1, general outpatient compensation: outpatient compensation is limited to designated medical institutions in the city, and other medical institutions will not compensate. There is no deductible for outpatient compensation, and the direct compensation is subject to the limit of single prescription per day, and the proportion of medical expenses compensation is 30%.
2. Conventional hospitalization compensation: the deductible line and reimbursement ratio are set according to the level of medical institutions. The deductible line of township hospitals is 100 yuan, and the reimbursement ratio is 80%; Municipal comprehensive medical institutions set up deductible 500 yuan, and the reimbursement rate is 60%; Municipal specialized medical institutions set up deductible 300 yuan, and the reimbursement rate is 60%; The designated medical institutions outside the city set up the deductible line 1000 yuan, and the reimbursement ratio was 40%. There is no deductible for low-income households, rural key entitled groups, revolutionary "five old" personnel, severely disabled people and other groups registered by the civil affairs department. If the participant is hospitalized due to illness for many times during the year, the deductible will be calculated by stages.
3. Large outpatient expenses compensation for special diseases: those who participate in cooperative medical care suffer from (1) hypertension; (2) diabetes; (3) hyperthyroidism; (4) dialysis of chronic nephritis and uremia; (5) Outpatient treatment of malignant tumor; (6) cerebrovascular accident; (7) Systemic lupus erythematosus; (8) coronary heart disease; (9) Aplastic anemia; (10) 10 psychosis and other diseases can be treated in the outpatient department of designated hospitals with the approval of the municipal joint medical office. There is no deductible for medical expenses compensation, and the reimbursement ratio is 40%.
Calculation formula of fund compensation: reimbursement amount = [total medical expenses-self-funded project expenses-deductible line] × compensation ratio.
(2) Compensation capping line:
1, the top line of annual outpatient medical expenses compensation for participating farmers is 30 yuan per person per year.
2. The highest compensation line for hospitalization medical expenses incurred by participating farmers in that year is: 40,000 yuan per person per year.
3. The capping line of large outpatient expenses compensation for special diseases is: 6000 yuan per person per year.