1. The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban workers (i.e. effective medical expenses).
Two, the new rural cooperative medical fund payment Qifubiaozhun and maximum payment limit. The hospitalization expenses below the annual deductible line of the hospital shall be paid by the individual. If the Qifubiaozhun is reached in the same overall period, the hospitalization expenses incurred by two or more hospitalizations can be reimbursed cumulatively. The hospitalization expenses exceeding Qifubiaozhun shall be calculated in sections and reimbursed cumulatively, and there is a maximum amount of accumulative reimbursement per person per year.
What are the special diseases reimbursed by the new rural cooperative medical fund?
(1) Chemotherapy and radiotherapy for malignant tumors;
(2) Hemodialysis and peritoneal dialysis for severe uremia;
(3) Anti-rejection therapy after tissue or organ transplantation;
(4) Schizophrenia with mental decline;
(5) Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system);
(6) Aplastic anemia;
(7) Anticoagulation therapy after cardiac surgery.
Not included in the reimbursement scope of the new rural cooperative medical system?
(a) the outpatient medical expenses of designated hospitals in non-co-ordination areas (except for outpatient treatment expenses for special diseases), and the expenses incurred by failing to seek medical treatment according to regulations and purchasing medicines by themselves;
(two) the cost of family planning measures and medical expenses in violation of the family planning policy;
(three) dental implants, orthodontics, optometry glasses, hearing AIDS, artificial organs, beauty therapy, cosmetic surgery, rehabilitation (such as qigong, massage, physical therapy, magnetic therapy, etc.). ), as well as various accompanying expenses, medical transportation expenses, home visits and other miscellaneous expenses during hospitalization;
(4) If there is a third party's liability, the medical expenses incurred due to personal injury, such as traffic accidents, medical accidents and work-related injuries, shall be borne by the third responsible person according to law.
(five) medical expenses caused by illegal acts such as suicide, self-mutilation, taking poison, taking drugs, fighting and other intentional acts of their families;
(six) medical expenses incurred during going abroad or staying in Hong Kong, Macao and Taiwan;
(seven) drugs and articles that are not reimbursed according to the medical insurance system for urban workers;
(eight) other expenses determined by the District Medical Management Committee.
Legal Basis: Opinions of the Ministry of Health on Standardizing the Physical Examination of the New Rural Cooperative Medical System Article 4 Conditions of Medical Institutions Undertaking the Physical Examination of the New Rural Cooperative Medical System In principle, medical institutions with strong service capacity shall be selected from the designated medical institutions of the new rural cooperative medical system at the county and township levels as medical institutions undertaking the physical examination of the new rural cooperative medical system, and service agreements shall be signed to clarify the quantity and quality of the physical examination and the rights and obligations of both parties. Medical institutions undertaking the health examination of the new rural cooperative medical system should have instruments and equipment (electrocardiogram, B-ultrasound, X-ray machine, biochemical analyzer, etc. ) It is suitable for health examination, has a sufficient number of medical personnel with corresponding professional qualifications, and can follow the corresponding technical operation specifications. Medical institutions undertaking the health examination of the new rural cooperative medical system should reasonably set up medical examination posts according to the health examination items, and each health examination item should be equipped with at least 1 person (including at least 2 medical examination items). Personnel engaged in physical examination should have knowledge and experience related to health examination and prevention and treatment of common diseases among rural residents, and should define management responsibilities and determine corresponding management and quality control personnel.