1. Individual payment standards: To raise funds for the new rural cooperative medical system, the central and provincial finances will subsidize 360 ??yuan, and the individual payment will be 90 yuan.
2. Outpatient reimbursement standards: There is no deductible for outpatient reimbursement. Village-level designated medical institutions are reimbursed at a rate of 45%; township-level designated medical institutions are reimbursed at a rate of 40%; county-level Chinese herbal medicine prescriptions (except Chinese herbal medicine granules without decoction) are reimbursed at a rate of 45%. Compensation and reimbursement will be carried out at a rate of 40%, and the annual cumulative payment cap is 300 yuan/person.
3. Hospitalization deductible and compensation and reimbursement ratio:
4. What issues need to be paid attention to when enjoying the new rural cooperative medical care policy?
1. The person, certificate, and card must be consistent, and it is strictly prohibited to impersonate or falsely hospitalize to obtain New Rural Cooperative Medical System funds.
2. When outpatient reimbursement, you need to provide: the original prescription, invoice, medical card (Xiangyun County Resident Health Card) and ID card (or household registration book) original and copy.
3. Documents required for hospitalization reimbursement: original hospitalization list and invoice (copies are invalid), original and copy of ID card (or household registration book), medical card (Xiangyun County Resident Health Card), original discharge certificate, etc.
4. Anyone who is hospitalized in a designated medical institution at the provincial or state level must go through the county joint management office for referral approval. For those who are hospitalized in designated medical institutions at the state or provincial level without the approval of the county joint management office, the reimbursement rate will be reduced by 10% on the basis of regulations, that is, the state level will be reimbursed at a rate of 40%, and the provincial level will be reimbursed at a rate of 35%. proportion of reimbursement.
5. For hospitalization in designated medical institutions outside the county that have not been approved by the Yunnan Provincial Health and Family Planning Commission and the Dali Prefecture Health Bureau, the minimum payment line is 800 yuan and the reimbursement rate is 30%.
6. If migrant workers are hospitalized in designated medical institutions at the provincial or state level, they can be reimbursed at the proportion stipulated in the policies of designated medical institutions at the provincial or state level if they present one of the local temporary residence certificates, unit certificates, and business license copies. Dali Huashan Eye Hospital reimburses according to the county-level hospital reimbursement policy.
7. Those who are hospitalized outside the county in a private hospital that is a designated medical institution without approval from the Yunnan Provincial Health and Family Planning Commission and the Dali Prefecture Health Bureau will not be eligible for reimbursement from the critical illness insurance after the New Rural Cooperative Medical System is reimbursed.
5. Which diseases can be included in the reimbursement scope for special diseases and chronic diseases?
The types and scope of 5 special diseases: malignant tumors (including various cancers, sarcomas, and leukemias), chronic renal failure, anti-rejection treatment after organ transplantation, systemic lupus erythematosus, and aplastic anemia.
16 types and scope of chronic diseases: mental illness, epilepsy, Parkinson's disease (paralysis shaking), coronary heart disease, bronchiectasis (including bronchial asthma), pulmonary heart disease, chronic heart failure, cerebrovascular accidents (including cerebral hemorrhage, cerebral infarction, brain atrophy), diabetes, liver cirrhosis, senile prostatic hyperplasia (II0, III0), chronic glomerulonephritis (including nephrotic syndrome), tuberculosis requiring clinical treatment, chronic active hepatitis, rheumatoid arthritis, Hyperthyroidism (hypothyroidism).
6. How to apply for the new rural cooperative medical treatment certificate for special diseases and chronic diseases? What is the compensation and reimbursement standard?
Patients suffering from the above special diseases and chronic diseases must submit an application in person, attach proof of illness in the past two years, and have it signed by a designated medical institution above the second level (psychiatric patients must be signed by Dali Prefecture Psychiatric Hospital), and report to the county joint management It is valid only after approval and is valid for two years. The dosage of prescription drugs in outpatient clinics for chronic diseases shall not exceed one month, and for special diseases it shall be extended to two months.
When the total outpatient expenses for the year exceed one year, the county joint management office will be reimbursed as one hospitalization at the county level. During the review, the prescription, original invoice, original and copy of ID card (or household registration book), and medical card (Xiangyun County Resident Health Card) are required. ). The capped line for outpatient reimbursement for 5 special diseases shall not exceed 40,000 yuan; the capped line for outpatient reimbursement for 16 chronic diseases shall not exceed 3,000 yuan. If the same patient suffers from multiple chronic diseases, for each additional disease type, the cap line will increase by 1500 yuan.
7. What is the reimbursement ratio for special examinations, special treatments and special materials?
1. CT, color Doppler ultrasound, DR, DDR, electronic gastrointestinal endoscopy, MRI examination and other examination items exceeding 50 yuan will only be reimbursed 1 times on a pro-rata basis.
2. Special treatment items such as Gamma Knife and Extracorporeal Vibration Lithotripsy are reimbursed proportionally after paying 20% ??out of pocket. Hyperbaric oxygen chamber treatment is reimbursed on a pro-rata basis for one course of treatment (within 10 times).
3. Medical materials: Imported and domestic consumables required for hospitalization in designated medical institutions in the county with an amount of less than 200 yuan (including 200 yuan) are included in the scope of reimbursement; imported consumables with an amount of more than 200 yuan are not reimbursed. If the total cost of domestic materials exceeds 10000 yuan (excluding 10000 yuan), the part exceeding 10000 yuan will be reimbursed after paying 50% out of pocket. If the reimbursement review outside the county cannot determine whether domestic or imported materials are made, they will be treated as imported materials.
8. What are the scope of non-reimbursement under the New Rural Cooperative Medical System?
1. Drug fees beyond the scope of the "Yunnan New Rural Cooperative Medical Care Essential Drug Catalog (Revised Edition)" and the "National Essential Drug Catalog".
2. Expenses not included in the "Basic Drug Catalog of New Rural Cooperative Medical Care in Yunnan Province (Trial)".
3. Outpatient medical expenses for treatment outside the county, excluding chronic diseases.
4. Chronic disease outpatient Chinese herbal medicine expenses and outpatient expenses at private designated medical institutions not approved by the Yunnan Provincial Health and Family Planning Commission and the Dali Prefecture Health Bureau.
5. Medical expenses for which there is a third party or other liability for compensation, expenses that should be borne by the doctor due to medical accidents or disputes.
6. Outpatient pregnancy check-up, premarital check-up, physical examination, family planning surgery fees, medical expenses arising from unmarried births and superbirths in violation of family planning policies, and infertility diagnosis and treatment expenses.
7. Various expenses borne by the public health department.
8. Medical expenses incurred due to alcoholism, drug use, poisoning of responsible persons, suicide, self-mutilation, fights, injuries caused by motor vehicles (including battery cars and mopeds), etc.
9. Injuries caused by violations of laws and regulations and medical expenses incurred during detention, arrest, and sentence.
10. Non-medical expenses: such as insurance premiums, escort fees, accompanying guests’ utility bills, accompanying guests’ bed and chair fees, air-conditioning fees, consultation fees, labor fees for self-invited consulting doctors, transportation fees, emergency vehicle fees, nutrition fees and other miscellaneous expenses.
11. Non-basic medical expenses: various non-therapeutic beauties, plastic surgery, hair dyeing, body odor treatment, installation of prostheses, dentures, artificial eyes, wigs, vision correction, hearing aids, walking aids, crutches, wheelchairs, etc. All expenses for various weight loss, weight gain, height gain and other programs. Expenses incurred for unapproved orthotics and orthodontics.
12. Unapproved various health care, massage, physiotherapy, magnetic therapy and other treatment expenses and the expenses of various self-use medical equipment.
13. Patients use disposable consumables such as urinals, basins, buckets, disposable changing pads, diapers, toilet paper, shoe covers, clean bags, etc.
14. Medical expenses incurred by participating people overseas (including Hong Kong, Macao and Taiwan).
15. Auxiliary examinations that are not related to definite diagnosis, differential diagnosis, chief complaint and changes in condition.
9. Treatment flow chart for patients with the New Rural Cooperative Medical System in Xiangyun County People’s Hospital
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