Where to get reimbursement for rural cooperative medical insurance?

In order to continue to promote the construction of the new rural cooperative medical system, improve the overall health level of rural residents, promote the coordinated development of urban and rural areas, and promote the construction of a harmonious new Shunyi and a higher-level moderately prosperous society, according to the "Beijing Municipal Health Bureau's Notice on Promoting 2009 Opinions on the Compensation Work of New Rural Cooperative Medical Care in this City" (Jingwei Nongzi [2008] No. 21 formulates these implementation rules.

1. Scope of application

(1) Residents with agricultural registered permanent residence in our district; school students and preschool children whose parents have agricultural registered permanent residence and themselves have non-agricultural registered permanent residence; immigrants from the reservoir area who have non-agricultural registered permanent residence and do not enjoy any government medical coverage; people who are married and do not enjoy any government medical care in our district

(2) The time to participate in the new rural cooperative medical insurance is calculated based on the fiscal year, and the benefits will be received in the same year.

2. Participation registration

Rural residents voluntarily participate in the new rural cooperative medical care as a family unit; participants are subject to territorial management, and the procedures are handled by the village committee where their household registration is located. People who marry from other places in our district go with their spouses to go through the processing procedures at the village committee where their household registration is located. .

3. Funding sources

(1) In 2009, the municipal financial subsidy standard is 140 yuan per person per year; the district financial subsidy standard is 130 yuan per person per year; the town financial subsidy standard is 130 yuan per person per year. 85 yuan per person per year. In 2010, the corresponding subsidy standards will be increased according to relevant regulations.

(2) Village collectives will provide financial support to economically disadvantaged villages determined by the municipal and district agricultural committees. The village collective support funds will be paid by the district and town finance departments, each of which will bear 50% of the required support funds.

(3) In 2009, each participating person will pay 60 yuan for the Central African Agriculture in the reservoir area. In principle, the town and village support funds for people with registered residence are paid by themselves, and each person pays 150 yuan. The town and village support funds for people who marry from other places in our district are paid by themselves, and each person pays 150 yuan. 4) The personal contributions of the minimum living security recipients and those receiving special care will be paid by the district finance department.

IV. Risk fund

The new rural cooperative medical fund will draw a risk fund based on a coefficient of 10%. , used when there is an overrun of basic overall funds

5. Scope of medical treatment

(1) Designated medical institutions in the region include all types of medical institutions at all levels under the district health system, 66055. Military hospital, psychiatric hospital, forensic hospital, Jingshun Hospital, Beijing Xingyuan Jinfang Traditional Chinese Medicine Hospital; 17 Grade IIIA comprehensive medical institutions, 15 Grade IIIA specialized medical institutions, and Grade IIIA traditional Chinese medicine medical institutions in the city 5 (see Attachment 1).

(2) If the patient is transferred to a designated third-level comprehensive medical institution for treatment, a transfer certificate must be issued by the designated secondary medical institution. If there is no time to go through the procedures due to special reasons and seek medical treatment in a public medical institution outside the district, the patient must report to the district's New Rural Cooperative Medical Care Management Center within two weeks from the date of hospitalization and complete relevant procedures. After passing the critical period (in principle, no more than 2 weeks) After that, he was promptly transferred to the designated medical institution of the new rural cooperative medical system in the district for medical treatment.

(3) In accordance with the principle of treating minor illnesses in the community and going to the hospital for serious illnesses, insist on seeking medical treatment nearby.

6. Expense reimbursement

(1) Reimbursement principles.

Medical reimbursement is based on general outpatient reimbursement and hospitalization reimbursement. General outpatient reimbursement funds are used to reimburse participants for outpatient medical expenses at designated medical institutions; inpatient reimbursement funds are used to reimburse participants for medical expenses for hospitalization and outpatient treatment of special diseases.

Special disease outpatient clinics refer to radiotherapy and chemotherapy for malignant tumors, renal dialysis, anti-rejection drugs after liver and kidney transplantation, aplastic anemia in children and hemophilia.

Medical expense reimbursement is implemented in different levels of hospitals and different reimbursement ratios.

The medical expenses incurred by participants during hospitalization or outpatient treatment for special diseases during the coverage year are cumulatively calculated, and the approved expenses are paid in proportions and cumulatively.

Reimbursement of medical expenses for participating students and children is in accordance with the "Notice of the Beijing Municipal Health Bureau on Adjusting the Medical Insurance Compensation Policy for Rural Students and Children in 2008" (Jingwei Nongzi [2008] No. 2) and the "Beijing Municipal Health Bureau" The relevant provisions of the Bureau's Opinions on Promoting the Compensation Work of New Rural Cooperative Medical Care in this Municipality in 2009 (Jingweinongzi [2008] No. 21) shall be implemented.

(2) Reimbursement cycle.

General outpatient medical expenses are reimbursed once a month; inpatient and special disease outpatient medical expenses are reimbursed every half month, subject to a cap.

(3) Reimbursement procedures.

Within the specified reimbursement time, participating patients or family members shall submit the new rural cooperative medical care certificate and reimbursement voucher to the village new rural cooperative medical care working group. The New Rural Cooperative Medical Care Working Group reports all the vouchers required for reimbursement in the jurisdiction to the town New Rural Cooperative Medical Care Management Office. After being reviewed by the management office, entered into the reimbursement system, and the reimbursement amount is determined, it is reported to the district New Rural Cooperative Medical Care Management Center.

The district new rural cooperative medical management center will review and report to the district finance bureau. The district financial bureau will allocate the reimbursement to each new rural cooperative medical management office. The new rural cooperative medical management office is safe, simple, convenient and appropriate. In the form of new rural cooperative medical care working group or directly, the reimbursement funds are sent to the reimbursement personnel, and they are signed and filed step by step.

(4) Reimbursement standards.

1. For general outpatient clinics, 50% of approved medical expenses are reimbursed by first-level hospitals, 35% by second- and third-level hospitals, and 40% by district traditional Chinese medicine hospitals. The actual reported funds are capped at 2,500 yuan.

2. Approved medical expense reimbursement for inpatient and special disease outpatient clinics, with a minimum payment of 0 yuan for first- and second-level hospitals and 1,000 yuan for third-level hospitals. The actual reported capital is capped at 180,000 yuan.

Approved medical expenses for inpatient and special disease outpatient clinics in designated secondary medical institutions will be reimbursed from 0 to 20,000 yuan, with 65% reimbursed; from 20,000 yuan to 50,000 yuan, 70% will be reimbursed; above 50,000 yuan, 75% reimbursement.

3. For hospitalization and outpatient treatment of special diseases in designated first-level medical institutions, 70% of the medical expenses will be reimbursed.

4. For reimbursement of inpatient and outpatient medical expenses for special diseases in designated tertiary medical institutions, the reimbursement ratio for each period is 10 percentage points lower than that of designated secondary medical institutions.

5. If a patient is transferred to hospital for treatment after emergency rescue and observation, the observation expenses within the seven days before hospitalization will be reimbursed together with the hospitalization expenses.

6. If a patient dies during emergency rescue and observation, the cost of observation within seven days before death will be reimbursed as hospitalization.

7. For students and preschool children with agricultural registered permanent residence who have not participated in the Beijing Student and Children’s Major Illness Medical Insurance, their hospitalization and special disease outpatient approved medical expenses will be reimbursed, starting from 0 for first- and second-level hospitals. The minimum payment line for tertiary hospitals is 650 yuan, and 70% of the portion above the minimum payment line is reimbursed.

8. For those who have participated continuously from 2004 to the present and have not been reimbursed for inpatient and outpatient medical expenses for special diseases before 2009, their reimbursement for inpatient and outpatient medical expenses for special diseases in 2009 will be increased by 5 percentage points for each period.

(5) Reimbursement voucher.

1. For reimbursement of general outpatient medical expenses, special receipts for outpatient charges in Beijing, outpatient prescriptions, and expense lists must be provided.

2. For hospitalization reimbursement, Beijing’s special receipts for hospitalization charges, item details, expense lists, and diagnosis certificates must be provided; for reimbursement of outpatient medical expenses for special diseases, Beijing’s special receipts for outpatient charges, outpatient prescriptions, and fees must be provided. Checklist and corresponding diagnostic certificate.

3. For reimbursement of inpatient and outpatient medical expenses for special diseases in designated tertiary comprehensive medical institutions, referral and transfer certificates issued by designated secondary medical institutions must be provided.

4. For medical expense reimbursement for those who participate in commercial medical insurance, in addition to providing a copy of the above reimbursement voucher, a claim split form issued by the insurance company must also be provided.

5. For reimbursement, all other participants must provide original vouchers for medical expenses that have not been reduced or exempted by other medical insurances.

(6) Expenses not included in the scope of reimbursement:

Expenses for medical treatment in non-designated medical institutions;

Failure to complete the transfer procedures, skipping to designated three The cost of medical treatment at a comprehensive medical institution;

The cost of treatment for suicide, self-mutilation, alcoholism, etc.;

The cost of infertility, infertility, pregnancy test, childbirth, family planning surgery, etc.,

Expenses incurred for animal injuries, vaccinations, physical examinations, beautification, plastic surgery, etc.;

Medical expenses incurred for various illegal activities such as fighting, fighting, drug abuse, etc.;

< p>Medical expenses for traffic accidents, work injuries, medical accidents and other liability accidents;

Treatment expenses for statutory occupational diseases;

Treatment expenses abroad and in Hong Kong, Macao and Taiwan;< /p>

Other medical expenses that should be paid by the individual in accordance with relevant regulations of the state and this city.

(7) Reimbursement items. The reimbursement items of the new rural cooperative medical care are implemented with reference to the "Beijing Basic Medical Insurance Drug Catalog", "Beijing Basic Medical Insurance Diagnosis and Treatment Item Catalog", and "Beijing Basic Medical Insurance Medical Service Facilities Catalog".

(8) Drug prices. The price of drugs provided by designated medical institutions to participants of the New Rural Cooperative Medical Care shall be based on the municipal bidding drug prices.

7. Scope of "Four Fees" Exemption

Personnel participating in the New Rural Cooperative Medical Care Service are exempted from registration fees, diagnosis and treatment fees, visit fees, and puncture fees (injections) when seeking medical treatment at community health service stations. , infusion).

8. Termination of reimbursement

The deadline for submission of reimbursement documents within the year is January 10 of the following year. For those who cannot be discharged before December 31, the medical institution where they are hospitalized will issue a settlement list for this year. Any documents not submitted by the due date will be deemed to have automatically given up the reimbursement qualification.

9. Organizational Leadership

(1) The District New Rural Cooperative Medical Care Management Committee is responsible for the formulation and adjustment of new rural cooperative medical policies, the organization and coordination of work, and the inspection and assessment of the situation. .

(2) The District New Rural Cooperative Medical Care Supervision Committee is responsible for supervising the income and expenditure of new rural cooperative medical care funds and the implementation of the system.

(3) The district new rural cooperative medical management center is responsible for the collection and use of new rural cooperative medical funds, the review and settlement of reimbursement vouchers, the supervision and inspection of designated medical institutions, and the business training and management of town-level agencies. Work assessment and policy research.

(4) The town’s New Rural Cooperative Medical Care Working Committee is responsible for organizing and mobilizing the town’s new rural cooperative medical care participation work, collecting and turning over participation funds, publicizing and popularizing reimbursement policies, calculating medical expense reimbursement, and collecting reimbursement funds. Issued business training and work assessment for village-level staff.

(5) The village’s new rural cooperative medical care working group is responsible for the collection and handover of the village’s new rural cooperative medical care participation funds, publicity of reimbursement policies, collection of reimbursement vouchers, delivery of reimbursement funds, and publicity of reimbursement status. Its work status is included in Village affairs are made public on Democracy Day.

(6) The personnel and working expenses of new rural cooperative medical management institutions and handling agencies at all levels shall be included in the fiscal budget of the same level.

(7) The new rural cooperative medical system is implemented under the unified leadership of the district government, with strong support and close cooperation from all relevant departments.

(8) Problems encountered in the implementation of the new rural cooperative medical care shall be coordinated and resolved by the district new rural cooperative medical care management committee office in conjunction with relevant departments.

(9) District television stations, radio stations and other publicity media should set up special columns to publicize system policies and typical cases. Adopt appropriate methods to release relevant information on fund collection, operation status and work progress provided by the district's new rural cooperative medical management agency. The district's new rural cooperative medical management agency produces and provides necessary promotional materials to towns and villages.

10. The Office of the District New Rural Cooperative Medical Care Management Committee is responsible for the interpretation of these "Implementation Rules".

11. These "Implementation Rules" will come into effect on January 1, 2009. The "Notice of the Shunyi District People's Government on Issuing the Implementation Opinions and Implementation Rules of the Shunyi District on Adjusting and Improving the New Rural Cooperative Medical System" issued by the Shunyi District People's Government on December 10, 2007 (Shunzhengfa [2007] No. 69) and "Notice of the Office of the People's Government of Shunyi District forwarding the Supplementary Opinions of the District Health Bureau on the Implementation Rules of the New Rural Cooperative Medical System in Shunyi District" (Shunzheng Banfa [2007] No. 77) is abolished at the same time

If someone uses The total medical expenses are 25,000 yuan, and the reimbursement formula is as follows: (25,000-500 "deposit line" - self-paid drugs) * 20%. If self-paid drugs account for a large proportion, the amount of reimbursement will not be much.

It is also important to go to designated medical institutions for medical treatment.

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