1. What is the medical insurance reimbursement policy in Jiangxi Province?
1, reimbursement scope
Childhood leukemia (0- 14 years old), congenital childhood diseases (0- 14 years old), end-stage renal disease, breast cancer, cervical cancer, severe mental illness, multidrug-resistant tuberculosis, AIDS opportunistic infection, lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction and cerebral infarction.
2. There is no reimbursement scope.
(1) self-purchased drug fee;
(two) beyond the province's new rural cooperative medical care basic drug list of drug costs;
(3) Registration fee, outpatient medical record fee, house call fee, Chinese medicine decoction fee, ambulance fee, escort bed fee, bed reservation fee, intensive care unit fee, consultation fee, air conditioning (including heating) fee, TV fee, telephone fee, personal life cooking fee, care worker fee, etc.
(4) Non-basic medical care (refers to special outpatient service, specialist outpatient service, bed fee exceeding 35 yuan/day, medical beauty, family bed, etc.). );
(five) medical expenses caused by fighting, alcoholism, drug abuse, detoxification, sexually transmitted diseases, work-related injuries, traffic accidents, intentional self-injury, non-productive pesticide poisoning, occupational poisoning, medical accidents, violations of laws and regulations, etc.;
(6) induced abortion;
(7) all kinds of cosmetic surgery, plastic surgery, weight loss surgery, physical defect correction surgery, as well as all kinds of health care and preventive treatment items and drug costs;
(8) the cost of purchasing organs or tissues for organ or tissue transplantation and artificial organ installation;
(nine) all expenses incurred by medical services, inspection and treatment projects without the approval of the price and health departments and the unauthorized increase of charging standards;
(10) defrauding medical expenses by not being hospitalized in front or being hospitalized under an assumed name;
(1 1) has obtained basic medical insurance compensation such as basic medical insurance for urban workers and urban residents;
(12) medical expenses incurred abroad;
(13) Other provisions of the new rural cooperative medical system.
Two, Jiangxi rural medical insurance reimbursement ratio
1, the reimbursement rates of township-level designated medical institutions and county-level designated medical institutions are 90% (excluding deductible) and 80% respectively.
2, the provincial and municipal designated medical institutions reimbursement ratio is 50%. On this basis, all districts, cities and overall planning areas can explore and select some designated medical institutions in provinces and cities with good direct subsidies, standardized services and low costs as agreed designated medical institutions, and their reimbursement ratio will increase by 10%. The reimbursement rate of non-designated medical institutions is 35%.
3, the use of national essential drugs, traditional Chinese medicine and traditional Chinese medicine technology to treat diseases, according to the provisions of the policy to increase the intensity of reimbursement, the proportion of reimbursement expenses of participating farmers in designated medical institutions shall not be higher than 90% of the total expenses, and those higher than 90% shall be reimbursed by 90%.
Three, Jiangxi medical insurance reimbursement materials
1. Outpatient reimbursement information: outpatient invoice, cooperative medical certificate calendar (or medical record).
2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate (or medical record) calendar, detailed list of expenses, discharge summary and other relevant certificates.
3, outpatient special disease reimbursement information: outpatient invoices, special disease cooperative medical certificate calendar.
4. Information for handling special diseases: outpatient treatment proposal for special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and photos.
Four, Jiangxi medical insurance reimbursement process
1, the insured households submit the materials required for reimbursement to the village (community) cooperative medical liaison, and after being audited by the village (community) cooperative medical liaison, they report to the town cooperative medical liaison, who will send them to the district agricultural easy office for reimbursement. Guide to reimbursement of new rural cooperative medical care.
2. Direct reimbursement by the hospital: When going through hospitalization procedures due to illness, you will issue a certificate of the new rural cooperative medical system to the hospital and directly participate in reimbursement.