One on the outpatient co-ordination of compensation
Ordinary outpatient co-ordination of the implementation of the limit of the cap compensation to the family unit of the participant. Special chronic disease outpatient coordination of 16 kinds of diseases, special chronic disease outpatient compensation does not set a starting line, the compensation ratio of 60% of the cost of the report, the annual ceiling line according to the types of diseases were determined, but the annual amount of subsidies and hospitalization subsidies do not exceed a total of 80,000 yuan.
Two, on the designated medical institutions and accidental injury
(1) designated medical institutions, the county implementation of the provincial and municipal health administrative departments announced the designated medical institutions as the county designated hospitals, but must sign a service agreement with the county co-management office, did not sign a service agreement for all non-designated hospitals.
(2) Our county does not recognize each other's designated medical institutions recognized by the counties and municipalities within Hengyang city, but in order to facilitate the remote areas of the participating farmers to seek medical treatment, it is proposed that the designated medical institutions recognized by the municipalities in the neighboring counties of the city, in the application to the county co-management office of the county, reported to the county health bureau for examination and approval, and the county co-management office of the county to sign a service agreement with the municipal hospitals, according to the standard reimbursement.
(3) All hospitalized medical expenses incurred due to injury are compensated according to the accidental injury standard regardless of the level of hospital.
Third, the relevant policy supplement
(1) newborns can enjoy the hospitalization compensation policy of the year of birth along with their mothers after applying for the relevant formalities in the county co-management office.
(2) Re-transferred military personnel and people who have moved in by marriage can pay the fees for enrollment immediately after going through the household registration procedures and start enjoying the compensation policy of the New Agricultural Cooperative Program three months after enrollment.
Four, other
1, part of the diagnosis and treatment program adjustment. The following diagnostic and therapeutic items need to strictly control the use and the cost of the corresponding proportion of control into the scope of compensation:
(1) imported various types of catheters (silk, sets), various types of imported and Sino-foreign joint venture in the body to place the material, various types of artificial organs (such as: artificial valves, artificial joints, artificial skin, artificial blood vessels, artificial ears, artificial crystals, etc.), various types of organ or tissue transplantation (including the cost of the source of the organ or tissue sources) ), coronary angiography and digital subtraction angiography (DSA) are included in the scope of reimbursement at 60% of their costs.
(2) 80% of the cost of domestic catheters (filaments and sleeves), domestic materials for placement in the body, magnetic resonance imaging (MRI), computerized body scanning (CT), color ultrasound, gamma knife therapy, X-ray knife therapy, intravenous pyelography, fiberoptic bronchoscopy, bronchial imaging, ambulatory electrocardiography, and various types of monitoring supervision will be included in the scope of reimbursement.
(3) The out-of-pocket part of cochlear implantation salvage treatment costs for participating rural deaf children aged 0-6 years old is included in the scope of reimbursement for hospitalization co-ordination.
2. It is strictly prohibited to arbitrarily expand the scope of reimbursement of the New Rural Cooperative Fund. It is not allowed to include public **** health-related expenses and family planning expenses that should be borne by the government in the expenditure of the New Agricultural Cooperative Fund. The new rural cooperative fund will not pay for the cost of drugs outside the catalog, the cost of diagnosis and treatment of non-subsidized diagnostic and therapeutic items, and the unreasonable costs caused by over-standard charges, self-supporting item charges, and over-service charges, as well as the unreasonable costs caused by violating the basic drug policy regulations, not following the stipulated proportion of drugs and exceeding the unified price limit standard.