I. Compensation Standards and Scope
(1) Outpatient Compensation Participating farmers enjoy compensation for outpatient visits to designated medical institutions within the county (district). The compensation ratio is 30%, with a ceiling of 30 yuan; for individual outpatient expenses totaling more than 500 yuan, the excess compensation ratio is 30%, with a ceiling of 600 yuan.
(2) Hospitalization Compensation
1. Township (township) health centers and the corresponding level of fixed-point medical institutions: 30% of the compensation for medical expenses incurred less than 300 yuan; 70% of the compensation for medical expenses incurred more than 300 yuan and less than 2,000 yuan; 50% of the compensation for medical expenses incurred more than 2,000 yuan.
2. County-level fixed-point medical institutions: 25% of medical expenses incurred up to 500 yuan; 65% of medical expenses incurred above 500 yuan and up to 10,000 yuan; and 50% of medical expenses incurred above 10,000 yuan.
3. Second-tier designated medical institutions within the city: 25% of medical expenses incurred up to 500 yuan; 55% of medical expenses incurred above 500 yuan and up to 10,000 yuan; and 50% of medical expenses incurred above 10,000 yuan.
4. Tertiary designated medical institutions within the city: 20% of medical expenses incurred up to RMB 1,000; 45% of medical expenses incurred above RMB 1,000 and up to RMB 10,000; and 40% of medical expenses incurred above RMB 10,000 (not included).
5. Provincial and other designated medical institutions outside the city: 20% of medical expenses incurred up to RMB 1,000; 40% of medical expenses incurred above RMB 1,000 (not included) and up to RMB 10,000; 35% of medical expenses incurred above RMB 10,000 (not included). Not reimbursed
The scope of treatment items that are not paid for by the New Rural Cooperative Medical Scheme
(1) Service items
1, out-of-hospital consultation fee, medical record cost, etc.
2, consultation fee, expedited fee for checking and treatment, surcharge on surgery by name, high quality premium fee, self-invited special nurses and other special medical services;
3 The fees for transportation to and from the clinic and emergency vehicles;
4. air-conditioning, television, telephone, baby warming box, food warming box, electric stoves, refrigerators, and compensation for damages to public property;
5. escorting, nursing, cleaning, and outpatient decoctions;
6. meals, recreational activities, and other special living services.
(2) Non-disease Treatment Programs
1, various beauty and fitness programs, as well as non-functional cosmetic and orthopedic surgeries;
2, various weight-loss, weight-gaining and height-gaining programs;
3, various health checkups;
4, various preventive and health care programs;
5, various medical consultations and medical appraisals. appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography (PET), electron beam CT, ophthalmology excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program;
2, eyeglasses, dental prostheses, eye prostheses, prosthetics, hearing aids and other rehabilitative appliances;
3, a variety of health care for their own use, Massage, examination and treatment instruments;
4. Disposable medical materials that cannot be charged separately as stipulated by the price department of each province.
(4) therapeutic projects
1, all kinds of organ or tissue transplantation of organ or tissue source;
2, in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues;
3, myopic orthopaedic surgery;
4, qigong therapy, music therapy, health care, nutrition therapy, magnetic therapy and other complementary therapeutic items , magnetic therapy and other complementary therapeutic programs.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction treatment programs;
2, a variety of scientific research, clinical validation of treatment programs;
3, illegal, criminal, assault, alcoholism, suicide, self-inflicted injuries, drug abuse, narcotics addiction, traffic accidents, medical malpractice and other incurred medical expenses;
4, Deposits, compensation management fees and other fees charged for the use of blood;
5. Other fees of unknown items in medical charges;
6. Diagnostic and treatment items not approved by the price department.
Two, the pilot counties in accordance with the new rural cooperative medical fund, solvency, the level of designated medical institutions, etc., to determine their own diagnostic and treatment items
(a) diagnostic and treatment equipment and medical materials
1, the application of X-ray computed tomography (CT), stereotactic radiography (Y-knife, x-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), the X-ray machine (including digital subtraction equipment), the X-ray machine (including digital subtraction equipment), the X-ray machine (including digital subtraction equipment) and the X-ray machine (including digital subtraction equipment). Line machine (including digital subtraction equipment), magnetic **** vibration imaging device (MR1), single photon emission computer scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment for examination, treatment projects;
2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystal Vascular stents and other internal replacement of artificial organs, internal placement of materials;
4. Bed fees (including bed facility service fees, etc.)
5. Disposable medical materials that can be charged separately as stipulated by the pricing department.
(B) treatment program category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplants;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy program.
(3) other expensive medical instruments and equipment for examination, treatment programs and medical materials, whether or not included in the new rural cooperative medical fund to pay for the scope of the pilot counties by their own regulations.