(1) Suspected patients with major diseases (or immediate family members and their guardians) must bring their social security cards (if they hold cooperative medical certificates, they should also bring their ID cards or household registration books) to the designated medical institutions for major diseases of the new rural cooperative medical system in this county, and they can be admitted to hospital only after being diagnosed. There is no designated medical institution for the treatment of major diseases in the county, and patients can go directly to the designated hospitals outside the county designated by the new rural cooperative medical system agency in the county (city, district).
(2) For patients with major diseases who meet the treatment conditions, the designated hospitals shall sign the application form (or referral application form) and be admitted to the hospital in time according to the regulations of the hospital.
(III) Patients (or immediate family members and their guardians) shall, within 3-4 days after diagnosis, carry the application form for medical treatment (or referral application form), social security card (such as holding cooperative medical certificate, ID card or household registration book) and ID card (or household registration book) and other related materials from designated hospitals to the county-level new rural cooperative medical service agencies in the participating areas to go through the audit procedures, among which the civil medical assistance objects shall go to the civil affairs offices of participating counties (cities, districts).
(4) After the patients are approved by the new rural cooperative medical management center and the county (city, district) civil affairs department, the designated medical institutions should sign an agreement with the patients on single-disease limited treatment and bed-based payment (except opportunistic infection of AIDS), and promise to make diagnosis and treatment according to the clinical pathway or routine diagnosis and treatment plan.
2. Major illness insurance refers to the maximum insurance amount paid to the insured suffering from major illness within the insurance validity period.
3, serious illness medical insurance according to the disease quota relief, the new rural cooperative medical system compensation 70%, the individual pays 30%, is a rural medical assistance object, emergency medical assistance pays 20%.
Extended data
Reimbursement scope
1. The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban workers (i.e. effective medical expenses).
2, the new rural cooperative medical fund payment Qifubiaozhun and maximum payment limit. The hospitalization expenses below the annual deductible line of the hospital shall be paid by the individual. If the Qifubiaozhun is reached in the same overall period, the hospitalization expenses incurred by two or more hospitalizations can be reimbursed cumulatively. The hospitalization expenses exceeding Qifubiaozhun shall be calculated in sections and reimbursed cumulatively, and there is a maximum amount of accumulative reimbursement per person per year.
Serious illness compensation
1, town risk fund compensation: all inpatients who participate in cooperative medical care will incur medical expenses exceeding 5,000 yuan at one time or within one year, that is, 500 1- 10000 yuan is 65%,10001-/kloc-0.
2. The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is1.654.38+0.000 million yuan.
3. The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis for severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental retardation; Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery.
References:
Baidu Encyclopedia-reimbursement scope of new rural cooperative medical care