At present, China's new rural cooperative medical system (referred to as "new rural cooperative medical system") has been implemented rapidly since it began to be implemented all over the country. According to the statistics of the Ministry of Health on June 30, 2004, 30 provinces, municipalities directly under the Central Government and autonomous regions launched a pilot project of the new rural cooperative medical system in 3 10 counties (cities), covering 95.04 million agricultural population and 68.99 million rural residents. The actual reimbursement scope and proportion of rural cooperative medical insurance are as follows: 1, outpatient compensation: (65438+). (3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan. (4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. (5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan. (6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan. 2. Reimbursement scope of hospitalization compensation (1): a. Drug expenses: auxiliary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic resonance, etc. 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan. (2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%. 3. Compensation for Serious Illness (1) Town Risk Fund Compensation: Where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or cumulatively throughout the year, they should be compensated by stages, that is, 500 1- 10000 yuan is 65%,1kloc-. (2) The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system inpatient and uremia clinic is1.65,438+0.000 yuan. The following do not belong to the reimbursement scope of rural cooperative medical insurance: 1, self-seeking medical treatment (no designated hospital or referral form), self-purchased drugs, drugs that cannot be reimbursed according to the provisions of public medical care, and medical expenses that do not conform to family planning; 2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses; 3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; 4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ; 5, within the scope of reimbursement, beyond the limit. Many farmers have bought some commercial medical insurance after purchasing the new rural cooperative medical system. If you buy commercial medical insurance, you must first reimburse the expenses of the new rural cooperative medical system, and then find an insurance company to reimburse the remaining expenses. Attached social security: the scope of reimbursement for social insurance-related medical insurance in Beijing.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.