Proportion of social security and medical insurance reimbursement in Taizhou

The annual reimbursement cap line for medical expenses of farmers participating in the new rural cooperative medical system has been raised from 1 10,000 yuan to 30,000 yuan. According to the regulations, after farmers are hospitalized, the expenses below the deductible line need to be paid by themselves, and those above the deductible line are reimbursed in proportion. Starting from this year, most of the deductible lines for farmers' hospitalization have been lowered, which means that the scope of reimbursement has been expanded. Starting from this year, the deductible for hospitalization in township-level designated medical institutions is 50 ~ 100 yuan (formerly 100 ~ 300 yuan); County-level designated medical institutions 200 ~ 300 yuan (formerly 300 ~ 500 yuan); Municipal and provincial designated medical institutions 500 ~ 800 yuan. At the same time, in order to reduce the expenses paid by the participating farmers themselves, if the farmers are hospitalized many times in one year, the highest-level hospital will only calculate the deductible line once. For example, a farmer is hospitalized three times a year, the first time in a township hospital, the second time in a county hospital and the third time in a municipal hospital. When reimbursing medical expenses, the first two hospitalizations are reimbursed according to the "zero deductible line". For pediatric inpatients, the reimbursement deductible line is reduced by 50% on the basis of the reimbursement deductible line specified by designated hospitals at the same level. According to the new policy, hospitalization expenses are no longer compensated by stages, and medical institutions at the same level only set a compensation ratio. For example. In the past, it cost farmers more than 2000 yuan to be hospitalized in township hospitals. According to the past policy, the deductible line below 300 yuan will not be reimbursed, 300 yuan ~ 1000 yuan, one reimbursement ratio, 1000 yuan ~ 2,000 yuan, and the other reimbursement ratio. According to the new policy, the reimbursement ratio will be unified. In the new reimbursement rate, the reimbursement rate for hospitalization in township hospitals is about 70%, 60% at county level and 50% at municipal and provincial hospitals. All localities can make fine adjustments according to local economic conditions. You can also reimburse some outpatient expenses to "take care of" these farmers. Malignant tumor, chronic renal insufficiency, hypertension over stage II, coronary heart disease, diabetic complications, sequelae of acute cerebrovascular disease, decompensated cirrhosis, organ transplantation, tuberculosis (except free items), mental illness and other special diseases, outpatient expenses can be included in the scope of payment of serious illness pooling fund, and subsidies can be given in a certain proportion or in the form of annual fixed lump sum. Some patients with particularly heavy medical burden can enjoy reimbursement for outpatient service and hospitalization twice. Take uremia as an example. When receiving kidney transplantation, you can enjoy a serious illness subsidy of up to 30,000 yuan. In addition, after the operation, most patients still need to take medicine in the outpatient department for a long time. Farmers do not need to go through any referral procedures when they see a doctor in a local county or township designated medical institution. Taking the city as a unit, municipal designated medical institutions implement "direct subsidy" for farmers' hospitalization. Farmers in the designated hospitals in this city can see a doctor on the spot, be hospitalized on the spot, and be reimbursed on the spot. Farmers who need to be transferred to hospitals in other areas can go through the corresponding referral procedures and go to designated medical institutions with the New Rural Cooperative Medical Certificate. The level of medical institutions that see a doctor can go back to their hometown with relevant medical bills and enjoy the same deductible and compensation ratio of designated medical institutions at the same level in the county. In order to encourage and guide farmers to use Chinese medicine services, when they are hospitalized in Chinese medicine hospitals, general hospitals and western medicine specialized hospitals, the reimbursement deductible line of medical institutions at the same level is reduced by 100 yuan, and the reimbursement ratio of Chinese medicine services is increased by 10%. When the participating farmers are hospitalized in medical institutions above the municipal level, the actual reimbursement ratio is lower than 30% of the total medical expenses, and after excluding the deductible, they will be reimbursed according to 30% of the total medical expenses. In addition, in the past, some farmers went to the hospital for emergency treatment because of accidents. However, the emergency department is mostly affiliated to the outpatient department and cannot be included in the reimbursement of hospitalization expenses. According to the new policy, if farmers are hospitalized immediately after emergency examination, the expenses incurred in emergency can be included in the hospitalization expenses and reimbursed according to the policy.

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