Rural medical insurance reimbursement scope and how much can be reimbursed

I. The scope of reimbursement of the new rural cooperative medical care is as follows: the part of medicine, examination fee, laboratory fee, operation fee, treatment fee, nursing fee, etc., which meets the reimbursement scope of the urban workers' medical insurance (i.e., the valid medical fee), incurred by the participant for the illness of hospitalization in a designated hospital during the coordinated period.

Second, the reimbursement rate:

1, outpatient

Village health clinics and village center health clinics reimbursement of 60% of the visit, each visit to the prescription drug cost limit of 10 yuan, the health center doctor temporary rehydration prescription drug cost limit of 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 yuan for each examination and operation and 200 yuan 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.

2. Hospitalization reimbursement scope:

A. Drugs: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees, with a limit of RMB 200 yuan; surgical fees (with reference to the national standard, reimbursement of more than RMB 1,000 will be made in accordance with the RMB 1,000 limit).

B. For elderly people over 60 years old who are hospitalized in Xingta Township Health Center, the treatment fee and nursing fee are compensated 10 yuan per day, with a limit of 200 yuan.

Reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.

3. Major illnesses:

Town risk fund compensation: all hospitalized patients who participate in cooperative medical care will be compensated for the one-time or yearly cumulative reportable medical expenses exceeding 5,000 yuan in segments, i.e., 5,001-10,000 yuan will be reimbursed at 65%, and 10,001-18,000 yuan will be reimbursed at 70%.

The annual limit of compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy is 11,000 yuan.

The new rural cooperative medical fund reimburses and pays for special diseases such as: chemotherapy and radiotherapy for malignant tumors; hemodialysis and peritoneal dialysis for severe uremia; anti-rejection treatment after tissue or organ transplantation; schizophrenia with mental decline; systemic lupus erythematosus (those with one of the complications in heart, lungs, kidneys, liver, and the nervous system); aplastic anemia; and anticoagulant treatment after heart surgery. 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 treatment, and general adjuvant treatments are not included in the reimbursement scope.