What is the reimbursement rate of rural medical insurance?

1. What is the reimbursement rate of rural medical insurance? (1) outpatient compensation 1. The expenses incurred by the insured in the village clinic and the village center clinic can be reimbursed by 60%, and the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration by doctors in health centers can be reimbursed to 50 yuan. 2. The expenses incurred by the insured in the town health center can be reimbursed by 40%, and the reimbursement for each medical examination fee and operation fee shall not exceed that of 50 yuan, and the reimbursement for prescription drug fee shall not exceed 100 yuan. 3. The expenses incurred by the insured in the secondary hospitals can be reimbursed by 30%, and the reimbursement for each medical examination and operation expenses cannot exceed that of 50 yuan, and the reimbursement for prescription drugs cannot exceed that of 200 yuan. 4. The expenses incurred by the insured in tertiary hospitals can be reimbursed by 20%, and the reimbursement for each medical examination and operation expenses cannot exceed that of 50 yuan, and the reimbursement for prescription drugs cannot exceed that of 200 yuan. 5. The reimbursement for each prescription attached to the invoice of traditional Chinese medicine shall not exceed 1 yuan. 6, township cooperative medical outpatient compensation can not exceed 5000 yuan per year. (II) Hospitalization compensation 1, scope of reimbursement: a. Drug expenses: supplementary examination: reimbursement for examination expenses such as electrocardiogram, X-ray fluoroscopy, film taking, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance. No more than 200 yuan; Surgical expenses (according to national standards, compensation for more than 1000 yuan shall be made by 1000 yuan). B, the treatment and nursing expenses of the elderly over 60 years old in the town health center, the highest daily reimbursement 10 yuan, the total reimbursement does not exceed 200 yuan. 2. Reimbursement ratio: 60% of the expenses incurred in hospitalization in town health centers can be reimbursed; Hospitalization expenses incurred in secondary hospitals can be compensated by 40%; Hospitalization expenses incurred in tertiary hospitals can be compensated by 30%. (III) Serious illness compensation risk fund in the town: if the insured person's one-time or annual accumulated expenses exceed 5,000 yuan due to hospitalization, he will be compensated by stages, that is, 65% if it exceeds 5,000 yuan but does not exceed1001-18000 yuan, and 70% if it exceeds18000 yuan. Generally, the reimbursement scope of the new rural cooperative medical system does not cover the following expenses: 1, self-seeking medical treatment without going to the designated hospital or handling the referral form, self-purchased drugs, drugs that are not included in the compensation scope according to the provisions of public medical care, and medical expenses that do not meet the reimbursement scope of family planning; 2. Outpatient treatment fees, visiting fees, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except those with family blood storage, which shall be reimbursed according to relevant regulations), and other expenses such as heating and cooling fees, ambulance fees, special nursing fees, etc. shall not be reimbursed; 3. The insured will not be reimbursed for medical expenses caused by car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; 4. Medical expenses incurred by the insured due to orthopedic surgery, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. No reimbursement; 5. Within the scope of reimbursement, expenses exceeding the limit shall not be reimbursed. Knowing the scope and proportion of reimbursement of the new rural insurance mentioned above, you should know that it is a drop in the bucket to rely on medical insurance for reimbursement of serious illness. If you give yourself more critical illness insurance, you can nip in the bud. You can get compensation in time after a serious illness and get treatment as soon as possible. This is also the reason why commercial critical illness insurance is so popular. Many people like to choose critical illness insurance products, which have the characteristics of wide coverage, 105 kinds of diseases, compensation for diseases, income without diseases, and more peace of mind for critical illness housekeeper services. Insurance can be selected according to economic strength, and the right one is the best.

Legal objectivity:

What is the proportion of medical insurance reimbursement? This is a very complicated problem, not to mention that the medical insurance policy has various regulations due to different regions, and even there are many kinds of medical insurance drugs. In addition, the ratio of outpatient reimbursement to hospitalization reimbursement is really difficult to calculate. 1. Different hospitals have different reimbursement rates for medical insurance. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not medical insurance and cannot be reimbursed. 2. On-the-job employee hospitalization medical insurance reimbursement ratio hospitalization, except for the self-funded part and self-paid 10%, the part exceeding the deductible of hospitalization medical insurance enjoys the overall payment ratio. Different levels of hospitals have different threshold fees and enjoy different proportions of overall payment. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan). From this perspective, the proportion of self-funded medical insurance hospitalization is hard to say. All self-funded parts are self-funded, and all threshold fees are self-funded. The second-class expenses shall be paid by 65,438+00% first, and then by 20% together with the first-class expenses. Very complicated! In fact, the computer system will automatically calculate. Medical insurance hospitalization, show the medical insurance card, read the card into the medical insurance system, pay the deposit (usually the threshold fee), and enter the fee into the system. The system automatically classifies it as self-funded, Class A, Class B, etc. Class B pays 65,438+00% first, and then enters the basic medical care. According to the number of hospitalizations per year (more than 1 deductible expenses are halved) and hospital level (deductible expenses are different), the calculation formula is as follows: if the medical expenses total 9,000 yuan, the reimbursement formula is [9000-500 (deductible expenses)-self-funded drugs ]*80%. If self-funded drugs account for a large proportion, there is not much amount to be reimbursed. 3. Proportion of reimbursement of supplementary medical insurance for retirees. Ms. Zhang, who lives in Shijingshan District, Beijing, reported that after retiring in 2000, she had to go to the hospital for a prescription every month because of chronic diseases. In the past, the reimbursement rate was always about 88% (for retirees under 70 years old, 70% of large medical expenses were paid by mutual funds, and 60% of the remaining 30% could be reimbursed by supplementary medical insurance, which was 88%). But now it is said that the proportion of supplementary medical insurance in social security card (that is, medical insurance card) is 50%, so only 85% can be reimbursed. She wants to know whether the social security card has adjusted the proportion of medical reimbursement. The staff of the Social Security Bureau replied that the social security card did not adjust any medical reimbursement ratio. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. If the reimbursement rate of Ms. Zhang's supplementary medical insurance is 60%, it should be because the funds reimbursed by Ms. Zhang's original unit are higher than the social supplementary medical insurance. After using the social security card, it can still be reimbursed according to the reimbursement ratio provided by the original unit, that is, 60% of the supplementary medical insurance.