How much is the reimbursement for Haikou New Rural Cooperative Medical System?

The new rural cooperative medical fund is divided into three parts: outpatient fund, inpatient fund and risk reserve.

(1) Outpatient Fund: it is withdrawn according to the annual per capita 6 yuan. It is used to compensate the medical expenses of participating farmers due to illness. Overexpenditure is not covered, and savings are accumulated.

(2) Hospitalization fund: 28 yuan per capita. Mainly used to compensate farmers for serious medical expenses.

(3) Risk reserve fund: drawn according to the annual per capita 2 yuan. Mainly used for medical expenses compensation for participating farmers who exceed the maximum capping line but still become poor due to illness or return to poverty due to illness; It is used to deal with emergencies such as financial overdraft of cooperative medical fund and epidemic of infectious diseases. In principle, the balance of the cooperative medical fund in the previous year will be transferred to the risk reserve of the cooperative medical fund in the next year.

Article 21 the scope of compensation of the fund

The new rural cooperative medical fund is mainly used to compensate the medical expenses incurred by participating farmers due to illness. The compensation includes: medical expenses, operation expenses, blood transfusion expenses, oxygen delivery expenses, ordinary bed expenses, routine examination expenses (B-ultrasound, electrocardiogram, radiation), routine laboratory expenses (routine blood, urine, stool and liver function) and other medical and examination expenses.

Twenty-second cooperative medical fund shall not compensate the following services and facilities:

(1) outpatient travel expenses, first aid expenses and stretcher expenses.

(2) TV fee, telephone fee, baby incubator fee, food and health care box fee, electric stove fee, gas fee, refrigerator fee, and compensation fee for damage to public property.

(three) escort fees, nursing fees, washing fees and outpatient decocting fees.

(4) Diets (including nutritious meals and medicated meals).

The general principles of fund compensation are: keeping expenditure within income, balancing income and expenditure, moderately guaranteeing, accumulating compensation in proportion by sections, and setting up deductible line and capping line. The deductible line for reimbursement of hospitalization medical expenses is 300 yuan, and the capping line is 8,000 yuan.

The medical expenses incurred by participating farmers in designated medical institutions that meet the prescribed scope of compensation shall be compensated according to the following standards. If the participating farmers need to be transferred to secondary medical institutions for hospitalization, the reimbursement ratio will be reduced by 5% under the same standards in this Municipality. For those who are transferred to tertiary medical institutions for hospitalization, the reimbursement rate will be reduced by 10% under the same standards in this city. The staff outside the hospital shall be reimbursed according to 50% of the similar compensation standards in this Municipality, and the total medical expenses for single diseases shall be controlled.

Proportion of compensation for hospitalization expenses

The hospitalization expenses are divided into medical institutions.

Town hospital secondary hospital tertiary hospital

300 - 3000 35﹪ 30﹪ 25﹪

300 1 - 5000 40﹪ 35﹪ 30﹪

500 1 - 10000 50﹪ 45﹪ 40﹪

/kloc-above 0/0000, 60% 55% 50%

Compensation procedure and method

(a) to participate in the cooperative medical care of farmers in the designated medical institutions in this city due to illness, medical expenses incurred by the district joint management office after the audit according to the provisions of compensation, the district joint management office should be approved and paid within the specified time.

(2) Compensation for hospitalization expenses of migrant workers. With my valid certificate, village-level certificate and the official invoice, medical expense list and medical record copy of non-profit medical institutions above the second level in the field, I will apply to the district joint management office for review and reimbursement, and the district joint management office will review and settle the payment within the specified time.

Twenty-seventh endemic diseases, occupational diseases in hospital medical expenses according to the relevant provisions of the state, the balance of compensation according to the relevant provisions of cooperative medical care.

Twenty-eighth the use of risk reserve, by the town management office to investigate and verify the use of funds and projects, reported to the district management office for approval, and accept social supervision.

Twenty-ninth participating farmers must carry a "medical certificate" every time they seek medical treatment in outpatient clinics. In addition to carrying the "Diagnosis Certificate" when staying in hospital, you must also show valid certificates such as ID card or household registration book.

Chapter V Approval and Management of Designated Medical Institutions

Thirtieth cooperative medical care is managed by designated medical institutions. After the examination and confirmation by the municipal joint management office, the unified logo will be hung and the annual inspection system will be implemented. Where the non-profit medical and health institutions that have obtained the practice license of medical institutions meet the requirements after examination and acceptance, they can be identified as designated medical institutions by signing a service contract with the municipal joint management office.

Article 31 All designated medical institutions should strengthen the management of medical personnel, enhance the service function, improve the service quality, meet the needs of farmers for disease prevention and treatment, improve and implement various diagnosis and treatment norms and management systems, publish the catalogue of basic drugs for cooperative medical care and the price of basic medical services, and strictly implement the price policy. In principle, participating farmers should seek medical treatment nearby.

Medical staff should be treated for illness, adhere to the principle of reasonable examination, reasonable treatment and reasonable referral, provide good medical services for participating farmers, make diagnosis and treatment in strict accordance with the prescribed technical specifications for medical diagnosis and treatment, and shall not prescribe drugs indiscriminately, abuse large-scale physical examination or prescribe drugs, and shall not relax the indications and standards for admission at will.