Reimbursement standard of new rural cooperative medical system (taking Anhui Province as an example);

Outpatient compensation:

60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 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.

The reimbursement for medical treatment in secondary hospitals is 30%, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.

Third-level hospitals will be reimbursed 20%, with the examination fee and operation fee for each visit limited to 50 yuan and prescription drug fee limited to 200 yuan.

Chinese medicine invoice with prescription, limit 1 yuan.

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

Hospitalization compensation:

Reimbursement scope:

A. Drug expenses: auxiliary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic resonance, etc., limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

B, 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.

Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

Compensation for serious illness:

Compensation from town risk fund: if the medical expenses of inpatients participating in cooperative medical care exceed 5,000 yuan at one time or for the whole year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan is 65%, and10001-8000 yuan is 75%.

The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.

The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis for severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental retardation; Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery. Other special diseases that can be reimbursed shall be subject to local specific policies.

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.

Reimbursement procedure of new rural cooperative medical system:

After the insured is discharged from the hospital, the hospitalization invoice, discharge record, expense list, referral certificate, a copy of my ID card or the household registration certificate signed or sealed by the patient shall be handed over to the township joint management office, and sent to the municipal agricultural insurance business management center after examination.