1, outpatient compensation:
(1) village health clinic and village center health clinic visit reimbursement 60%, each visit prescription drug fee limit of 10 yuan, the health center doctor temporary rehydration prescription drug fee limit of 50 yuan.
(2) Township health centers are 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.
(3) 30% reimbursement for visits to secondary hospitals, with a limit of 50 RMB for each examination and operation and 200 RMB for prescription drugs.
(4) 20% reimbursement for tertiary hospitals, with a limit of RMB 50 for each examination and surgery and RMB 200 for prescription drugs.
(5) Chinese medicine invoices attached to the prescription are limited to $1 per sticker.
(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.
2, hospitalization compensation
(1) reimbursement scope:
A, medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic *** vibration and other inspection fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan).
B, the elderly over 60 years old hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) Reimbursement ratio: 60% reimbursement from the town health center; 40% reimbursement from the secondary hospital; 30% reimbursement from the tertiary hospital.
3. Compensation for major illnesses
(1) Town risk fund compensation: all hospitalized patients participating in cooperative medicine one-time or annual cumulative reportable medical expenses exceeding 5,000 yuan segmented compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%.
The annual limit of compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy is 11,000 yuan.
Not covered by the reimbursement
1, self-medical treatment (without designated hospitals for medical treatment or referral orders), self-purchased medicines, medicines that cannot be reimbursed by the public medical care regulations, and medical expenses not in line with the family planning;
2, outpatient treatment fees, consultation fees, hospitalization fees, meals, accompanying guests, nutritional costs, blood transfusion costs (except for those who have a family blood bank, which is reimbursed in accordance with the relevant provisions), heating and cooling costs ), heating and cooling costs, ambulance fees, special care fees and other expenses;
3, car accidents, fights, suicide, alcoholism, workplace accidents and medical malpractice medical expenses;
4, orthopedics, cosmetic surgery, dentures, prosthetics, organ transplants, naming surgery fees, consultation fees, etc.;
5, reimbursement within the scope of the portion of the limit outside the scope of reimbursement.
Scope of reimbursement:
(1) Payment of hospitalization expenses for patients due to illness. Mainly includes: medicine, surgery, materials, hospitalization, treatment, laboratory fees, inspection fees, etc. during hospitalization.
(2) Payment of outpatient treatment costs for chronic diseases. Chronic diseases mainly refer to: hypertension (stage II), heart disease with cardiac insufficiency, cerebral hemorrhage and cerebral infarction recovery, rheumatoid arthritis, chronic active hepatitis, chronic obstructive pulmonary emphysema and pulmonary heart disease, epilepsy, hepatomegaly, decompensated cirrhosis of the liver, diabetes mellitus with ineffective dietary control, chronic nephritis, Parkinson's disease, SLE, herniated intervertebral discs, chronic pelvic inflammatory disease and appendicitis and Other chronic diseases that have been examined and approved by the District New Rural Cooperative Medical Care Chronic Disease Expert Committee and the District Management Center. Radiotherapy for malignant tumors, dialysis treatment for chronic renal insufficiency, aplastic anemia, leukemia, hemophilia, schizophrenia, and anti-discharge treatment for organ transplants are included in the inpatient reimbursement for the extra-large outpatient fees.
Participating farmers suffering from the above chronic diseases, by their own application, with the diagnosis of the second class A hospital documents, by the District New Rural Cooperative Medical Care Chronic Disease Expert Committee identification, reported to the District Management Center for approval to receive the "Chronic Disease Clinic Certificate", which is examined by the District Management Center at the beginning of each year.
(3) Payment of special examination costs when patients are hospitalized for illness. This mainly refers to high-cost medical items such as CT, cardiac and angiographic X-ray machine, electronic gastroscope, color Doppler instrument, hyperbaric oxygen chamber, extracorporeal shock wave lithotripsy, hemodialysis, and organ transplantation. All patients who need to check the above items shall be advised by the designated hospitals and apply in person for approval by the District Management Center.
(4) Meet the conditions for childbirth at hospitals above the second level, designated medical institutions and designated delivery points.
(5) For farmers in the production, living and learning process of accidental injuries (excluding non-payment of items), no other party responsible for; if there is a responsibility of the other party should be responsible for the other party. Accidental injury compensation in a certain range of publicity for more than 1 month, no objection, no report, or investigation to confirm, before payment of compensation.
(6) participating and farmers in the door ...... >>
Question 2: How much outpatient consumption can be reimbursed by the New Rural Cooperative Outpatient reimbursement standards
1, the village health clinic outpatient reimbursement for every 3 yuan to make up 1 yuan (at a rate of 30% compensation);
2, township health center outpatient clinic for every 4 yuan to make up 1 yuan (at a rate of 25% compensation);
3, out of the work of the patients enrolled in the hospital, regardless of hospital level. Annual one-time reimbursement of 20 yuan at a rate of 30%, accounting for the implementation of rounding, single person fixed standard, the whole household capped, the maximum reimbursement of 20 yuan per person per year, the maximum reimbursement of 10 yuan each time, each household capped at the standard of the number of households × people reimbursement of 20 yuan.
4, newborns with their mothers can enjoy outpatient reimbursement for the year, the household cap accordingly increased by one person.
5, outpatient reimbursement compensation, special chronic disease reimbursement compensation, hospitalization reimbursement compensation and included in the annual 15,000 yuan per household cap line.
6, 60% reimbursement for village health clinics and village center health clinics, prescription drug cost limit of 10 yuan per visit, and prescription drug cost limit of 50 yuan for temporary rehydration by health center doctors.
7, township health center visit reimbursement of 40%, each visit to the examination fees and surgical costs limit of 50 yuan, prescription drug costs limit of 100 yuan.
8. 30% reimbursement for secondary hospitals, with a limit of 50 RMB for each examination and surgery and 200 RMB for prescription drugs.
9. 20% reimbursement for tertiary hospitals, with a limit of 50 RMB for each examination and surgery and 200 RMB for prescription drugs.
10, Chinese medicine ** attached to the prescription limit of 1 yuan per sticker.
11, town-level cooperative medical outpatient reimbursement annual limit of 5,000 yuan.
Hospitalization reimbursement standards
1, medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic *** vibration and other inspection fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan).
2, the elderly over 60 years old hospitalized in Xingta Township Health Center, treatment and care costs reimbursement of 10 yuan per day, a limit of 200 yuan.
Hospitalization reimbursement rate: 60% reimbursement from the town health center; 40% reimbursement from the secondary hospital; 30% reimbursement from the tertiary hospital.
New rural cooperative disease compensation reimbursement standard
1. Town risk fund compensation: all the rural cooperative medical insurance hospitalized patients with a one-time or yearly cumulative reportable medical expenses exceeding 5,000 yuan above the sectional compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%.
2. The annual limit of 11,000 yuan for compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy.
Question 3: What items can be reimbursed by the new rural cooperative medicine You are where ah Here we only reimburse the prescribed medication, including needles %50 View original post >>
Question 4: How much can be reimbursed for hospitalization of the new rural cooperative medicine How to calculate the ratio, thank you The following is the reimbursement unit of the new rural cooperative medicine requirements, reimbursement ratios, etc.
And the new rural cooperative medicine is not only for the new rural cooperative medicine, but for the new rural cooperative medicine!
First, the 2016 outpatient reimbursement ratio of the New Rural Cooperative Medical
1. 60% reimbursement for the village health office, health center;
2. 40% reimbursement for the township health center;
3. 30% wrestling ratio of the second-level hospital;
4. 20% reimbursement for the tertiary hospital;
5. township-level cooperative medical outpatient reimbursement Limit 5000 yuan / year.
Second, the 2016 New Rural Cooperative Hospitalization Reimbursement Ratio
1. New EEG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other auxiliary examination items limit reimbursement of 200 yuan;
2. Surgical expenses starting line of 1000 yuan reimbursement in accordance with the national standard, more than 1,000 according to the reimbursement of 1,000 yuan;
3. Hospitalization treatment fee and nursing fee for the elderly over 60 years old can be reimbursed 10 yuan per day, with a limit of 200 yuan;
4. The reimbursement ratio of hospitals at all levels is: 60% for township health centers; 40% for secondary hospitals; and 30% for tertiary hospitals.
3. 2016 New Rural Cooperative major disease reimbursement ratio
1. Outpatient co-ordination township and village subsidy ratio increased to 65% and 75% respectively.
2. first-class medical institutions hospitalization costs below 400 yuan, there is no starting line;
3. second-class medical institutions subsidy ratio increased to 75% ~ 80%;
4. third-class medical institutions subsidy ratio increased to 55% ~ 60%.
5. Provincial tertiary medical institutions subsidy ratio increased to 55%.
6. 70% of the quota of NPC subsidized diseases for 8 major diseases such as children's congenital heart disease, and 12 major diseases such as lung cancer, the quota of NPC subsidized diseases strives to reach 70%.
2016 New Rural Cooperative reimbursement scope
Farmers participating in the New Rural Cooperative, all outpatient and hospitalized in the designated medical institutions, can get the New Rural Cooperative reimbursement, and its reimbursement scope mainly includes reimbursement of medicines, reimbursement of inspection costs, and reimbursement of bed fees. Take drug reimbursement as an example, Class A drugs can basically be reimbursed, some Class B drugs can be reimbursed, and Class C drugs can not be reimbursed; take hospitalization reimbursement as an example, inpatient hospital bed fee or outpatient (emergency) hospitalization bed fee can also be reimbursed. However, it is important to note that the following are not covered by the New Rural Cooperative Medical Scheme:
1. Self-purchased drugs;
2. Drugs beyond the "Provincial New Rural Cooperative Medical Scheme Basic Drugs Catalog";
3. Registration fees, outpatient medical records fees, consultation fees, traditional Chinese medicine decoction fees, ambulance fees, companion beds, beds, intensive care fees, consultation fees, air-conditioning (including heating) fees, and other fees. (including heating) fees, television fees, telephone charges, personal care fees, nursing fees, etc.;
4. non-basic medical (referring to special outpatient clinics, specialist outpatient clinics, beds costing more than 35 yuan / day, medical cosmetic, home beds, etc.) costs;
5. fights, fighting and assaults, alcoholism, drug abuse, drug addiction, sexually transmitted diseases, work injuries and injuries sustained during the course of the labor service, traffic accidents, intentional self-injury, self-inflicted injuries, non-productive pesticide poisoning, and self-harm. Self-inflicted injuries, unproductive pesticide poisoning, occupational poisoning, medical accidents, violation of discipline and other causes of medical expenses;
6. abortion and induced abortion;
7. all kinds of cosmetic surgery, orthopedics, weight loss, correction of physiological defects and all kinds of health care, preventive medical treatment and drug costs;
8. organ, tissue transplantation, installation of artificial organs required to buy organs or tissues;
9. the cost of the purchase of the organ or tissue;
10. 9. medical services, examination and treatment items not approved by the price and health departments, as well as all costs incurred by the unauthorized increase in fees and charges;
10. fraudulent medical expenses such as not being hospitalized under a name or being hospitalized under an impostor;
11. the urban workers' basic medical insurance and urban residents' basic medical insurance and other basic medical insurance compensation;
12. the urban workers' basic medical insurance and urban residents' basic medical insurance compensation;
13. the urban workers' basic medical insurance and urban residents' basic medical insurance compensation;
14. Other basic medical insurance compensation;
12. Medical expenses incurred outside the country;
13. Other provisions of the new rural cooperative medical care.
Question 5: What materials do you need to prepare for the reimbursement of the New Rural Cooperative Medical Care, and how much can you reimburse? Reimbursement Required Information
1. Outpatient reimbursement materials: outpatient invoices, the cooperative medical care calendar (or medical records).
2, hospitalization reimbursement to bring information: hospital invoices, cooperative medical certificate book (or medical records), detailed list of costs, discharge summary, other relevant certificates.
3. Outpatient reimbursement for special diseases: outpatient invoice, cooperative medical certificate for special diseases.
4, for special diseases to carry information: outpatient treatment of special diseases proposal, cooperative medical certificate book, medical records, relevant laboratory reports, two photos.
Second, the reimbursement process:
Participating households will be reimbursed for the information required to be submitted to the village (community) cooperative medical liaison by the village (community) cooperative medical liaison after the review of the town cooperative medical liaison in the town liaison sent to the District Farmers Office Settlement Reporting Center for reimbursement.
New rural health insurance reimbursement process:
1, the applicant: the patient himself or her spouse, parents, children. Participating patients can not personally handle the application procedures and no spouse, parents, children, by their brothers and sisters to apply on their behalf; no brothers and sisters, by the head of the village committee to apply on their behalf. By his agent to apply, should submit a copy of the agent's identity card and proof of relationship with the patient.
2, the acceptance of institutions: county-level (including county-level, the same below) designated medical institutions.
3, the results of the application: (1) application for reimbursement of the patient's identity materials are true, submit complete materials, should be accepted; (2) the patient's identity materials in doubt, should be transferred to the cooperative medical management agency to verify its identity; (3) the submission of incomplete materials, should be a one-time written notice of the need to make up for all the materials.
The scope of reimbursement and reimbursement ratio of the new rural medical insurance:
1, outpatient compensation:
(1) 60% reimbursement for the village health clinic and the village center health clinic visit, the prescription drug fee limit of 10 yuan for each visit, and the doctor's temporary rehydration of the health center prescription drug fee limit of 50 yuan.
(2) Township health centers are 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.
(3) 30% reimbursement for visits to secondary hospitals, with a limit of 50 RMB for each examination and operation and 200 RMB for prescription drugs.
(4) 20% reimbursement for tertiary hospitals, with a limit of RMB 50 for each examination and surgery and RMB 200 for prescription drugs.
(5) Chinese medicine invoices attached to the prescription are limited to $1 per sticker.
(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.
Hospitalization compensation
(1) reimbursement scope:
A, medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other inspection fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan).
B, the elderly over 60 years old hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) reimbursement ratio: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.
Compensation for major illnesses
(1) town risk fund compensation: all hospitalized patients participating in the cooperative medical treatment of one-time or annual cumulative reported medical expenses exceeding 5,000 yuan or more segmented compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%.
The annual limit of 11,000 yuan for compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy.
Question 6: What is the percentage of reimbursement for Class B drugs in the New Rural Cooperative Medicine? 5 points First, this ratio varies from place to place
Second, there are various answers on the Internet, only the local answer is the most authoritative and accurate
Third, at the same time, you can consult the relevant enterprises or departments
Fourth, I wish you a smooth job, career, life, well-being, family, and happiness in the Year of the Goat
Question 7: How to calculate the ratio of reimbursement of the rural medical insurance Hi, the new rural medical insurance reimbursement To be divided into hospital level:
The township hospitals starting line 240 yuan reimbursement ratio of 90%; county hospitals starting line 500 yuan sales ratio reported 75%;
Third-level municipal hospitals starting line 700 yuan reimbursement ratio of 60%; second-level municipal hospitals starting line 500 yuan reimbursement ratio of 65%;
Provincial hospitals starting line 1,000 yuan reimbursement ratio 55%; Other Medical institutions starting line of 1000 yuan reimbursement ratio of 35%
Question 8: The specific process and conditions for reimbursement of the new rural cooperative medical card. Reimbursement:
(a) participate in the county new rural cooperative medical personnel, the county agricultural medical office issued by the Chun'an County new rural cooperative medical card, renewal of the original "Chun'an County new rural cooperative medical card" continues to be valid.
(2) Participants in the county's new rural cooperative medical care, outpatient and inpatient hospitalization in the county designated medical institutions can be in accordance with the provisions of the reimbursement rate of cooperative medical care, the implementation of immediate card reimbursement. Special medical expenses and outpatient and hospitalization costs in local health insurance designated medical institutions outside the county first by their own advance payment, after the end of medical treatment, with the relevant information back to the township where the household registration declaration.
The scope of reimbursement:
(a) participate in the county new rural cooperative medical personnel, due to a variety of diseases in the county designated medical institutions outpatient, inpatient treatment of the expenses incurred in accordance with the provisions of reimbursement;
(b) participate in the county new rural cooperative medical personnel, in the work, business, business trips, visiting relatives during the outpatient in the county outside of the local health insurance designated medical institutions, The expenses incurred in hospitalization are reimbursable according to the regulations.
Reimbursement standards:
(a) Participants in the new rural cooperative medical personnel in the county hospitalization, special outpatient reimbursement of expenses, the implementation of the zero start report: 501 yuan part of the reimbursement of 10%, 501 yuan - 2000 yuan part of the reimbursement of 25%; 2001 yuan - 5000 yuan part of the reimbursement of 30%; 5001-10,000 yuan part of the reimbursement 30% for the part of 5001-10000RMB; 40% for the part of 5001-10000RMB; 50% for the part of 10001RMB and above. The reimbursement rate for hospitalized medical expenses incurred in local health insurance designated medical institutions outside the county will be reduced by five percentage points according to the above standards, and the annual cumulative maximum reimbursement amount will remain unchanged.
(2) The general outpatient medical expenses incurred by the participants of the new rural cooperative medical care in the designated medical institutions within the county will be reimbursed by 10%; the general outpatient medical expenses incurred in the designated medical institutions outside the county will be reimbursed by 5%.
(c) The maximum reimbursement amount for hospitalization, special disease outpatient and general outpatient expenses per person per year for new rural cooperative medical practitioners is 30,000 RMB.
Settlement procedures:
(a) In the county fixed-point medical institutions outpatient medical expenses in the clinic medical institutions card reimbursement. The fixed-point medical institutions should summarize and timely fill in the monthly "new rural cooperative medical outpatient medical fee reimbursement list" and "new rural cooperative medical outpatient medical fee application and allocation form", to the county agricultural medical office for the cost of the audit and disbursement procedures.
(2) hospitalized in the county designated medical institutions, can enjoy the new rural cooperative medical funds reimbursement of part of the cost, in the discharge procedures, by the clinic designated medical institutions card reimbursement. The fixed-point medical institutions should summarize and timely fill in the monthly "new rural cooperative medical hospitalization expense list" and "new rural cooperative medical hospitalization expense application and allocation form", to the county agricultural medical office for expense audit and payment procedures.
(C) in the county outside the health insurance designated medical institutions outpatient, inpatient treatment, the first by the participants to pay all the costs, after the end of medical treatment, with the designated medical unit of the valid invoices, summary lists, medical records card, the new rural cooperative medical care card and ID card copy, to the location of the township Agricultural Medical Office to declare the township agricultural medical office reported to the county Agricultural Medical Office for review and reimbursement.
(d) Special diseases (malignant tumor, tuberculosis, mental illness, aplastic anemia, chronic renal failure dialysis, systemic lupus erythematosus, hemophilia) in the county, out of the county designated medical institutions outpatient clinics incurred in the medical expenses, first by the participants to advance all the costs, the end of the medical treatment, with a designated medical unit of the valid invoice, medical record card, hospital certificate, ID card copies and the New Rural Cooperative Medical Card, to the location of the township Agricultural Medical Office to declare the township Agricultural Medical Office reported to the county Agricultural Medical Office in accordance with the hospitalization reimbursement method to give reimbursement (longer course of the disease, higher medical expenses, halfway as appropriate, pre-reported pin).
(E) has participated in the commercial insurance of the medical expenses incurred by the person, can be commercial insurance company's claim form and a copy of the valid bills reimbursement in accordance with the above methods, but the total amount of reimbursement of the two shall not exceed the actual incurred medical expenses.
The scope of medication, diagnostic and treatment programs, and standards of medical service facilities for new rural cooperative medical practitioners are based on the urban basic medical insurance system of the county.
The scope of non-reimbursement of the new rural cooperative medical care:
(a) the medical expenses of urban workers who have participated in the medical insurance;
(b) self-purchase of medicines;
(c) dentures, orthodontics, optometry, hearing aids, artificial organs, cosmetic treatments, plastic and orthopaedic surgeries, qigong, ***, home hospital beds, special care, health checkups, non-medical personal services, etc.
The new rural cooperative medical care is not reimbursable. Physical examination, non-medical personal services and other items, as well as accompaniment fees, Chinese medicine decoction fees, blood transfusion fees, transportation fees, consultation fees, miscellaneous expenses during hospitalization, etc.;
(d) pregnancy, miscarriage, abortion, childbirth and other planned births ...... >>
Question 9: How much can the New Rural Cooperative actually reimburse Compensation Scope and Standards
1, outpatient compensation:
(1) 60% reimbursement for visits to village health clinics and village centers, with a limit of 10 yuan on the cost of prescription drugs for each visit, and a limit of 50 yuan on the cost of temporary rehydration prescriptions for doctors at the clinic.
(2) Township health centers are 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.
(3) 30% reimbursement for visits to secondary hospitals, with a limit of 50 RMB for each examination and operation and 200 RMB for prescription drugs.
(4) 20% reimbursement for tertiary hospitals, with a limit of RMB 50 for each examination and surgery and RMB 200 for prescription drugs.
(5) Chinese medicine invoices attached to the prescription are limited to $1 per sticker.
(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.
2, hospitalization compensation
(1) reimbursement scope:
A, medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic *** vibration and other inspection fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan).
B, the elderly over 60 years old hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) reimbursement ratio: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.
3. Compensation for major illnesses
(1) Town risk fund compensation: all hospitalized patients participating in cooperative medicine one-time or annual cumulative reportable medical expenses exceeding 5,000 yuan segmented compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 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.
Not covered by the reimbursement
1, self-medical treatment (without designated hospitals for medical treatment or referral orders), self-purchased medicines, medicines that cannot be reimbursed by the public medical care regulations, and medical expenses not in line with the family planning;
2, outpatient treatment fees, consultation fees, hospitalization fees, meals, accompanying guests, nutritional costs, blood transfusion costs (except for those who have a family blood bank, which is reimbursed in accordance with the relevant provisions), heating and cooling costs ), heating and cooling costs, ambulance fees, special care fees and other expenses;
3, car accidents, fights, suicide, alcoholism, workplace accidents and medical malpractice medical expenses;
4, orthopedics, cosmetic surgery, dentures, prosthetics, organ transplants, naming surgery fees, consultation fees, etc.;
5, reimbursement within the scope of the portion of the limit outside the scope of reimbursement.
Scope of reimbursement:
(1) Payment of hospitalization expenses for patients due to illness. Mainly includes: medicine, surgery, materials, hospitalization, treatment, laboratory fees, inspection fees, etc. during hospitalization.
(2) Payment of outpatient treatment costs for chronic diseases. Chronic diseases mainly refer to: hypertension (stage II), heart disease with cardiac insufficiency, cerebral hemorrhage and cerebral infarction recovery, rheumatoid arthritis, chronic active hepatitis, chronic obstructive pulmonary emphysema and pulmonary heart disease, epilepsy, hepatomegaly, uncompensated cirrhosis, diabetes mellitus with ineffective dietary control, chronic nephritis, Parkinson's disease, systemic lupus erythematosus, herniated intervertebral discs, chronic pelvic inflammatory disease and appendicitis and Other chronic diseases that have been examined and approved by the District New Rural Cooperative Medical Care Chronic Disease Expert Committee and the District Management Center. Radiotherapy for malignant tumors, dialysis treatment for chronic renal insufficiency, aplastic anemia, leukemia, hemophilia, schizophrenia, and anti-discharge treatment for organ transplants are included in the inpatient reimbursement for the extra-large outpatient fees.
Participating farmers suffering from the above chronic diseases, by their own application, with the diagnosis of the second class A hospital documents, by the District New Rural Cooperative Medical Care Chronic Disease Expert Committee identification, reported to the District Management Center for approval to receive the "Chronic Disease Clinic Certificate", which is examined by the District Management Center at the beginning of each year.
(3) Payment of special examination costs when patients are hospitalized for illness. This mainly refers to high-cost medical items such as CT, cardiac and angiographic X-ray machine, electronic gastroscope, color Doppler instrument, hyperbaric oxygen chamber, extracorporeal shock wave lithotripsy, hemodialysis, and organ transplantation. All patients who need to check the above items shall be advised by the designated hospitals and apply in person for the approval of the District Management Center.
(4) Meet the conditions for childbirth at hospitals above the second level, designated medical institutions and designated delivery points.
(5) For farmers in the production, living and learning process of accidental injury (excluding non-payment of items), no other party responsible for; if there is a responsibility of the other party should be responsible for the other party. Accidental injury compensation in a certain range of publicity for more than 1 month, no objection, no report, or investigation to confirm, before payment of compensation.
(6) Participating farmers are hospitalized immediately after the outpatient examination, and the outpatient examination costs closely related to the current hospitalization are included in the calculation of the current hospitalization costs. During the hospitalization due to the need for medical conditions, the hospitals treated by the application, the district cooperation management center ...... >>