Yunnan Province new new rural cooperative medical reimbursement ratio:
1, hospitalization according to different levels of hospitals to implement proportional reimbursement. The starting line is 100 yuan at the township level, 300 yuan at the Anning city level, 600 yuan at the Kunming city level, and 800 yuan at the provincial level. The compensation ratio is 70% at town level, 50% at Anning city level, and 30% at Kunming city and provincial level. The maximum limit of hospitalization compensation for the participants is 15,000 yuan for the whole year. Participants holding Rural Special Hardship Household Relief Certificates, Rural Low-income Benefit Receiving Certificates and Rural Five Guaranteed Household Subsistence Certificates issued by the Municipal Civil Affairs Bureau are exempted from the hospitalization starting line when they are reimbursed.
2, participating pregnant women hospital delivery compensation, while the implementation of the policy of limited charges (refers to all direct costs incurred during the hospital delivery of the mother, including bed fees, nursing fees, examination fees, laboratory fees, surgical fees, drug costs, etc.), township-level normal single-fetal hospital delivery charges controlled within 400 yuan, a one-time compensation for each case of 400 yuan; Anning municipal and above medical institutions controlled within 600 yuan, each case of a one-time compensation for 600 yuan or less, with a one-time compensation of 400 yuan per case. Critical or out-of-town resident or worker participating pregnant women in non-designated medical institutions normal single-fetus inpatient delivery of a one-time compensation of 400 yuan per case.
3. The designated medical institutions for Anning New Agricultural Cooperative Medical Care:
(1) Village level: village health office.
(2) Township level: seven township health doctors.
(3) Anning city level: Anning People's Hospital, Anning Hospital of Traditional Chinese Medicine, Anning Maternal and Child Health Center, Yunhua Hospital, Luzhang Tongan Base Hospital, Kunsteel Hospital, Dianda Hospital (private hospital).
(4) Kunming City level: Kunming First People's Hospital, Kunming Third People's Hospital (Kunming Infectious Diseases Hospital), Kunming Children's Hospital, Kunming Maternal and Child Health Hospital, Kunming Hospital of Traditional Chinese Medicine, Yunnan Provincial Psychiatric Hospital, Kunming Yan'an Hospital.
(5) provincial level: the First Affiliated Hospital of Kunming Medical College (Yunnan University Hospital), the Second Affiliated Hospital of Kunming Medical College (Workers' Hospital), the Third Affiliated Hospital of Kunming Medical College (Yunnan Tumor Hospital), the First People's Hospital of Yunnan Province (Kunhua Hospital), the Second People's Hospital of Yunnan Province (Yunnan Provincial Red Cross Hospital), the Third People's Hospital of Yunnan Province, and the 43rd Hospital of the PLA in Kunming, Yunnan Provincial Armed Police Headquarters Hospital.
4. The procedure of medical treatment and compensation for the participants: within the city, the participants are not restricted by administrative divisions and are free to choose the designated medical institutions, but when they are hospitalized outside of the city area, they have to be reimbursed only with the consent of the designated medical institutions or the town or street offices' cooperative management offices. Critically ill patients or participants who live or work outside the city can be referred first and then go through the referral procedures, and if they are hospitalized in a non-designated medical institution, the reimbursement standard will be in accordance with the reimbursement ratio of provincial hospitals. Participants holding the "Anning City New Rural Cooperative Medical Card" to the New Rural Cooperative Medical Institutions, their medical fees are reduced on-site in accordance with the regulations, and the compensation procedures are as follows:
(1) Outpatient: Participants holding the "Medical Card" in the health centers and village health offices (offices) to implement on-site reduction.
(2) hospitalization: participants holding a Medical Card are hospitalized in municipal and township-level designated medical institutions for on-site remission (of which: traumatic injuries need to be certified by the township and street offices' cooperative management office as belonging to the supplementary scope). For those who are referred to be hospitalized in a medical institution outside the jurisdiction of the city, with the certificate of hospitalization referral, hospitalization receipt, certificate of diagnosis of the condition, discharge certificate, patient's ID card (hukou booklet), list of medication and other related materials, go back to the town health center where the hukou is located, and the city hospital of traditional Chinese medicine to review and reimbursement.
5. The time limit for reimbursement procedures for out-of-town visits is two months after discharge from the hospital, after which no reimbursement will be made in principle, but extensions may be considered as appropriate in cases where the delay is due to inconvenient transportation, incomplete reimbursement materials, natural disasters, and other special reasons.
6, the standards and procedures for applying for assistance for major diseases:
Participants who are hospitalized due to serious and special illnesses incur one-time out-of-pocket expenses (the total cost of hospitalization minus the amount of reimbursement from the cooperative medical system, the amount of compensation from the insurance company, and the amount of other supplementary assistance) of more than 10,000 yuan (10,000 yuan), of which 10,000-30,000 yuan (30,000 yuan) subsidies for out-of-pocket expenses of 25%; 50% of the subsidy for more than 30,000 yuan.
Application for assistance for major illnesses need to provide the materials and procedures:
(1) I put forward a written application and fill out the application form to the village (neighborhood) Committee;
(2) the village (neighborhood) Committee receives the application, a timely investigation to understand the situation of the applicant has been granted subsidies, such as the case of the applicant is true, in the applicant resides in the village (neighborhood) people's group publicity for five days, such as no objections, the review and seal to the township, the street office of the co-management office. The town, the street office of the joint management office.
(3) town, street office after receiving the application form to seriously implement the applicant has been subsidized, such as the application is true, review and seal to the city co-management office. After receiving the application form, the city co-management office to seriously implement the applicant has been subsidized, if the situation is true, in accordance with the subsidy standard subsidy opinion, submitted to the city health bureau director's office of the enlarged meeting of the audit, after the audit, the issuance of a notice of appropriation, and will be subsidized to the applicant's health hospitals. Health centers in accordance with the municipal co-management office subsidy notice, to do the work of subsidies issued.
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