Reimbursement Ratio of New Rural Cooperative Medical Insurance:
The outpatient expenses of the participants are reimbursed in accordance with the following regulations: 25% of the outpatient expenses are reimbursed at both the village health office and the town and street health center of the designated medical institutions of the cooperative medical system, and the total amount of outpatient reimbursement will be reimbursed at the maximum amount of RMB150 per person per year. Outpatient medical expenses at designated medical institutions above the second level (inclusive) are not reimbursed.
Hospitalization reimbursement is handled in accordance with the following provisions:
(1) Starting line. 100 yuan for the first-level fixed-point medical institutions, and medical expenses below the starting line will not be reimbursed. There is no starting line for second and third level designated medical institutions.
(ii) Reimbursement rate. The reimbursement rate for hospitalization in the first-level designated medical institutions is 65% of the medical expenses within the scope of reimbursement. The second and third level designated medical institutions hospitalization implementation of segmented compensation, divided into 5,000 yuan (including 5,000 yuan), more than 5,000 yuan to 10,000 yuan (including 10,000 yuan) and more than 10,000 yuan of three segments (the same below).
Expanded Information:
Urban residents who are hospitalized for more than two times in one billing year. Starting from the second hospitalization, the starting standard fee will no longer be charged. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the starting standard of the hospital to which they are transferred or to which they are re-admitted.
1. For students and children
In a settlement year, for medical expenses of less than 180,000 RMB incurred within the scope of reimbursement, the starting standard for tertiary hospitals is 650 RMB, and the reimbursement rate is 50%, with an upper limit of 2,000 RMB; the starting standard for secondary hospitals is 300 RMB, and the reimbursement rate is 60%; and there is no starting standard for tertiary hospitals, and the reimbursement rate is 65%.
2, aged 70 and above
In a settlement year, if the medical expenses of less than 100,000 RMB that meet the scope of reimbursement are incurred, the starting standard for tertiary hospitals is 650 RMB, the reimbursement rate is 50%, and the upper limit is 2,000 RMB; the starting standard for secondary hospitals is 300 RMB, the reimbursement rate is 60%; and the reimbursement rate for first-class hospitals does not have any starting standard, and the reimbursement rate is 65%.
3, other urban residents
In a billing year, incurred in line with the scope of reimbursement of medical expenses of less than 100,000 yuan, the starting standard for tertiary hospitals 659 yuan, the reimbursement rate of 50% capped at 2,000 yuan; second-level hospitals inpatient starting standard of 300 yuan, reimbursement rate of 55%; first-class hospitals do not have the starting standard, the reimbursement rate of 60%.?
Baidu Encyclopedia-Medicare Reimbursement Rate