1, reimbursement ratio of serious illness of new rural cooperative medical system:
(1) The proportion of township and village subsidies for outpatient co-ordination increased to 65% and 75% respectively;
(2) If the hospitalization expenses of first-class medical institutions are below 400 yuan, there is no deductible;
(3) The subsidy ratio of secondary medical institutions will be increased to 75% to 80%;
(4) The subsidy ratio of tertiary medical institutions will be increased to 55% to 60%;
(5) The subsidy ratio of provincial tertiary medical institutions is increased to 55%;
(6) 70% of the quota for 8 serious diseases such as congenital heart disease and lung cancer 12 serious diseases, and strive to reach 70%;
2, the new rural cooperative medical outpatient reimbursement ratio:
(1) The reimbursement rate of village clinics and health centers is 60%;
(2) The reimbursement rate of town hospitals is 40%;
(3) The proportion of stroke in secondary hospitals is 30%;
(4) The reimbursement rate of tertiary hospitals is 20%.
The materials required for reimbursement of the new rural cooperative medical system are as follows:
1, original hospitalization invoice, original discharge certificate, list of hospitalization expenses and medicines, original and photocopy of outpatient medical records and discharge summary;
2. ID card or household registration book, original and photocopy of the new agricultural guarantee;
3, the new rural cooperative medical insurance card;
4. Original receipt of medical expenses;
5. If you entrust others to handle reimbursement, you need to provide the ID card and a copy of the trustee. The reimbursement process of the new rural cooperative medical system is as follows:
1. The insured patients of the new rural cooperative medical system can be reimbursed directly by swiping their ID cards and medical insurance cards at designated medical institutions of township-level general outpatient clinics in the region, and hospitalized at designated medical institutions in and outside the region, and directly by swiping their cards at checkout.
2. Insured patients who are hospitalized in public medical institutions outside the city and above should submit the original medical expense invoice, detailed list of hospitalization expenses, discharge summary, medical card, household registration book, outpatient medical records and ID card of the agent directly to the new rural cooperative medical system window for reimbursement of medical expenses three months after discharge.
3. Special disease outpatient reimbursement. Insured patients can apply to the new rural cooperative medical management center with the medical records and related inspection reports issued by designated medical institutions at or above the second level and the approval form for outpatient treatment of special diseases of the new rural cooperative medical system. After approval, their outpatient medical expenses can be included in the reimbursement scope of the new rural cooperative medical system.
4. If you are hospitalized due to accidental injury, you need to submit the certificate of the cause of accidental injury and the medical records of the hospital after discharge. Those who cannot provide valid certificates and records will not be accepted. After the insured patient submits the information, it will be completed within 30 working days after the acceptance of the new rural cooperative medical system window. However, the reimbursement can only be made after investigation and review by the inspectors of the new rural cooperative medical management center.
To sum up, in a settlement year, the reimbursement rate of township hospitals is 90%, county hospitals are 85%, municipal hospitals are 80%, and municipal hospitals are 75%.
Legal basis:
Article 26 of People's Republic of China (PRC) Social Insurance Law
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Article 27
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.