjoy the subsidy of hospitalization delivery in 200 yuan.
2 1. The admission and discharge standards and average hospitalization days of the participants shall be implemented according to the standards issued by the Ministry of Health. According to the illness should be discharged from the hospital, the hospital medical institutions and county joint management office notice without justifiable reasons refused to leave the hospital, since the date of notification, no subsidy for all expenses.
22, participants need to take medicine after discharge consolidation treatment, the amount of drugs in county hospitals shall not exceed 80 yuan, in township hospitals shall not exceed 50 yuan, beyond the part is not included in the scope of subsidies.
23. The auxiliary inspection items of the county joint management office for designated medical institutions shall be inspected regularly or irregularly in accordance with the "Detailed Rules for the Evaluation of Hospital Classification Management Standards in Hunan Province", and the positive rate of auxiliary inspection items shall not be lower than the prescribed standards.