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1. Persons participating in the new rural cooperative medical care can enjoy corresponding subsidies when they go to designated medical institutions in their jurisdiction with their cooperative medical care certificates and ID cards.
2. Patients who cannot be diagnosed and treated by designated medical institutions due to limited technical and equipment conditions must be approved by the hospital and issued with a certificate, and reported to the district cooperative medical office for record.
3. Special emergency patients who go to medical institutions outside the district for rescue and hospitalization must present the first aid certificate and go to the district rural cooperative medical office to complete relevant procedures within five days, otherwise no subsidy will be given.
4. Farmers who participate in cooperative medical care and are hospitalized due to illness such as traveling or working in other places must seek medical treatment at local designated medical institutions for cooperative medical care (those who do not have cooperative medical care must seek medical treatment at local public medical institutions). And get in touch with the district cooperative medical office within five days to register. After discharge, go to the district new rural cooperative medical office for review with a copy of the prescription, one-day hospitalization list, diagnosis certificate, payment receipt, copy of the medical record and cooperative medical certificate. Otherwise, no subsidy will be granted.
5. Persons participating in the New Rural Cooperative Medical Care System who suffer from tuberculosis and AIDS must comply with the relevant provisions of the "Henan Province Tuberculosis Centralized Management Implementation Rules" and other relevant regulations.
6. Those who go to medical institutions outside the district without approval will not be subsidized.
7. Designated medical institutions at all levels and types must diagnose and treat patients according to their registered diagnosis and treatment scope and according to their own technical and equipment conditions. It is strictly prohibited to forcibly admit and treat patients. For those who cause medical accidents or medical disputes, in addition to being handled in accordance with the "Regulations on Handling Medical Accidents", the parties and responsible persons will be given financial and administrative penalties.
Starting from October 1 this year, Henan will fully launch the New Rural Cooperative Medical Care Critical Illness Insurance Policy. The New Rural Cooperative Medical System critical illness insurance policy is also called secondary reimbursement for serious illness. According to the policy, in addition to the normal New Rural Cooperative Medical System reimbursement, participating farmers who fell ill after January 1 this year can also receive secondary reimbursement. The minimum payment for secondary reimbursement is 15,000 yuan. , the annual compensation cap is 300,000 yuan.
At present, the Provincial Government General Office has issued the "Henan Province New Rural Cooperative Medical Care Critical Illness Insurance Implementation Plan (Trial)" (hereinafter referred to as the "Plan") to all localities to urge implementation.
The secondary reimbursement compensation ratio is divided into three levels, with the lowest being 50%
On August 7, 71-year-old Ms. Huang was discharged from the hospital because she was urgently hospitalized due to inflammatory bowel disease. , she spent 65,000 yuan in the hospital, and after the New Rural Cooperative Medical System was reimbursed, she also paid 35,000 yuan out of pocket. Fortunately, she caught up with the critical illness insurance policy that was about to be implemented in our province.
“The province’s critical illness insurance policy will be officially implemented from October 1st. However, eligible participating farmers from January 1st to September 30th this year can also enjoy this policy.” Province Dai Nengguang, a researcher at the Rural Health Department of the National Health and Family Planning Commission, said.
Take Ms. Huang as an example. After approval and reimbursement by the New Rural Cooperative Medical System, her out-of-pocket expenses of 35,000 yuan will be 30,000 yuan in compliance expenses. At that time, her second reimbursement amount from the New Rural Cooperative Medical System will be It is (30,000 yuan - 15,000 yuan) × 50% = 7,500 yuan.
To give another example, Mr. Liu, a 78-year-old lung cancer patient, spent 400,000 yuan on hospitalization. After excluding the New Rural Cooperative Medical System reimbursement, he paid 200,000 yuan out of pocket. After verification, the 200,000 yuan expense included compliance expenses. is 150,000 yuan, then his secondary reimbursement amount is (50,000 yuan - 15,000 yuan) × 50% + 50,000 yuan × 55% + 50,000 yuan × 65% = 77,500 yuan.
In addition, the new rural cooperative medical system can only reimburse "compliant expenses" for major illnesses, which are tentatively defined as out-of-pocket medical expenses within the scope of the new rural cooperative medical essential medicine catalog and the basic diagnosis and treatment item catalog.
Where does the money come from? No more payment, it will be paid by the New Rural Cooperative Medical System Fund
"Participating farmers do not need to pay additional money. The New Rural Cooperative Medical Care serious illness insurance funds will be paid by the New Rural Cooperative Medical System Fund. "Wang Yaoping, director of the Rural Health Work Division of the Provincial Health and Family Planning Commission, said that the financing standard is based on the per capita net income of rural residents in the previous year as the basis for differentiated financing. In the future, the financing level of critical illness insurance will be based on the new rural cooperative medical care financing level and fund payment status. Gradually improve.
According to Dai Nengguang, in 2014, our province’s financing standards were divided into three levels: 16 yuan, 15 yuan and 14 yuan. “Cities with high incomes also have high financing levels. For example, Zhengzhou City’s per capita 16 yuan, while in Zhoukou City it is 14 yuan per person.
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However, although the financing levels of each prefecture and city are different, the reimbursement ratio enjoyed by the people is the same.
Compensation measures will be implemented immediately before 2015
“Before 2015, all reports will be reported immediately. Dai Nengguang introduced that real-time reporting means that patients are reported immediately when they are discharged. Currently, there are 295 medical institutions in our province that have achieved cross-regional "instant reporting."
Seeing medical treatment outside the province Or non-immediate reporting of participating patients in the province, with valid identification, a copy of the referral certificate and the New Rural Medical Care Hospitalization Compensation Fee Settlement Invoice, go to the service outlet designated by the commercial insurance agency in the participating area to handle the New Rural Medical Care Critical Illness Insurance Compensation Procedures, commercial insurance Institutional service outlets will settle compensation fees for participating patients through the provincial New Rural Cooperative Medical System Management Information System.
The Provincial Health and Family Planning Commission requires commercial insurance institutions to set up at least one service outlet in each coordinating area to provide services to patients outside the province. Settlement services are provided to hospitalized and non-immediately reported patients within the province, and business personnel can also be assigned to the New Rural Cooperative Medical Care Agencies (or designated medical institutions) in various coordinating areas to provide "one-stop" settlement services
Classification of critical illness insurance
In 2014, the threshold for critical illness insurance is 15,000 yuan, and reimbursement is divided into three levels: 15,000 to 50,000 yuan (including 50,000 yuan) The part will be compensated at a rate of 50%
The part between 50,000 yuan and 100,000 yuan (including 100,000 yuan) will be compensated at a rate of 55%.
The part above 100,000 yuan will be compensated at a rate of 55%. 65% will be compensated, and the annual compensation limit is 300,000 yuan.
You may encounter these situations...
What to do if you are hospitalized outside the province?
< p>The self-payment will be discounted at 40% and then reimbursed according to regulationsMr. Cai has been working in Beijing for many years and brought his parents to Beijing from his hometown in Nanyang countryside. In June this year, Mr. Cai suffered a sudden cerebral infarction. Mr. Cai's father was hospitalized in a hospital in Beijing and spent 90,000 yuan. After excluding the New Rural Cooperative Medical System reimbursement, Mr. Cai's father also paid 60,000 yuan out of pocket. Mr. Cai asked if his father was hospitalized outside the province and could enjoy the second reimbursement. ?
“Yes, but the standards are different. "Dai Nengguang introduced that for participating patients who are hospitalized outside the province, 60% of their out-of-pocket medical expenses after being compensated by the New Rural Cooperative Medical System will be regarded as compliant out-of-pocket medical expenses and included in the scope of major illness insurance compensation.
In the case of Mr. Cai Take the father as an example. Because his family paid 60,000 yuan out of pocket, his qualified medical expenses are 60,000 yuan × 60% = 36,000 yuan. Based on this calculation, his secondary reimbursement is (36,000 yuan - 15,000 yuan). Yuan) For patients who have been hospitalized three times this year due to tract diseases, what are the provisions for the second reimbursement of the New Rural Cooperative Medical System?
The "Plan" stipulates that within the year, participating patients (including multiple times) will be reimbursed. Hospitalized patients) will only be deducted once from the New Rural Cooperative Medical Care critical illness insurance deductible. Compliant out-of-pocket medical expenses above the deductible will only be compensated by the critical illness insurance once, and the remaining expenses for that time will not be included in the compensation calculation again.
Take Mr. Gao as an example. For the first time he was hospitalized, after deducting the New Rural Cooperative Medical System reimbursement, his out-of-pocket expenses were 10,000 yuan; the second time was 7,000 yuan, and the third time was 15,000 yuan. Then, Mr. Gao’s second time The amount of the first reimbursement is (10,000 yuan + 7,000 yuan + 15,000 yuan - 15,000 yuan) × 50% = 8,500 yuan.
The new rural cooperative medical insurance critical illness insurance is consistent with the new rural cooperative medical insurance operation year. From January 1st to December 31st of each year, if a single hospitalization occurs in multiple years and the compliance out-of-pocket medical expenses exceed the deductible, the critical illness insurance compensation policy will apply in the year of discharge.
Will it make medical treatment difficult and expensive?
Reporter Li Xiaomin, intern Qiu Sijie
This newspaper reported that with the protection of critical illness insurance, will people gather in large hospitals and create new problems? Is it difficult to see a doctor? Will medical institutions increase prices, making new medical treatments more expensive? In this regard, Wang Yaoping, director of the Rural Health Work Division of the Provincial Health and Family Planning Commission, revealed that supporting policies are currently being formulated and will be officially implemented from October 1. .
A question: Will minor illnesses end up in big hospitals? Answer: "Fixed compensation" will be implemented for common diseases
After learning that the New Rural Cooperative Medical System critical illness insurance policy will be fully promoted, Mr. Huang, a Zhengzhou citizen who has been paying attention to the New Rural Cooperative Medical Care policy, first reacted: Will it be irritating? More people flock to big hospitals?
“We have also taken this issue into consideration when formulating policies, so we are formulating supporting policies.” Wang Yaoping said that in order to guide patients with common diseases and frequently-occurring diseases to stay at the grassroots level for treatment, and prevent people from suffering from serious illness insurance after the launch of For blind referral, our province will achieve fixed compensation for common diseases, and out-of-pocket medical expenses for fixed-compensation diseases will not be included in the coverage of serious illness insurance.
“Fixed compensation means a fixed price for reimbursement of a disease. Hospitals at any level will reimburse this amount. We use economic leverage to guide patients with common diseases to seek medical treatment in primary medical institutions and guide patients to rational diversion.” Wang Yaoping He said that at present, the Provincial Health and Family Planning Commission is organizing experts to investigate some common diseases and frequently-occurring diseases, and the first batch of 30 fixed compensation lists for common diseases is planned.
Second question: What should I do if I go to a large hospital without referral? Answer: The reimbursement ratio of the New Rural Cooperative Medical System will be reduced by 20%
Mr. Wang, who has been working in clinical practice, often encounters such patients. Some diseases can be treated in county-level hospitals, but due to distrust, some patients will give up " "Small" seeks "big". Currently, for participating patients who are directly hospitalized in designated medical institutions at the municipal level or above without issuing a referral certificate, the reimbursement of the New Rural Cooperative Medical System in our province will be automatically reduced by 10%.
“After October 1 this year, the hospitalization expense reimbursement ratio will be automatically adjusted from the current 10% reduction to a 20% reduction.” Wang Yaoping said that this is to strictly guide the referral process, reasonably guide and Diversion and integration of inpatients will gradually establish a hierarchical diagnosis and treatment system.
At the same time, for those who directly go to designated medical institutions at the municipal level or above for hospitalization without completing the transfer approval procedures as required, our province requires that 80% of the compliant out-of-pocket medical expenses for that hospitalization be included in serious illness Insurance compensation coverage.
Three questions: Will medical institutions take the opportunity to increase prices? Answer: Unreasonable increases in regulatory control costs
For ordinary people, a hidden worry is whether individual medical institutions will take advantage of the support of critical illness insurance to increase prices.
“We will also introduce a series of policies to control and prevent.” Wang Yaoping introduced, such as the increase in average hospitalization expenses per day (daily), the actual hospitalization compensation ratio, and the proportion of drug expenses outside the catalog , the proportion of Class A drugs, the proportion of out-of-catalogue diagnosis and treatment expenses, and the proportion of consumable expenses, etc., are the main indicators of cost growth control for medical institutions. Statistics are regularly reported and disclosed to the public to effectively control unreasonable increases in medical expenses.
At the same time, he mentioned that our province will also promote the payment method of New Rural Cooperative Medical System according to disease grouping (path A, B, C) in Yiyang and Xixian counties. It has been fully rolled out in designated medical institutions at the county and township levels in all coordinated areas across the province to further standardize medical service practices and control unreasonable increases in medical expenses.
Four questions: What should the participating farmers in the three pilot cities do? Answer: All will be integrated into the provincial level before 2016
In fact, since 2013, the three cities of Zhengzhou, Xinxiang and Luoyang in our province have successively tried the new rural cooperative medical insurance. Municipal level coordination. It is understood that at present, the threshold for critical illness insurance in Zhengzhou is 20,000 yuan, that in Xinxiang is 30,000 yuan, and that in Luoyang is 20,000 yuan. The reimbursement rate for critical illness insurance in the three cities is 50%.
According to the "Henan Province New Rural Cooperative Medical Care Critical Illness Insurance Implementation Plan (Trial)", in 2014, these three prefectures and cities continued to implement municipal level planning and gradually connected with the provincial level planning plan. In 2016 All projects have been integrated into the provincial level planning.