The reimbursement process of the new rural cooperative medical system in Heilongjiang Province is divided into two categories, as follows:
First, see a doctor in this province.
See a doctor in this province, mainly for hospitalization and outpatient reimbursement. Please refer to the following figure for the process.
Two, medical treatment outside the province, the province's reimbursement reference is as follows.
Only hospitalization outside the province can be reimbursed, and outpatient service cannot be reported. When you need to go back to your hometown (insured place) for reimbursement, you probably need to go through the following procedures:
1, inpatient medical records
2. Cost list
3. Hospitalization invoice
4. Disease diagnosis
5, discharge summary
6. ID card and household registration book
7, cooperative medical book (or card, card)
8. Transfer procedure or certificate (work certificate or emergency certificate)
Does not belong to 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.
Reimbursement standard
( 1)
The reimbursement rate of designated medical institutions of the new rural cooperative medical system at township (district) level is 90%, and the deductible line is 100 yuan; The reimbursement rate of the designated medical institutions of the new rural cooperative medical system at the county (city, district) level is 70%, and the deductible line is 500 yuan; Counties, provinces and cities
The reimbursement rate of NCMS first-class designated medical institutions is 45%, and the deductible line is 800 yuan. Who did not refer to the county and provincial and municipal designated medical institutions for medical treatment, reimbursement of 25%, deductible 800 yuan; Just go outside the province.
Medical reimbursement 10%, deductible line 800 yuan, skip referral is not reimbursed.
(2) outpatient compensation for special diseases.
1, 5 special diseases. Chemotherapy and radiotherapy for malignant tumor, dialysis treatment for chronic renal failure, anti-rejection drugs after organ transplantation, systemic lupus erythematosus, chronic leukemia.
2. Compensation standard. The medical expenses incurred by outpatients suffering from the above five kinds of special and serious diseases shall be compensated according to the proportion of hospital grades, and the deductible line shall be deducted only once a year and reimbursed once every quarter, with the capping line 100000 yuan (including hospitalization medical expenses).
(3) outpatient compensation for chronic diseases
1、
2 1 chronic diseases. (1) hypertension; (2) diabetes; (3) coronary heart disease; (4) stroke; (5) Malignant tumor; (6) cor pulmonale; (7) Chronic heart failure; (8) tuberculosis; (9) Chronic
Obstructive pulmonary disease; (10) Hepatitis B; (1 1) rheumatic heart disease; (12) chronic nephritis; (13) liver cirrhosis; (14) Schizophrenia and affective psychosis; (15) epilepsy; (16) manufacturing
Blood diseases; (17) rheumatoid arthritis; (18) rheumatoid arthritis; (19) hyperthyroidism; (20) pancreatitis; (2 1) Asthma.
2. Diagnosis and treatment. slow
Patients with sexually transmitted diseases should be first diagnosed in the secondary designated medical institutions within their jurisdiction. The first-time doctors should fill in the chronic disease outpatient diary and the chronic disease outpatient list, and the staff of the designated medical institutions should register regularly.
Report to the municipal joint management office for the record. Patients with chronic diseases must go to the designated medical institutions designated by the municipal joint management office for medical treatment with the "Chronic Disease Outpatient Medical Record" and "Chronic Disease Outpatient Card", and go to the designated medical machines in provinces and cities for medical treatment due to illness.
Outpatient treatment building shall be approved by the municipal joint management office.
(4)
) Lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction, cerebral infarction, hemophilia, type I diabetes, hyperthyroidism, cleft lip and palate, phenylketonuria, hypospadias 14.
Major diseases are included in the compensation scope of the new rural cooperative medical system, and the implementation time is 1 year. The reimbursement standard is 70% of the total expenses of designated medical institutions, and major diseases treated in hospitals at or below the county level are reimbursed in hospitals at or below the county level.
Reimbursement is allowed, and patients only need to pay the highest medical expenses promised by the hospital as hospitalization deposit. The promised hospitals shall not ask patients to pay more for any reason. When the cost during the treatment exceeds the promised cost, medical treatment will be carried out.
Acting as agent for temporary advance payment. A total of ***22 kinds of serious diseases must be screened by designated medical institutions in counties (cities, districts), and referred by the local cooperative medical management department according to the actual situation (other referral methods are invalid).
The designated hospitals that won the bid will treat those who have corresponding surgical indications according to the clinical path of the disease, and all those who need medical treatment will be treated according to the clinical path of the disease. Aids patients should be diagnosed first.
Third-level hospitals or provincial and municipal disease control institutions issue diagnosis certificates, cooperative medical institutions issue referral certificates, and patients go to designated hospitals for medical treatment.
File source
Notice of Health Department of Heilongjiang Province and Finance Department of Heilongjiang Province on Doing a Good Job in Collecting Farmers' Personal Expenses in 20 12 (Heiwei Agricultural Development [201] No.644) and Order of Harbin Municipal People's Government (No.228).
Measures for the Administration of New Rural Cooperative Medical System in Harbin and Notice of Harbin New Rural Cooperative Medical System Coordination Leading Group on Doing a Good Job in New Rural Cooperative Medical System in 20 12 years (1 1No.).
"20 13 New Rural Cooperative Medical Scheme for Serious and Extraordinary Diseases" (for Trial Implementation)