1, to participate in the object of all rural villagers with Jianghai District agricultural household registration or 2007 rural cooperative medical care in the register of residents, can be the household family belongs to the object of participation of all members as a unit to participate in cooperative medicine. Living apart from their children to participate in the cooperative medical care for the elderly, their children must have a family together to participate. 2, funding standards government financial support funds according to the number of participants per person 60 yuan standard arrangements. Cooperative medical care is divided into 2 grades, including Waihai, Lile street villagers to participate in the standard grade, each person to pay 50 yuan; Jiaotou, Jiaobei street villagers to participate in raising the grade, each person to pay 70 yuan. Collective economic organizations should support villagers to participate in the new rural cooperative medical care. Due to family economic difficulties, the inability to participate in the new rural cooperative medical care for low-income households, should be village (neighborhood) Committee as a unit to the District Office of Rural Cooperative Medical Care application, after review by the civil affairs department, its participation in the new rural cooperative medical care of the individual part of the contribution by the District of the new rural cooperative medical care insurance assistance fund to give a solution. 3, reimbursement standards (1) in the city of the town-level hospitals (such as Waihai People's Hospital, Lele), hospitalization, the total amount of hospitalization. People's Hospital, etc.), 60% of the total hospitalization cost above RMB 200 can be reimbursed; (2) in county-level hospitals (e.g. Municipal Maternal and Child Health Hospital, Municipal Tuberculosis Prevention and Control Institute, Municipal Second People's Hospital, Xinhui Chinese Medicine Hospital, Xinhui People's Hospital, etc.) and specialized hospitals (e.g. Municipal Third People's Hospital, New Hope Eye Hospital, Xinhui Shadie Hospital, Baishi Hospital, etc.), 50% of the total hospitalization cost above RMB 300 can be reimbursed; and The portion of the total hospitalization cost above RMB 500 will be reimbursed 50%; (3) 30% of the total hospitalization cost above RMB 500 will be reimbursed for hospitalization in hospitals above the county level in the city (Downtown Hospital, Wuyi Traditional Chinese Medicine Hospital, and Municipal People's Hospital) and in non-profit medical institutions outside of the city (excluding hospitals in Hong Kong, Macao, Taiwan, and foreign countries); and (4) for women who have given birth in accordance with the family planning policy, the subsidy for a normal delivery is RMB 200, and the subsidy for a cesarean delivery is RMB 500. Cesarean section patients who have combined total hysterectomy and oophorectomy will be reimbursed for hospitalization expenses according to the reimbursement ratio of their hospitalization hospitals of the same level, without separate fixed compensation for cesarean section. (5) The maximum reimbursement per person per year for villagers participating in the standard class is 17,000 yuan, and the maximum reimbursement per person per year for villagers participating in the enhanced class is 30,000 yuan. (6) For hospitalized patients who participate in both the basic medical insurance for urban workers and the new rural cooperative medical care, the new rural cooperative medical care will only reimburse the part of the amount of their individual contributions to the medical insurance. The reimbursement method is to deduct the non-reimbursable part of the expenses on the basis of the individual contribution amount of his/her medical insurance and reimburse him/her according to the following ratios: 80% for township hospitals, 70% for county hospitals, and 50% for non-profit medical institutions above the county level and outside the city. If the individual contribution amount of his/her health insurance is not enough to deduct the non-reimbursable part of the expenses, no reimbursement will be given.4. Non-reimbursable Scope: (1) Services: out-of-hospital consultation fee, expedited fee for examination and treatment, surcharge for named surgery, special nurse, bed fee for accompanying person, meal fee, ambulance fee, and other special medical services. (2) Non-disease treatment programs: all kinds of cosmetic, bodybuilding, weight loss, weight gain, height increase programs, cosmetic and orthopedic surgery, orthopedic and corrective surgery for myopia and strabismus, medical malpractice appraisal, and costs incurred in rehabilitative treatment. (3) Diagnostic and therapeutic equipment and medical materials: application of positron emission tomography (PET), electron-beam CT examination, treatment programs, glasses, dentures, prosthetic eyes, artificial crystals, artificial limbs, hearing aids and other appliances, and pricing department regulations can not be charged separately for disposable medical materials. (4) Therapeutic items: organ or tissue sources for various types of organ or tissue transplants, supplementary therapeutic items such as qigong therapy and music therapy. (5) Others: ① Expenses for blood transfusion, blood mutual aid and use of blood products. (② various eugenics, infertility, infertility, sexual dysfunction treatment programs, abortion, IUD, induced abortion (excluding stillbirth induced abortion), ligation, an abortion, waiting for delivery and other costs. ③ Work-related injuries, traffic accidents (excluding self-inflicted injuries in traffic). ④Medical expenses incurred by illegal crimes or personal faults, such as brawling, alcoholism, sexually transmitted diseases, suicide, drug taking, intentional self-injury, self-mutilation, and drug rehabilitation. ⑤ Hospitalization expenses for simple examination. ⑥ Expenses for admission to sanatoriums and nursing homes at all levels. (7) Self-purchased medicines and self-financed examinations during hospitalization, and out-of-hospital examination fees of hospitals that have not signed the two-way referral agreement. (viii) Hospitalization medical expenses paid for injuries caused by a third party, which should be borne by the third party in accordance with the law. 5, outpatient reimbursement villagers participating in the new rural cooperative medical care with a medical card and ID card to the health center where I am domiciled and its subordinate computerized outpatient clinics, to give the following reimbursement: (1) exemption from the registration fee; (2) 50% reduction of the consultation fee; (3) 10% reduction of treatment costs, of which 15% reduction for low-income households, of which 15% reduction for low income households. (3) treatment fees are reduced by 10%, of which 15% is for low-income households; (4) auxiliary examination fees are reduced by 10%, of which 15% is for low-income households; and (5) Chinese medicine fees for Chinese medicine outpatient clinics are reduced by 5%, of which 10% is for low-income households. Outpatient compensation is calculated on a household basis, with each household's outpatient compensation quota for the year being the number of people in the household participating in cooperative medical care multiplied by 10 yuan. The outpatient reimbursement quota is limited to the use of the year, the year does not reach the use of the limit, not carried over to the next year to use. 6, chronic disease outpatient reimbursement part of the large outpatient costs of chronic diseases can be reimbursed for part of the cost, including: cirrhosis of the lost compensation stage, cancer (radiotherapy), chronic renal failure (uremic stage), nephrotic syndrome, aplastic anemia, thalassemia, systemic lupus erythematosus, the provisions of the program tissue Outpatient anti-rejection treatment after organ transplantation, post-stroke sequelae, etc. The starting line for reimbursement of large outpatient expenses for chronic diseases is RMB 1,000, and the portion of outpatient expenses above the starting line is reimbursed at 30%, with quarterly reimbursement and a cumulative annual maximum limit of RMB 3,000 (combined with the hospitalization reimbursement limit for the year). The identification of chronic diseases to the county level or above, subject to the diagnostic certificate of medical institutions, and by the District Cooperative Medical Leadership Group Office for the record. 7, reimbursement procedures to participate in the new rural cooperative medical care due to hospitalization, to be hospitalized within 48 hours after admission to the village (neighborhood) committee cooperative medical management institutions report (including the name of the head of the household, his name, suffering from what disease, admitted to the hospital), where the village (neighborhood) rural cooperative medicine The village (neighborhood) rural cooperative medical care management group shall promptly register the report. Within one month after the discharge procedures, with the hospitalization certificate, medical records, original invoices (photocopies will not be reimbursed) and a list of expenses, to the village (neighborhood) committee to fill out the "Jianghai District, the new rural cooperative medical expense reimbursement reimbursement submission form" for reimbursement. The reimbursement approval will not be processed for more than three months. In special cases, the reimbursement will be approved by the District Cooperative Medical Office after the street office concerned has issued a certificate. If the patient also participate in commercial insurance, need to be in the insurance company for reimbursement procedures and then take the original hospitalization receipts back to the village (neighborhood) committee for reimbursement procedures, the insurance company reported the cost of not additionally deducted in the reportable expenses, but the total amount of reimbursement can not be more than 90% of the total cost of hospitalization. 8, the Waihai, Lile People's Hospital to implement the hospitalization instant reimbursement system. 9, the cooperative medical care guarantee relief fund district financial establishment New Rural Cooperative Medical Protection Relief Fund, enjoy the cooperative medical reimbursement, its out-of-pocket expenses exceeding a certain amount of low-income households and other villagers, you can apply to the District Rural Cooperative Medical Office to apply for financial assistance, the specific reimbursement can be made after January 1, 2008 to the village (neighborhood) Committee or log on to the website of the Health Bureau of the Jianghai District () inquires. 10, the fund publicity and supervision of the various street offices, health centers and villages (neighborhood) Committee have set up a rural cooperative medical protection system, which can be used to protect the rural population and the rural population. ) Committee have set up a rural cooperative medical reimbursement bulletin board, income and expenditure and reimbursement announced once a month. 11, the second reimbursement of the collective economic conditions of the village (neighborhood) Committee, you can implement the second reimbursement, i.e., enjoy the district-level rural cooperative medical subsidies for villagers and then give appropriate subsidies or assistance for serious illnesses. However, the total amount of reimbursement from the district and village (neighborhood) levels of cooperative medical care cannot exceed 90% of the total hospitalization costs of the villagers.12. Other participants who falsely report, fraudulently claim or fraudulently obtain subsidies from cooperative medical care funds will, upon verification, be reimbursed by the District Office of Rural Cooperative Medical Care for the losses incurred by the parties concerned through legal means and will stop the household from enjoying the compensation for the current year's cooperative medical care and from participating in the cooperative medical care in the following year. Inter-year hospitalized patients, according to its hospitalization start date to define the specific applicable reimbursement methods
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