First, the proportion of reimbursement for rural cooperative medical care in Linyi, Shandong Province
1. Reimbursement scope: It conforms to the reimbursement scope stipulated by the new rural cooperative medical system, and even expenses arising from emergency, outpatient and hospitalization in different places can be applied for reimbursement.
2. Reimbursement ratio:
(1) outpatient reimbursement
(1) The reimbursement rate for general outpatient service is 50%, and each person will be reimbursed in 80 yuan every year;
(2) The maximum reimbursement for outpatient observation is 30 yuan, 1 1,000 yuan per year;
(3) The reimbursement rate for outpatient serious illness is 50%, and patients with cirrhosis, cerebral thrombosis and sequelae of cerebral hemorrhage, rheumatoid arthritis (active stage), femoral head necrosis, hypertension with complications, diabetes, pulmonary heart disease, systemic lupus erythematosus, aplastic anemia, organ or tissue transplantation anti-rejection treatment, leukemia, severe mental illness, congenital adrenal hyperplasia and congenital hypothyroidism are reimbursed 654.38 million yuan per person per year. Patients with malignant tumor, uremia and hemophilia are reimbursed 30,000 yuan per person per year.
(ii) Hospitalization reimbursement
(1) 200 yuan, the deductible line for hospitalization reimbursement at township level (level 1), with the reimbursement ratio of 85%.
(2) 500 yuan, the deductible line for hospitalization reimbursement of county-level (secondary) designated medical institutions, the reimbursement ratio is 70%.
(3) The deductible line for hospitalization reimbursement of municipal (tertiary) designated medical institutions is 700 yuan, and the reimbursement ratio is 55%.
(4) The deductible line for hospitalization reimbursement in provincial (tertiary) designated medical institutions is 1000 yuan, and the reimbursement ratio is 50%.
(5) With the consent of the county-level new rural cooperative medical management institution, the unified reimbursement deductible line is 1 1,000 yuan, the reimbursement ratio is 40%, and the guaranteed reimbursement ratio is 20%.
(6) The reimbursement rate of drugs, Chinese herbal pieces and non-drug and non-surgical therapies such as acupuncture, massage, cupping and scrapping in the list of essential drugs is increased by 10% on the basis of the original reimbursement rate. The deductible lines of Dezhou City, county-level Chinese medicine hospitals and maternal and child health hospitals were reduced by 200 yuan, and the compensation ratio was increased by 5% on the basis of the original reimbursement ratio.
(7) Twenty major diseases such as childhood leukemia, congenital childhood diseases, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, opportunistic infection of AIDS, multidrug-resistant tuberculosis, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer and rectal cancer are designated in municipal and provincial medical institutions.
(8) Accidental injuries caused by self-reasons, except in the case that they are not reimbursed according to the Catalogue of New Rural Cooperative Medical Treatment Projects in Shandong Province, the threshold for hospitalization reimbursement is 1 1,000 yuan, and the reimbursement ratio is segmented. If the age of the insured is between 16 years old (including 16 years old) and 60 years old, the reimbursement ratio is 20%; /kloc-those under 0/6 years old and over 60 years old (including 60 years old) will be reimbursed at the rate of 30%.
The second is the compensation standard of different medical institutions.
1, five guarantees, deductible for low-income people;
2, Chinese medicine hospitals, ethnic hospitals or general hospitals of Chinese medicine and proprietary Chinese medicine in accordance with the reimbursement rate of medical institutions at the same level increased by 20% to give compensation;
3. The hospitalization medical expenses of farmers participating in the new rural cooperative medical system will be compensated by the new rural cooperative medical system, and 40% will be compensated for the part exceeding 10000 yuan;
4. Insured farmers who have been hospitalized in outpatient clinics for many times within one year shall be compensated according to the compensation standards of different medical institutions, but the accumulated amount during the year shall not exceed 100000 yuan.
It should be noted that when reimbursing hospitalization expenses, you need to bring the "IC" card for participating in the new rural cooperative medical system, the patient's valid ID card or household registration book, the manager's valid ID card or household registration book, the discharge summary and the discharge invoice.
From the above explanation, we can know that the reimbursement ratio of rural cooperative medical care varies according to different hospitals, so it is very important to choose a good hospital for medical treatment. I hope everyone understands.