:November 06, 2009 Source:Jinjiang New Rural Cooperative Publisher:Li Zhihui Hits:688 According to the People's Government of Jinjiang City on the issuance of Jinjiang City, 2010 years of new rural cooperative medical work management approach notice (Jinzheng Wen 〔2009〕 No. 304), in 2010, Jinjiang New Rural Cooperative Hospitalization Settlement Compensation based on the collation of the following: 1. Hospital Scope: Jinjiang this city Within the new rural cooperative designated hospital list and stationed window phone number attached, Jinjiang City outside the designated hospitals, including nationwide (except Hong Kong, Macao, Taiwan) public non-profit medical institutions, and must be the local new rural cooperative designated medical institutions. 2. Compensation standards: compensation is limited to the participant's own inpatient treatment due to disease in designated hospitals or outpatient treatment for special illnesses. The scope of compensation for NHB in Jinjiang City includes treatment, medicine, laboratory fees, examination fees, surgical fees, hospitalization fees, etc. The compensable scope basically refers to the current year's Quanzhou City urban workers' basic medical insurance drug list, diagnostic and therapeutic items, service items, and the provisions of the payment standards. Psychiatric drugs and diagnostic and therapeutic items are canceled at the individual's own expense, and all of them are included in the compensation scope of Jinjiang New Agricultural Cooperative Medical Insurance. According to the relevant policies of supporting Chinese medicine at the higher level, the proportion of individual out-of-pocket expenses for Chinese medicine diagnosis and treatment (drinking tablets and Chinese medicine diagnosis and treatment items) is canceled, and all of them are included in the scope of reimbursement. The hospitalization bed fee compensation for participants is subject to a maximum limit of no more than RMB 20 per day, i.e., the daily hospitalization bed fee of no more than RMB 20 per day will be settled according to the actual amount, and that of more than RMB 20 per day will be settled according to RMB 20 per day. New rural cooperative hospitalization compensation establishes a starting line and a ceiling line. The actual amount of reimbursement for each hospitalization of a participant is as follows: the expenses within the scope of Jinjiang New Farmers' Cooperative Compensation, minus the corresponding starting line, multiplied by the corresponding reimbursement ratio. The hospitalization compensation standards are as follows: Level of designated medical institutions Compensable medical expenses (yuan) Compensation ratio (%) First-level designated hospitals in Jinjiang City (i.e., township health centers or street community health centers, the list is attached) More than 100 80% Second-level designated hospitals in Jinjiang City (i.e., municipal hospitals, the list is attached) More than 300 65% Designated hospitals outside of Jinjiang City More than 800 40% Capping line: Each time a participant receives actual compensation for one or more times in a year, the actual amount of compensation is: the costs that fall within the scope of the NAC compensation minus the corresponding starting line, multiplied by the corresponding compensation ratio. A year once or more times to get the actual compensation cumulative maximum amount of 100,000 yuan. 3. Compensation for special objects (1) exempted from the starting line object: newborns (infants) hospitalization cost compensation does not set up a starting line, according to the proportion of the compensation of the level of hospitals to compensate for the medical expenses and the mother and the mother of a combined, capping line is calculated according to one person. There is no starting line for the compensation of hospitalization expenses for newborns (infants); medical expenses are calculated together with those of the mother, and the cap line is calculated on a per-person basis. There is no starting line for low-income insurance recipients hospitalized in Level 1 and Level 2 designated hospitals in Jinjiang City, and the compensation ratio for expenses within the scope of compensation has been increased to 100% and 85%, respectively. (2) The starting line for children under 14 years of age at all levels of designated hospitals is 100 yuan for expenses within the scope of compensation. (3) Rural families with one daughter and two daughters (limited to the couple themselves and their one and two daughters) and low-income recipients will have their compensation ratio increased by 20% on top of the implementation of the compensation standard. That is to say, the compensation ratio of compensable expenses of first-class and second-class designated hospitals in Jinjiang City and designated hospitals outside the city is increased to 100%, 85% and 60% respectively. (4) Quanzhou City Hospital of Traditional Chinese Medicine twinning help Jinjiang City Zimao Health Center, determined that all participants in Jinjiang City to Quanzhou City Hospital of Traditional Chinese Medicine inpatient treatment and outpatient costs of special diseases in accordance with the Jinjiang City, the second-level designated hospitals compensation standards. (5) Accidental injuries to minors (non-third-party liability, non-lawful acts; valid proof must be provided) hospitalization expenses are included in the scope of compensation; (6) injuries to others, traffic accidents, industrial accidents in which compensation should be made by the third-party liable person in accordance with the law, but compensation is really unavailable; the hospitalization expenses of the injuries sustained by those who have seen the righteousness of the person who has failed to be compensated for the injuries sustained by the person who has not been able to be compensated for the injuries sustained by him/her, the relevant certificates will be issued by the villages (communities) and the towns (streets), and the public security organs and other relevant certificates The village (community) and town (street) and public security organs and other relevant certificates will be issued by the village (community) and the town (street) and public security organs, etc., signed by the leaders in charge and reviewed by the New Agricultural Cooperative Service Center. (7) Participants in the urban and rural poor family medical assistance objects, in addition to enjoying the New Farmers' Cooperative Compensation, can still enjoy the approved medical assistance. (8) Extraordinary diseases: six kinds of extraordinary diseases such as removal of malignant tumors, heart-related surgeries, surgeries for severe burns (scalds), cochlear implantation, organ transplants, and therapeutic surgeries for aplastic anemia, etc., are hospitalized in a tertiary fixed-point hospital outside of Jinjiang City, in which the reimbursement of surgical fees is settled with reference to the reimbursement standards of a second-tier fixed-point hospital hospitalization in Jinjiang City. (9) Limit settlement types: pneumonia, acute glomerulonephritis, acute bronchitis, acute gastroenteritis, bronchial asthma, normal delivery; appendicitis surgery, cholecystitis gallbladder stone surgery, uterine fibroid surgery, inguinal hernia surgery, cesarean section surgery, surgery for benign tumor of the thyroid gland, cataract surgery, surgery for benign tumor of the ovary, hemorrhoids surgical treatment, and 15 other types of illnesses are limit settlement types. (For details, please refer to "Jinjiang City New Rural Cooperative Medical Partial Single Disease Hospitalization Expenses Limit Settlement and Limit Reimbursement Implementation Rules (Trial)".) (10) China Unicom Jinjiang Branch provides 20 yuan additional accidental death insurance for each household free of charge for the participating households; the participants who hold the number of China Unicom's registration of real-name system of continuous in-network customers contribute to try to carry out the pilot of the general outpatient settlement compensation, and the compensation amount is The maximum amount of compensation is 120 yuan per person per year. 4. The scope of non-compensation (1) self-purchased medicines, non-special disease outpatient expenses, observation room medical expenses, rehabilitative medical expenses, and medicines and related expenses not reimbursed by the relevant provisions of the Quanzhou City Urban Employee's Basic Medical Insurance; (2) scaling, cleaning, dentures, orthodontics, optometry, prosthetics, hearing aids, cosmetic treatments, plastic and orthopaedic surgeries, qigong, massage, home hospital beds, health care, and massage, and other medical expenses are not compensated for by the insurance company. (3) Expenses incurred for home hospital beds, home hospital beds, health care and special care, health checkups, non-medical personal services, escort fees, Chinese medicine decoction fees, transportation fees, consultation fees, consultation fees and other miscellaneous expenses during hospitalization, etc.; (3) Expenses incurred for home hospital beds, hospital beds or hospitalization by impersonation, etc.; (4) Expenses incurred for illegal and criminal behaviors, injuries to other people, suicides, self-inflicted injuries and self-injuries, fights and brawls, drug addiction , drug rehabilitation, alcoholism, intentional violation of rules and regulations and other violations of laws and regulations of other circumstances resulting in injuries incurred medical expenses; no birth certificate and other violations of the national family planning policy of normal delivery, cesarean section surgery will not be reimbursed; (5) traffic accidents, medical accidents, workplace accidents resulting in injuries to participants and other medical expenses that should be borne by a third party in accordance with the law; (6) nuclear radiation, nuclear explosions or nuclear contamination, wars, (6) Hospitalization medical expenses caused by nuclear radiation, nuclear explosion or contamination, war, riot or armed rebellion; (7) Medical expenses incurred during the period when the participant does not seek treatment at the designated medical institutions or when the participant is out of the country; (8) Medical expenses incurred during the occurrence of serious natural disasters or disease outbreaks and epidemics and other unforeseen risks; (9) Hospitalization medical expenses incurred by those who have already participated in the basic medical insurance for urban workers and those who are entitled to publicly-funded medical care and other social medical care insurance during the validity period; (10) Hospitalization medical expenses incurred by those who have already participated in the basic medical insurance for urban workers and who enjoy publicly-funded medical care and other social medical care insurance; (11) Hospitalization medical expenses incurred by a third party due to a work-related accident Hospitalized medical expenses; (10) Medical expenses that have not been settled for more than two months of the year without any special reasons; (11) Other non-compensable expenses determined by the Jinjiang New Farmers' Cooperative Medical Insurance Administrative Committee.5. Compensation example: Assuming that the total hospitalized expenses of an adult participant (not a low-income insurance or birth control participant) are 3,000 yuan, and that the expenses within the scope of the New Farmers' Cooperative Medical Insurance compensation are 2,000 yuan after deducting non-compensable expenses, the starting line will be deducted and he will be reimbursed in the townships in Jinjiang after the starting line is deducted. After deducting the minimum payment line, he can get 1520 RMB for medical treatment in township health centers or street community health centers in Jinjiang, 1105 RMB for medical treatment in municipal designated hospitals in Jinjiang City, and only 480 RMB for medical treatment in designated hospitals outside Jinjiang City.
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