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 will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.
(3) Secondary hospitals will be reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.
(4) Tertiary hospitals will reimburse 20% of the cost, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs.
(5) Chinese medicine invoices with prescription attached 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. Pharmaceutical Fees: Auxiliary Examinations: Limit of 200 RMB for each examination fee such as EKG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, MR*** vibration, etc.; Surgical Fees (with reference to the national standard, reimbursement of more than 1000 RMB will be made in accordance with the limit of 1000 RMB).
B, the elderly over 60 years of age hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) Reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.
3. Compensation for major illnesses:
(1) Compensation from the town's risk fund: Any hospitalized patient who participates in the rural cooperative medical insurance will be compensated for the one-time or yearly cumulative reportable medical expenses of more than 5,000 yuan in segments, i.e., 5,001-10,000 yuan will be reimbursed at 65%, and 10,001-18,000 yuan will be reimbursed at 70%.
(2) The annual limit of compensation for township-level cooperative medical care inpatient and outpatient blood dialysis for uremia, and outpatient radiotherapy and chemotherapy for oncology is 11,000 yuan.
Two, the residents of medical insurance reimbursement rate
1. Baoding hospitalization reimbursement treatment:
(1) first-class hospital hospitalization: medical insurance coverage for more than 200 yuan (the starting standard) above the part of the reimbursement of 90%;
(2) second-class hospitalization: medical insurance coverage for more than 400 yuan (the starting standard) above the part of the reimbursement of 80%;.
(3) hospitalization in tertiary hospitals: 70% reimbursement for the part of the cost within the scope of medical insurance exceeding 600 yuan (starting standard);
(8) hospitalization in a different place (transfer and emergency treatment in a different place): 50% reimbursement for the part of the cost within the scope of medical insurance exceeding 600 yuan (starting standard);
2. Outpatient treatment for special illnesses in Baoding City: the insured person suffers from coronary heart disease, hypertension, diabetes, mental illness, cirrhosis, malignant tumors, renal dialysis, kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia, hemophilia, breast cancer (endocrine therapy), hepatomegaly, chronic heart failure, chronic renal insufficiency, hyperthyroidism, epilepsy, hepatitis C, prostate cancer (endocrine therapy), bladder tumors (perfusion therapy), and so on. (perfusion therapy), post liver transplant, post hematopoietic stem cell transplant, rehabilitation therapy, chronic hepatitis B (antiviral therapy), pediatric cerebral palsy, and 27 other medical conditions are entitled to reimbursement of 60% to 80% under the monthly limit upon confirmation of application.
3. Baoding general outpatient treatment: the integrated fund pays 50% of the medical fees within the scope of the policy incurred by insured residents in the outpatient clinics of community health centers (general outpatient clinics incurred in other residents' designated hospitals are not entitled to this treatment). The maximum reimbursement limit for a single visit is 40 yuan. The maximum reimbursement limit for a single visit is RMB 40. The maximum reimbursement limit for a single year is RMB 160, of which the maximum reimbursement limit for insured residents aged 60 or over for men and 55 or over for women is RMB 240. The reimbursement for general outpatient services is not limited to any type of disease, and the medical expenses are settled directly at the community health service centers.
4. Baoding Municipal Maternity Expense Subsidy Treatment: For insured residents who comply with the family planning policy and give birth to a child, the subsidy for a normal delivery (including assisted delivery) is 600 yuan, and the subsidy for a cesarean section is 1,200 yuan.
5. Subsidies for the assembly of auxiliary aids for the insured disabled in Baoding City: Insured residents with lower limb disabilities and hearing-impaired children under the age of 7 who hold a disability certificate are given subsidies for the assembly of lower limb prostheses and the provision of hearing aids in designated institutions for the assembly of auxiliary aids for the disabled. Every five years, the subsidy for ordinary thigh prostheses and calf prostheses for people with lower limb disabilities with a disability card is 2,000 yuan each, and the subsidy for hearing impaired children under 7 years old with hearing aids is 2,400 yuan each.
6. Treatment of major medical insurance: medical expenses incurred by insured persons who are hospitalized due to illness and whose personal responsibility exceeds the starting line of 20,000 yuan within the scope of the policy are eligible for treatment of major medical insurance, and are reimbursed at a rate of 50%-80%.
Legal Basis: The Social Insurance Law of the People's Republic of China
Article 28 Medical expenses that conform to the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public ****health;
(4) those that seek medical treatment outside China.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the payment is made.
Article 31 The social insurance administration organization may, in accordance with the needs of management and service, sign service agreements with medical institutions and drug business units to regulate the behavior of medical services.
Medical institutions shall provide reasonable and necessary medical services to insured persons.