The reimbursement scope of the new rural cooperative medical system refers to the medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which are in line with the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses).
The expenses reimbursed by medical insurance are:
1. Maximum bed fee for township hospitals 12 yuan/day, and maximum bed fee for municipal and above medical institutions 15 yuan/day.
2, drug costs, scope of use, the implementation of the provisions of the provincial drug list.
3, check the 360 question and answer fee inspection, testing, etc. , limit 600 yuan.
4. The treatment fee shall be settled in 300 yuan according to the facts, and the above part of 300 yuan shall be included in the reimbursement scope by 50%.
5. The operation fee shall be charged according to the prescribed charging standard.
6, blood transfusion surgery or rescue, the maximum hospitalization 500 yuan each time.
7. The maximum cost of materials for each hospitalization is 2000 yuan.
8, all kinds of tumor patients with radiotherapy, chemotherapy and renal failure need dialysis outpatient expenses, as hospitalization expenses for compensation.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.