New rural cooperative reimbursement procedures:
Participants discharged from the hospital, will be signed or stamped by the patient's own hospitalization invoices, discharge records, cost lists, referral certificates and a copy of my ID card or proof of domicile paid to the Township Hopping Management Office, after examination and approval of centralized and uniformly sent to the municipal rural insurance business management center.
"New Rural Cooperative", 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, with the main focus on the coordination of major diseases of the farmers' medical care mutual **** relief system.
The New Rural Cooperative Medical Scheme (NRMS) is a medical insurance system of mutual assistance***financing created by the farmers themselves in China, which plays an important role in guaranteeing the access of farmers to basic health services, and in alleviating the poverty of farmers due to illnesses and the return of poverty due to illnesses. The reimbursement scope of the new rural cooperative, broadly including outpatient compensation, hospitalization compensation and compensation for major diseases three parts.
The scope of reimbursement for the new rural cooperative medical care is as follows:
Participants are entitled to reimbursement for medicines, examination fees, laboratory fees, surgical fees, treatment fees, and nursing care fees that are in line with the reimbursement scope of the urban workers' medical insurance (i.e., valid medical fees) when they are hospitalized in designated hospitals due to illnesses during the coordinated period.
The New Rural Cooperative Medical Fund pays for the establishment of a starting standard and a maximum payment limit. Hospitalization expenses below the hospital year starting payment standard are paid by the individual. If the starting standard is reached within the same coordinating period, hospitalization costs incurred for two or more hospitalizations can be reimbursed cumulatively. Hospitalization expenses exceeding the threshold are calculated in segments and reimbursed cumulatively, with a maximum annual cumulative reimbursement limit per person.
New Rural Cooperative Reimbursement Standard:
Outpatient Reimbursement:
Village Health Office and Village Center Health Office reimbursement of 60% of the cost of prescription drugs per visit is limited to 10 yuan, and the cost of temporary rehydration of prescription drugs by the doctor of the health center is limited to 50 yuan.
Township health centers will be reimbursed 40% of the cost of each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.
Second-level hospitals are reimbursed 30% of the cost, with a limit of 50 yuan per visit for examinations and surgeries, and 200 yuan for prescription drugs.
Tertiary hospitals will reimburse 20% of the fees, with a limit of 50 RMB for each examination and surgery and 200 RMB for prescription drugs.
Chinese medicine invoices accompanied by a prescription are limited to $1 per sticker.
Township-level cooperative medical outpatient compensation is limited to 5,000 yuan per year.
Hospitalization Compensation:
Reimbursement Scope:
A. Pharmaceutical Fees: Auxiliary Examinations: Electrocardiogram, X-ray Fluoroscopy, Films, Laboratory Tests, Physiotherapy, Acupuncture, CT, Nuclear Magnetic *** vibration and other examination fees, limit of 200 yuan; Surgical Fees (with reference to the national standard, reimbursement of more than 1,000 yuan is made in accordance with the amount of 1,000 yuan).
B. For elderly people over 60 years old hospitalized in health centers, treatment and nursing fees are reimbursed 10 yuan per day, with a limit of 200 yuan.
Reimbursement rates: town health centers reimburse 60 percent; secondary hospitals reimburse 40 percent; tertiary hospitals reimburse 30 percent.
Compensation for major illnesses:
Town risk fund compensation: all hospitalized patients who participate in cooperative medical care are compensated in segments where the one-time or yearly cumulative reportable medical expenses exceed 5,000 yuan, i.e., 65% for 5,001-10,000 yuan and 70% for 10,001-18,000 yuan.
Town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy compensation annual limit of 11,000 yuan.
The new rural cooperative medical fund reimbursement to pay for special diseases are: malignant tumors chemotherapy, radiotherapy; severe uremia blood and abdominal dialysis; tissue or organ transplantation after the anti-rejection reaction treatment; schizophrenia with mental decline; systemic lupus erythematosus (one of the cardiac, pulmonary, renal, hepatic, and neurological complications); aplastic anemia; cardiac surgery, anticoagulation therapy. The rest of the reimbursable special diseases are subject to specific local policies.
Specific outpatient treatments for special diseases include supportive therapies and symptomatic treatment of systemic and local reactions that are necessary during the treatment period, and general adjuvant treatments are not included in the reimbursement scope.
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