(2) The municipal hospital of traditional Chinese medicine implements the deductible line for township hospitalization, and the reimbursement ratio remains unchanged.
(3) Newborns who meet the national family planning policy and are not within the payment time limit at birth will enjoy the treatment of the new rural cooperative medical system with their participating parents, and the compensation expenses incurred will be merged with their parents 1. Newborns are exempted from the participation fee of the year, which is not included in the number of participants in the year, and governments at all levels do not provide additional subsidies.
(4) If the participating farmers are hospitalized again in the same year, the deductible expenses will be deducted again. For patients hospitalized for malignant tumor (including malignant tumor resection, conservative treatment, radiotherapy and chemotherapy and follow-up treatment), end-stage renal disease and cerebral palsy for many times during the year, the deductible of the highest level medical institution is deducted only once.
(5) If the insured rural residents are transferred from higher medical institutions to lower medical institutions for continuous hospitalization due to the same disease, the hospitalization deductible line of lower medical institutions shall not be deducted when calculating the hospitalization compensation expenses of lower medical institutions; If the hospitalization from a lower medical institution is transferred to a higher medical institution for further hospitalization, the deductible expenses of the lower medical institution shall be deducted from the deductible of the higher medical institution when calculating the hospitalization compensation expenses.
(6) Participating rural residents can independently choose the designated medical institutions of the new rural cooperative medical system in the overall planning area. If a referral is needed due to illness, the designated medical institution shall issue a referral certificate in time, and the patient or his family shall go to the county-level new rural cooperative medical service agency for examination and approval. Due to special reasons such as urgency, danger and severity of illness, patients or their families should go to the hospital where they live to issue emergency certificates and go through relevant procedures within 5 working days. Those who fail to go through the referral approval and filing procedures within the prescribed time limit will not be reimbursed, and the reimbursement rate for not going through the referral procedures will be reduced by 10 percentage point.
(7) In any of the following circumstances, the new rural cooperative medical system shall compensate according to the compensation scheme of the actual payment of the participating farmers:
The medical services received are subsidized by the special fund;
(2) The medical services received are reduced or exempted by medical institutions.
(8) The medical expenses incurred by the participants who live in different places and seek medical treatment in designated medical institutions of the new rural cooperative medical system agreed in different places shall be compensated according to the provisions of the new rural cooperative medical system in the participating places after the registration and filing of the new rural cooperative medical system.
(9) The compensation standard shall be formulated by the Municipal Health Bureau if the single disease is paid.
Extended data
Critical illness insurance compensation.
1, the compliance medical expenses of the new rural cooperative medical system exceeded12,000 yuan (deductible line), and then entered the serious illness compensation procedure, and was hospitalized several times in the year.
2, the new rural cooperative medical insurance personal burden of compliance medical expenses calculation method. Compliance medical expenses borne by individuals = total hospitalization expenses in the current year-compensation expenses of the new rural cooperative medical system in the current year-non-compliance medical expenses (that is, expenses not included in the compensation scope of the new rural cooperative medical system for serious illness insurance).
3. The serious illness insurance policy is inclined to the rural poor, and the deductible line for compliant medical expenses is calculated at 50%, and the compensation ratio is increased by 10 percentage point.
The maximum compensation per person per year is 300,000 yuan.
The Municipal Health and Family Planning Bureau formulated the Detailed Rules for the Implementation of New Rural Cooperative Medical Insurance in xinji city, which was undertaken by xinji city Branch of China Life Insurance Company.
Xinji city Municipal People's Government-Notice on Printing and Distributing the New Rural Cooperative Medical System in xinji city 20 16