How much can rural medical insurance be reimbursed?

The reimbursement rate of rural medical insurance: 60% of outpatient village clinics and village center clinics, the limit of prescription drug cost per visit 10 yuan, and the limit of prescription drug cost for temporary rehydration of doctors in health centers in 50 yuan; 40% reimbursement for medical treatment in the town health center, with the limit of examination fee and operation fee for each visit, and the limit of prescription drug fee 100 yuan.

legal ground

Article 23 of the Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

I. reimbursement for rural clinics

1. repayment ratio

(1) 60% reimbursement for village clinics and village center clinics;

2. 40% reimbursement for medical treatment in town hospitals;

③ 30% reimbursement for treatment in secondary hospitals;

④ 20% reimbursement for treatment in tertiary hospitals;

2. Qifubiaozhun

① The cost limit of prescription drugs for each visit is 10 yuan, and the cost limit of temporary rehydration prescription drugs for hospital doctors is 50 yuan.

② The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription fee is 100 yuan.

(3) For secondary hospitals, the limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 200 yuan;

④ In tertiary hospitals, the limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription fee is 200 yuan.

⑤ The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

6. The annual compensation limit for rural cooperative medical clinics is 5000 yuan.

Two. Hospital reimbursement in rural areas

1. repayment ratio

(1) 60% reimbursement for urban hospitals;

② 40% reimbursement from secondary hospitals;

③ 30% reimbursement from tertiary hospitals.

2. reimbursement standard

(1) Medical expenses: auxiliary examination: the expenses for electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

② The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

3 rural serious illness reimbursement ratio (more than 5000 yuan)

1.5001-10000 yuan will be reimbursed by 65%.

2.10001-18000 yuan will be reimbursed by 70%.

3. The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is 1. 1.0000 yuan.

Four, all kinds of people in rural areas medical insurance reimbursement ratio and Qifubiaozhun.

1. Reimbursement ratio of students and children and minimum payment standard (1.8 million yuan or less)

1. repayment ratio

① The reimbursement rate of tertiary hospitals is 55%;

② The reimbursement rate of secondary hospitals is 60%;

③ The reimbursement rate of first-class hospitals is 65%.

2. Qifubiaozhun

The qifubiaozhun for tertiary hospitals is 500 yuan;

② The Qifubiaozhun for secondary hospitals is 300 yuan;

③ There is no Qifubiaozhun in the first-class hospital.

2. Reimbursement proportion and minimum payment standard for people over 70 years old (below 65438+ 10,000 yuan)

1. repayment ratio

① The reimbursement rate of tertiary hospitals is 50%;

② The reimbursement rate of secondary hospitals is 60%;

③ The reimbursement rate of first-class hospitals is 65%.

2. Qifubiaozhun

The qifubiaozhun for tertiary hospitals is 500 yuan;

② The Qifubiaozhun for secondary hospitals is 300 yuan;

③ There is no Qifubiaozhun in the first-class hospital.

The role of rural medical insurance

Rural medical insurance is a part of China's social security, which enables farmers to enjoy the social security of rural medical insurance and is one of the important links in China's economic construction. Insured farmers can choose different hospitals for medical treatment, generally taking the principle of proximity, and different hospitals have different reimbursement rates. Generally, the reimbursement rate of inpatients is relatively large, which can be divided into chronic diseases, special diseases and accidental injuries. Different reimbursement rates can be adopted to avoid poverty and anti-poverty due to illness to a certain extent.

In addition, the implementation conditions of medical insurance are relatively high, in which the social medical insurance should be based on the high degree of industrialization and the high income level of the agricultural population, that is, the large-scale insured population with high income level also needs national or local laws to enforce, and the statutory insurance companies have high basic management level and good reputation. On the other hand, commercial health insurance excludes people with poor health. These conditions are not available in most rural areas of China, so they are not suitable for universal promotion.

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