The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses).

Two, the new rural cooperative medical fund payment Qifubiaozhun and maximum payment limit. The medical expenses of deductible line in our hospital are 1000 yuan, and the hospitalization expenses below deductible line are paid by individuals. If the Qifubiaozhun is reached in the same overall period, the hospitalization expenses incurred by two or more hospitalizations can be reimbursed cumulatively. The hospitalization expenses exceeding Qifubiaozhun shall be calculated in sections and reimbursed cumulatively. The maximum amount of accumulated reimbursement per person per year is 50,000 yuan.

Kecheng District, the new rural cooperative medical reimbursement quota segmentation standard, reimbursement ratio is as follows:

100 1 yuan-5,000 yuan, with 30% reimbursement.

500 1 yuan-10000 yuan, with 35% reimbursement.

1000 1 yuan-25,000 yuan, with 45% reimbursement.

50% for 0 yuan above 250065438+.

Qujiang district new rural cooperative medical reimbursement quota segmentation standard, reimbursement ratio is as follows:

1000 yuan-1000 yuan, 30% reimbursement.

10000 yuan -20000 yuan, 35% reimbursement.

More than 20 thousand yuan, 40% reimbursement.

Three, the specific outpatient treatment costs of special diseases, can be regarded as hospitalization expenses to be reimbursed, once every three months. The reimbursement standard is the same as the general hospitalization effective medical expenses.

Qujiang District, the new rural cooperative medical fund reimbursement payment of special diseases are:

(1) Treatment of malignant tumor;

(2) Hemodialysis and peritoneal dialysis for chronic renal failure;

(3) Anti-rejection therapy of organ transplantation;

(4) Aplastic anemia;

(5) psychiatric treatment;

(6) Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system).

The special diseases reimbursed and paid by the new rural cooperative medical fund in Kecheng District are:

(1) Chemotherapy and radiotherapy for malignant tumors;

(2) Hemodialysis and peritoneal dialysis for severe uremia;

(3) Anti-rejection therapy after tissue or organ transplantation;

(4) Schizophrenia with mental decline;

(5) Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system);

(6) Aplastic anemia;

(7) Anticoagulation therapy after cardiac surgery.

Specific outpatient treatment of special diseases includes necessary supportive treatment and symptomatic treatment of systemic and local reactions during treatment, while general adjuvant treatment is not included in the scope of reimbursement.

Three, the following circumstances are not included in the scope of reimbursement of the new rural cooperative medical system:

(a) the outpatient medical expenses of designated hospitals in non-co-ordination areas (except for outpatient treatment expenses for special diseases), and the expenses incurred by failing to seek medical treatment according to regulations and purchasing medicines by themselves;

(two) the cost of family planning measures and medical expenses in violation of the family planning policy;

(three) dental implants, orthodontics, optometry glasses, hearing AIDS, artificial organs, beauty therapy, cosmetic surgery, rehabilitation (such as qigong, massage, physical therapy, magnetic therapy, etc.). ), as well as various accompanying expenses, medical transportation expenses, home visits and other miscellaneous expenses during hospitalization;

(4) If there is a third party's liability, the medical expenses incurred due to personal injury, such as traffic accidents, medical accidents and work-related injuries, shall be borne by the third responsible person according to law.

(five) medical expenses caused by illegal acts such as suicide, self-mutilation, taking poison, taking drugs, fighting and other intentional acts of their families;

(six) medical expenses incurred during going abroad or staying in Hong Kong, Macao and Taiwan;

(seven) drugs and articles that are not reimbursed according to the medical insurance system for urban workers;

(eight) other expenses determined by the District Medical Management Committee.