New Rural Cooperative, the full name of the new rural cooperative medical care, refers to the government organization, guidance, support, farmers voluntarily participate in the individual, collective and government financing, to the main medical co-ordination of the farmers' medical care mutual **** relief system. New rural cooperative insurance is based on the basic medical insurance, the high cost of medical expenses incurred by patients with serious illnesses to give further compensation want to know more about ** New rural cooperative insurance reimbursement for serious illnesses include what the scope of knowledge, follow the editor to take a look at it together. "New Rural Cooperative", the full name of the new rural cooperative medical care, refers to the government organization, guidance, support, voluntary participation of farmers, individual, collective and government financing, to the main medical co-ordination of farmers' medical mutual **** relief system. New Rural Cooperative Medical Insurance is based on the basic medical insurance, the high medical expenses incurred by patients with serious illnesses to give further compensation for the protection of the policy. **New Rural Cooperative Medical Insurance Policy It is understood that Hunan Province to participate in the new rural cooperative medical care residents, medical reimbursement scope has been clearly defined. The Hunan Provincial New Rural Cooperative Medical Coordination Leading Group recently issued a clear opinion: in general, the first level and the following medical institutions (generally township health centers) should be no less than 75%, the second level of medical institutions no less than 60%; third-level medical institutions no less than 45%. According to the latest policy, the provincial health department to the public commitment to the implementation of 9 health measures to benefit the people, including the comprehensive promotion of 32 kinds of major diseases in the new rural cooperative insurance work, the policy reimbursement rate of 80% or more to expand the scope of the new rural cooperative reimbursement in Hunan and improve the reimbursement rate of the new rural cooperative reimbursement in Hunan, a powerful initiative. Specifically, comprehensively promote the children's leukemia and other 32 kinds of major diseases new rural cooperative insurance work, the policy reimbursement rate of more than 80%. Hunan new rural cooperative reimbursement rate is how much? It is understood that the hospitalization fee compensation starting line: in general, township health centers not more than 100 yuan, county hospitals not more than 300 yuan, municipal hospitals not more than 500 yuan, provincial hospitals not more than 700 yuan. Peak line: according to the new rural cooperative operation year hospitalization compensation cumulative, in principle, shall not be less than 30,000 yuan. New Rural Cooperative Medical Reimbursement Scope (a) participating farmers in the area of designated medical institutions outpatient, inpatient and hospitalization and approved the transfer to the extra-territorial medical institutions hospitalization of the diagnosis and treatment costs incurred, in addition to the "Hebei Province, New Rural Cooperative Medical Diagnostic and Treatment Project Compensation Provisions" in the determination of the compensation is not compensated for and limited compensation for the project, are based on the "Hebei Province, the medical service project specifications and service prices (for trial implementation)". The implementation and reimbursement of Taocheng District new rural cooperative medical care standards. (2) the following items are not included in the new rural cooperative medical reimbursement 1, services (1) registration fee (including special outpatient, specialist outpatient registration fee), outpatient, inpatient medical records of the cost; (2) consultation fees, self-requested consultation, outside the expert surgical fees, surgery fees by name, examination, treatment, surgery to speed up the cost of special medical services fees, escort fees, bed charter fees, escort fees, and so on, and so on. (3) Transportation fee for medical treatment and referral, ambulance fee; (4) Meal (nutrition) fee, living supplies fee, cleaning fee, medicine decoction fee, heating fee, air-conditioning fee, TV fee, telephone fee, etc. (5) Blood transfusion fee (including whole blood, component blood and blood products); (6) Hebei Province, medical services and service prices (for trial implementation) "outside the scope of the diagnostic and treatment projects (including new projects, new technologies, new devices, new materials, etc.); (7) medical institutions to carry out diagnostic and treatment projects without the price, the health sector review and approval. 2, non-disease diagnosis and treatment projects (1) a variety of bodybuilding, beauty, hair, body, weight loss, fat and height; (2) non-functional cosmetic, orthopedic, etc.; (3) dental (including dental implants), dental cleaning, orthodontic malformations and their complications (4) assembly of prosthetic eyes, wigs, prosthetics, etc.; (5) optometry (including contact lenses) etc. 3, preventive health care programs (1) inoculation, preventive medicine, preventive injections, disease screening and general treatment and its complications of the diagnosis and treatment costs; (2) women's and children's health care and its complications of the diagnosis and treatment costs; (3) pre-marital checkups, diagnosis of hereditary diseases in pregnancy; (4) health care massages, podiatry, hydrotherapy, body therapy, diet therapy, qigong medical treatment; (5) Health check-ups (including overseas and outbound health check-ups), medical consultation (including health consultation and psychological consultation), etc. using the New Rural Cooperative Disease Coordination Fund; (6) Disease prevention and treatment projects supported by special funds, such as tuberculosis prevention and treatment, AIDS prevention and treatment, schistosomiasis prevention and treatment, endemic disease prevention and treatment, etc. (7) Free treatment of diseases by the state and fee waiver of the treatment projects. (8) the national free treatment of disease programs, fee waiver part of the treatment program. 4, health care, rehabilitation equipment and supplies Self-use health care, rehabilitation of a variety of massage, magnetic therapy, inspection, testing, treatment of equipment and supplies, including hearing aids, orthopedic devices, traction, crutches, wheelchairs, massagers, magnetic therapy supplies, back protector, lumbar protector, bowl protector, knee pads, blood pressure meter, blood glucose detector and so on. **New Rural Cooperative Major Disease Insurance Reimbursement Scope 5. Treatment Programs (1) organ or tissue source for all types of organ or tissue transplants; (2) vision correction surgery, rehabilitation medical treatment, etc.; (3) music therapy (except for patients with mental illnesses), health care nutritional therapy, magnetic therapy, and other complementary therapeutic programs; (4) sexual dysfunction, male and female infertility Infertility diagnosis and treatment, non-pathological termination of pregnancy, non-pathological caesarean section; (5) family planning and its complications, sequelae of the diagnosis and treatment costs. 6. Circumstances that will not be compensated (1) work-related injuries, fights, traffic accidents, criminal accidents, alcoholism, drug abuse, drug addiction, drug abuse, smoking cessation, drug rehabilitation, self-injury, self-inflicted injuries, suicides and medical accidents, etc. (3) medical expenses for the treatment of family planning and its complications and sequelae. (2) Unplanned childbirth (including natural and pathological childbirth). (3)Medical expenses incurred abroad and in Hong Kong, Macau and Taiwan. (4) All kinds of medical technology appraisal, judicial appraisal, work injury, disability appraisal, family planning, identification of disabled children. (5) All costs incurred from the day after the notification of discharge for patients who refuse to leave the hospital without following medical advice. (6) Expenses incurred for hospitalization and convalescence. Its basic principle is to introduce commercial insurance organizations to undertake major disease insurance, giving full play to the synergistic and complementary roles of the basic medical insurance and major disease insurance under the New Rural Cooperative Medical Care Scheme. The insurance for major illnesses is coordinated at the city and state level, with the city and state as the unit of unified fund management, unified protection policy, unified organization and implementation. City Case 1: Shijiazhuang rural cooperative medical reimbursement for major diseases? In the participating farmers suffering from serious illnesses hospitalized in high medical expenses in accordance with the provisions of the New Rural Cooperative Compensation, the individual's annual cumulative burden of compliance with the medical costs exceeding 13,000 yuan of the part of the standard into the New Rural Cooperative insurance compensation scope of major illnesses. The following items are not included in the compensation scope of the New Rural Cooperative Insurance for Major Diseases: (1) pharmacy purchase, outpatient expenses (except for end-stage renal disease); (2) hospitalization in a non-designated medical institution without the approval of the New Rural Cooperative Insurance Management Center of the county in which the household registration is located; (3) work-related injuries, fights, assaults, traffic accidents, medical accidents, criminal offenses, self-inflicted injuries, self-inflicted injuries, suicides, drug abuse, alcoholism, smoking cessation, drug rehabilitation, etc.; (4) medical expenses incurred by individuals in the New Rural Cooperative Insurance for Major Diseases. Smoking cessation, drug rehabilitation, etc.; (d) all types of organs, tissue transplantation of organ and tissue sources; (e) more than the provincial price department of medical services prices set by the standard part; (f) not obtain permission from the health administrative department and access to large-scale inspection, diagnosis, treatment; (g) beauty, fitness projects and non-functional cosmetic, orthopedic surgery and other non-disease treatment projects (viii) artificial organs and materials placed in the body, beyond the "Hebei Province, the new rural cooperative medical treatment program compensation reimbursement provisions version)" limited price limit; (ix) beyond the "Hebei Province, the new rural cooperative medical reimbursement of the Drug List" and "People's Republic of China *** and the Pharmacopoeia of China," the range of chemicals used for diagnosis and treatment of drugs outside the scope of the drug; (x) due to the natural irresistible factors caused by emergency, critical, and severe diseases; (xi) due to the natural world, the natural world, the natural world, the natural world, the natural world, the natural world, and the natural world, the natural world, the natural world. irresistible factors caused by the emergency, critical and serious patients rescue and treatment costs. City Case 2: How much is the reimbursement for major diseases in rural cooperative medicine in Henan Province? 1. Starting line, reimbursement ratio and ceiling line.
The starting line for major disease insurance is 10,000 yuan, 50,000 yuan (including 50,000 yuan) part of the compensation at a rate of 50%, 50,000 yuan 100,000 yuan (including 100,000 yuan) part of the compensation at a rate of 55%, more than 100,000 yuan of the part of the compensation at a rate of 65%, the annual compensation ceiling is 300,000 yuan. For patients who are hospitalized outside the province, 60% of their out-of-pocket medical expenses after being compensated by the New Agricultural Cooperative Medical Insurance are considered as compliant out-of-pocket medical expenses and are included in the compensation scope of the major disease insurance. During the year, participating patients (including those who have been hospitalized for several times) will only pay the starting line of the New Rural Cooperative Major Disease Insurance once. Compliance with out-of-pocket medical expenses above the starting line will only be compensated once by the major disease insurance, and the remaining expenses of the current time will not be repeated in the calculation of compensation.
2. Insurance year. New rural cooperative medical insurance and new rural cooperative operation year consistent, from January 1 to December 31 each year. If a single hospitalization across the year and the compliant out-of-pocket medical expenses exceed the starting line, the compensation policy for major medical insurance will be implemented according to the year of discharge. The start time: October 1, 2018, the full start of the work of the new rural cooperative insurance work. January 1, 2018 to September 30, the period of compliance with the out-of-pocket medical expenses incurred in accordance with the provisions of the new rural cooperative insurance compensation scope, hospitalized patients can go to the participating commercial insurance agency service outlets to handle the compensation procedures. 2018 year Zhengzhou, Xinxiang, Luoyang City, three cities to continue to implement the municipal The first thing you need to do is to get your hands dirty. The above is for you to introduce the knowledge of **New rural cooperative insurance reimbursement for major illnesses including which scope, I hope you can help, if there are still questions, you can contact a lawyer for you to answer.