1.What is the individual contribution standard for participating farmers in Chang'an District, Xi City in 2018?
●Answer:The individual contribution standard for farmers is:190 yuan per person.
2.What is the reimbursement rate for urban and rural residents' health insurance designated hospitals?
●Answer:The designated hospitals are divided into three levels: provincial, municipal and district.
(1)Provincial level 3 hospitals starting line 3000 RMB/person, hospitalization reimbursement ratio is 55%, children and college students reimbursement ratio is 60%;
(2)Municipal level 3 hospitals starting line 2000 RMB/person, hospitalization reimbursement ratio is 65%, children and college students reimbursement ratio is 70%;
(3)Provincial, municipal, and district hospitals starting line is 400 RMB/visit The hospitalization compensation ratio is 75%, and 80% for children and college students;
(4) The starting line for first-level hospitals (including community health centers and street health centers) is RMB150 per visit, the hospitalization compensation ratio is 85%, and the compensation ratio for children and college students is 90%.
3. What is the percentage of hospitalization compensation for the elderly?
●Answer:The hospitalization reimbursement ratio is 90% for people over 80 years of age (including 80 years of age) in first-level medical institutions, and 80% in second- and third-level medical institutions; the hospitalization reimbursement ratio for people over 90 years of age (including 90 years of age) in first-, second- and third-level medical institutions is 90%.
4. Under what circumstances is the referral form not required?
●Answer:The following nine cases do not need a referral form, you can be directly hospitalized in the tertiary designated hospitals, the normal enjoyment of health insurance compensation:
(1) Pregnant women;
(2) children under the age of five;
(3), the elderly over the age of 65;
(4) malignant tumors;
(5) critically ill;
(6) emergency treatment;
(7) postoperative follow-up;
(8) special diseases (tuberculosis, infectious diseases, mental illness);
(9) ophthalmology patients.
5. How do I get reimbursed for hospitalization of college children?
Answer:5% increase on the original hospitalization reimbursement rate.
6. How are cancer patients reimbursed for radiotherapy?
●Answer:For enrolled patients who need radiotherapy, if they receive consecutive radiotherapy at the same designated medical institution in the same year, the starting line will be set only once, and no starting line will be set for subsequent radiotherapy. Patients who have applied for outpatient chronic disease will be reimbursed according to the outpatient chronic disease policy if the hospitalization cost of continuous radiotherapy does not reach the hospital's starting line.
7. How are children and college students reimbursed for outpatient expenses due to fractures and other accidental diseases?
●Answer:Children and college students are included in the reimbursement of dependent medical expenses during outpatient treatment due to bone fracture, joint dislocation, and respiratory foreign body. There is no starting line and the compensation rate is 70%. The maximum annual compensation limit is 1,500 yuan.
Question 8. How are patients hospitalized for tuberculosis and mental illness reimbursed?
●Answer:For general tuberculosis hospitalized patients, the reimbursement ratio has been increased to 70% in the designated hospitals of tertiary comprehensive (specialized) hospitals; the starting line for psychiatric hospitalized patients in the designated hospitals of tertiary comprehensive (specialized) hospitals is 500 yuan, and the reimbursement ratio is in accordance with the standard of tertiary hospitals.
Question 9: How will the insured be reimbursed if they need to be referred to a tertiary designated hospital due to illness and are not referred?
●Answer:If the original NCMS enrollees go directly to the tertiary designated hospitals without referral, the reimbursement ratio will be reimbursed by 30% lower than the original reimbursement ratio.
Question 10: What is the outpatient reimbursement ceiling?
●Answer:Based on the number of participants in a family, reimbursement will be capped on a per-family basis, common to the whole family, and paid in full.
Question 11: What are the reimbursement rates for street health centers, community service centers, social level medical institutions, and village health centers?
●Answer:70% of medical expenses (excluding out-of-pocket expenses) within the current outpatient reimbursement scope are reimbursed by street health centers, community service centers, and social first-class medical institutions, and 80% are reimbursed by village health offices.
Question 12: Is the fee for a simple medical checkup reimbursed?
●Answer:Simple physical examination and laboratory tests are not reimbursed. However, those who are admitted directly after outpatient diagnostic tests are covered for reimbursement.
Question 13: Are there outpatient reimbursements for secondary and tertiary care facilities?
●Answer:No reimbursement. Outpatient reimbursement is limited to designated street health centers, community service centers, social level 1 medical institutions and designated village health centers.
Question 14: What are the dosage requirements in the prescription?
●Answer:Prescription dosage is appropriate for one day and limited to three days. Chronic diseases or special cases can be extended appropriately, usually not more than seven days, and no hitchhiking drugs unrelated to the disease should be prescribed.
Question 15.Is it necessary to keep the joint treatment book in the healthcare facility for a long time for outpatient reimbursement?
●Answer:The designated medical institutions are not allowed to accumulate joint treatment certificates of the participants for any reason in order to clear the accounts.
Question 16: Can the balance in the outpatient co-ordination account be carried forward to the next year?
●Answer:No. The purchase of disease-free medicines is strictly prohibited.
Question 17: What do you mean by 'Outpatient Reimbursement Direct'?
●Answer:Participating patients can choose to visit designated medical institutions for outpatient reimbursement in the whole region, and receive outpatient reimbursement subsidies on the same day of the visit.
Question 18: What are the outpatient lithotripsy medical institutions in the region? What is the reimbursement rate?
●Answer:There are 10 designated institutions:
(1) Chang'an District Hospital;
(2) Xi'an Aerospace General Hospital;
(3) Nuclear Industry 215 Hospital;
(4) Shaanxi Provincial Transportation Hospital;
(5) Xi'an Jiren Hospital;
(6) Taihe Hospital;
. p>(7) Chang'an District Dachan Hospital;
(8) Xi'an Qikang Hospital of Integrative Medicine;
(9) Chang'an Youyi Hospital;
(10) Shaanxi Forestry Hospital.
Expenses incurred by enrolled patients for extracorporeal lithotripsy in outpatient clinics of the above hospitals will be reimbursed at a rate of 70% per outpatient visit, with the total amount of reimbursement per person not exceeding the maximum line for the entire household (x150 yuan for the number of enrolled households).
Question 19: What do you understand by 'general medical expenses'? How do you define 'general medical expenses' for the poor?
●Answer:According to the document forwarded by Xi Municipal Health Bureau (No. 396 of Shaanxi Health Regulation [2011]), the policy of general medical expenses of the New Rural Cooperative will be implemented for all street (center) health centers, village health offices, and community health service centers (stations) that have been equipped with the use of basic medicines to realize the zero-differential rate of sales. In street (center) hospitals and urban community health service centers, each person pays 1 yuan out-of-pocket for outpatient care, and 9 yuan out-of-pocket for the New Farmers' Cooperative; in village health offices and community health service stations, the individual pays 0.5 yuan out-of-pocket, and the New Farmers' Cooperative pays 4.5 yuan out-of-pocket. The portion paid by the New Rural Cooperative is covered by the outpatient co-ordination fund within the family's ceiling line. The general medical expenses in the outpatient co-ordination for the poor are fully reimbursed by the New Farmers' Cooperative, and the personal burden is eliminated.
Question 20: Where is the hospitalization reimbursement for Chang'an District Hospital? What percentage?
●Answer:Reimbursement is made on the same day after discharge at the hospital's comprehensive treatment department. The starting line is 400 RMB per visit and the reimbursement rate is 75%.
Question 21: Why can't I get direct reimbursement for outpatient chronic diseases at PTU?
●Answer:Since the First Affiliated Hospital of Jiaoda has not implemented the outpatient chronic disease direct reimbursement, patients can take their ID cards, chronic disease booklets, hospital invoices, medical records, prescriptions and other relevant information to the health centers in the place of domicile for reimbursement.
Question 22: Why did you spend more than 4,000 yuan to have a baby at the Aerospace Hospital, and only 380 yuan was reported for comprehensive treatment? Did you report it?
●Answer:Deliveries are covered by a flat-rate reimbursement, with normal deliveries covered at a flat rate of 380 yuan and cesarean deliveries covered at a flat rate of 800 yuan. The reimbursement is correct.
Question 23: Why can't I get reimbursed for my baby's hospitalization at Tianyou Hospital?
●Answer:Tianyou Hospital is not a provincial or municipal tertiary designated medical institution, so it can't be reimbursed (except for serious illnesses).
Question 24: Why can't I be reimbursed for my hospitalization at Xijing Hospital directly?
●Answer:Because Xijing Hospital does not have a through train, so you cannot be reimbursed directly. Please bring the relevant documents to the local hospital for reimbursement after you are discharged from the hospital.
Question 25.I am a farmer in Chang'an District. I work in other places. Now I am hospitalized due to illness. Can I be reimbursed after discharge? How can I report it?
●Answer:You can report it. Reimbursement is made at the Joint Treatment Unit of the health center where you are domiciled.
Required:Copy of hospitalized medical record, original invoice, list of expenses, proof of employment or local residence, certificate of joint treatment, ID card, questionnaire on the cause of accidental illness.
Question 26: What is the process of reimbursement for major illnesses? How long does it take for the money to come down?
●Answer:You need to provide the hospitalization invoice, the first page of the medical record, the list of expenses, the application form for reimbursement of the New Farmers' Cooperative, the ID card, the certificate of joint treatment, and the bankbook.
For more information, please call 029-85285273.
Question 27. Sorry, my family is from Chang'an District. I saw a doctor at the Provincial Hospital of Traditional Chinese Medicine and was referred by the Chang'an District Hospital. Where do I go to report the bill?
●Answer:Provincial Hospital of Traditional Chinese Medicine does not have a through train. Please bring the relevant information to the Hopital Therapy Section of the township health center where your household registration is located for reimbursement.
Question 28: How long will it take to get reimbursed after discharge from the comprehensive treatment?
●Answer:For through-train designated hospitals, reimbursement will be made on the day of discharge. Non-through-train designated hospitals go to the township health center where the household is located for reimbursement, and the payment will take about 3 months.
Question 29: When is the annual review for chronic diseases?
●Answer:The annual review takes place at the beginning of two years. Patients can apply for annual review at any time during the review year. Anyone who remains inactive beyond the specified period is considered willful and must reapply for accreditation.
Question 30: What information do I need to provide for the annual review of chronic diseases?
●Answer:For the annual examination, patients are required to provide a diagnosis certificate issued by the attending physician of the designated medical institution of the second level or above, a joint treatment certificate, and an ID card.
Question 31: What is the reimbursement rate for chronic disease reimbursement?
●Answer:The compensation ratio is 65%.
Question 32.What is the maximum reimbursement for chronic diseases?
●Answer:
The maximum reimbursement for _class outpatient special chronic diseases is 20,000 yuan per year/person;
The maximum reimbursement for _class outpatient special chronic diseases is 0.8 million yuan/person/year;
Three-class outpatient special chronic diseases are reimbursed up to 0.5 million yuan/person/year.
Question 33: What information must be provided for chronic disease reimbursement?
●Answer:Valid invoice issued by the designated medical institution (invoice or receipt), relevant outpatient medical records corresponding to the invoice, outpatient medical record book of special chronic diseases, *** proof of treatment, and ID card.
Question 34: Do I need to provide information to apply for chronic disease identification?
●Answer:The information required to apply for the identification of _category chronic diseases:Within two years (within 24 months from the date of application), electronic inpatient medical records of the designated medical institutions above the second level (the first diagnosis is the same as the chronic disease applied for), the proof of joint treatment, ID card, two recent 1-inch color photos;
The information required to apply for the identification of category II and category III chronic diseases:Within one year (within 12 months from the date of application) ) electronic inpatient medical records of designated medical institutions at or above the second level (the first diagnosis is consistent with the application of chronic diseases), proof of joint treatment, ID card, two recent 1-inch color photos.
Question 35: Where to apply for special chronic disease outpatient medical certificate for mental illness?
●Answer:Xi'an Ten Hospital and Xi'an Ankang Hospital.
Question 36.How many medicines are reimbursed for coronary heart disease?
●Answer:No more than 3 drugs are reimbursed for coronary heart disease.
Question 37.Can I be reimbursed for hypertension checkups?
●Answer:Examination fees are reimbursed, but no more than one type of examination is reimbursed.
Question 38.Can I be reimbursed for treatment of chronic pulmonary heart disease at the First Affiliated Hospital of Jiao Tong University?
●Answer:You can be reimbursed. Go back to the township health center where your hukou is located for reimbursement.
Question 39: How can a patient be reimbursed for blood transfusion if he is hospitalized?
●Answer:If whole blood and component blood are used, 60% will be included in the reimbursement scope of the New Rural Cooperative.
Question 40: How to reimburse hospitalization in different years?
●Answer:The reimbursement of hospitalization expenses for patients in different years will be settled according to the date of discharge, and the reimbursement policy and relevant regulations of the second year will be implemented; the reimbursement of hospitalization expenses for patients who have not been insured continuously will be implemented according to the reimbursement policy and relevant regulations of the year of insurance participation.
Question 41: An elderly person suddenly fell seriously ill and was sent to the hospital for resuscitation. How can I get reimbursed for the cost of resuscitation?
●Answer:Participating patients whose pre-hospital resuscitation is ineffective and who have not been hospitalized are required to provide complete emergency medical records, outpatient bills, cost lists, and death certificates. After deducting the starting line, their medical expenses can be subsidized according to the hospitalization reimbursement standard of the corresponding designated hospital.
Question 42: Are newborn babies reimbursed for vaccinations?
●Answer:The hospitalization reimbursement for newborn babies only includes basic medical expenses such as hospitalization, consultation, examination and medicine. but does not include living expenses (milk powder, diapers, etc...) and other life-related expenses (baby commemorative book, commemorative coins, photos, video camera, umbilical cord cutting, umbilical cord blood preservation, fetal hair souvenirs, etc.). and preventive health care and medical checkups.
Question 43.I am enrolled in United Therapeutics and my company provides health insurance for its employees. How will I be reimbursed if I get sick?
●Answer:Participate in the residents' health insurance or employees' health insurance and other national public **** financial subsidy nature of health insurance, participate in the New Farmers' Cooperative Program for farmers, according to the Provincial Health Commission can only enjoy one.
Question 44: What is the deadline for funding for combination therapy?
●Answer:December 31 each year is the deadline for funding.
Question 45.What is the deadline for payment of the Combined Therapy for newborns born in December?
●Answer:Extended until January 20 of the following year.
Question 46: What information do I need to carry with me for the payment of joint treatment for newborns?
●Answer:My household's Household Register and Joint Treatment Certificate.
Question 47: What are the conditions for marriage, relocation and treatment in this province?
●Answer:The Hukou has been moved from place A to place b in the year of marriage, the fees have been paid in place A, and you are living in place b.
Question 48: What documents are required for marriage relocation?
●Answer:Marriage certificate, hukou, joint therapy certificate, ID card, and certificate of joint therapy relocation issued by the district and county joint therapy offices in Shaanxi Province.
Question 49: What documents are needed to reissue a joint treatment certificate?
●Answer:A certificate of replacement of the lost certificate issued by the street office, the household account book of the household or the ID cards of all the people.
Question 50: What is the office address of the Chang'an District Healing Center?
●Answer:17 East Chang'an Street, Quwei Street, Chang'an District (northeast corner of the old district government cross, the first floor of North Road 150m east of the cross).
Million car purchase subsidy