Proportion of medical insurance reimbursement for rural residents
Rural outpatient reimbursement
1。 Reimbursement ratio
① 60% reimbursement for treatment in village clinics and village center clinics; ② 40% reimbursement for medical treatment in town hospitals; ③ 30% reimbursement for treatment in secondary hospitals; ④ 20% reimbursement for treatment in tertiary hospitals;
2。 Qifubiaozhun
① The cost limit of prescription drugs for each visit is 65,438+00 yuan, and the cost limit of temporary rehydration prescription drugs for hospital doctors is 50 yuan. ② The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription fee is 100 yuan. ③ In secondary hospitals, the examination fee and operation fee for each visit are limited to 50 yuan, and the prescription fee is limited to 200 yuan; ④ In tertiary hospitals, the examination fee and operation fee for each visit are limited to 50 yuan, and the prescription fee is limited to 200 yuan. ⑤. Traditional Chinese medicine invoice with prescription, with the limit of 1 yuan. 6. The annual compensation limit for rural cooperative medical clinics is 5000 yuan.
Rural hospitalization reimbursement
1。 Reimbursement ratio
(1) township hospitals for reimbursement of 60%; ② 40% reimbursement from secondary hospitals; ③ 30% reimbursement for tertiary hospitals.
2。 Reimbursement standard
① medical expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and MRI are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
② 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.
Proportion of reimbursement for serious illness in rural areas (more than 5,000 yuan)
1。 500 1- 10000 yuan will be reimbursed by 65%.
2。 10001-18000 yuan will be reimbursed by 70%.
3。 The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in town-level cooperative medical care inpatient and uremia outpatient department is 1. 1 0,000 yuan.
Reimbursement proportion and qifubiaozhun of all kinds of people in rural medical insurance
1。 The proportion of reimbursement for students and children and the minimum payment standard (below 6.5438+0.8 million yuan)
1。 Reimbursement ratio
① The reimbursement rate of tertiary hospitals is 55%; ② The reimbursement rate of secondary hospitals is 60%; ③ The reimbursement rate of the first-level hospital is 65%.
2。 Qifubiaozhun
The qifubiaozhun for tertiary hospitals is 500 yuan; ② The Qifubiaozhun for secondary hospitals is 300 yuan; ③ There is no Qifubiaozhun in tertiary hospitals.
2。 Reimbursement rate and minimum payment standard for the elderly over 70 years old (below 6,543,800 yuan)
1。 Reimbursement ratio
① The reimbursement rate of tertiary hospitals is 50%; ② The reimbursement rate of secondary hospitals is 60%; ③ The reimbursement rate of the first-level hospital is 65%.
2。 Qifubiaozhun
The qifubiaozhun for tertiary hospitals is 500 yuan; ② The Qifubiaozhun for secondary hospitals is 300 yuan; ③ There is no Qifubiaozhun in tertiary hospitals.
New rural medical insurance policy
1, increase the reimbursement ratio of the new rural cooperative medical system, and the personal subsidy amount is 60,000 yuan per person per year.
At present, the new rural cooperative medical system is widely implemented in rural areas of China, and the reimbursement ratio is: the reimbursement ratio of village clinics (community health service stations) is 25%; The reimbursement rate of outpatient service in township hospitals is 40%; The proportion of outpatient reimbursement in county-level hospitals is 30%. It is estimated that after the implementation of the new medical insurance policy next year, the reimbursement rate of farmers using the new rural cooperative medical system will increase to a certain extent, specifically: the reimbursement rate of township hospitals is 55%; 40% for county-level hospitals; 35% of hospitals outside the county. Moreover, the total personal allowance per person per year is 60,000 yuan.
2, reduce the price of drugs and large-scale inspection items.
It is difficult for farmers to see a doctor mainly because drugs are expensive and related inspection items are too expensive. It is expected that this phenomenon will be alleviated next year. It is understood that after the implementation of the new medical insurance policy, the comprehensive reform of county-level public hospitals will be further consolidated and improved, the drug addition will be cancelled, and the zero-difference sales of drugs will be implemented. In this way, the price of drugs will be reduced, and the inspection cost of related medical items will also be reduced.
3. Integration of urban and rural medical insurance
The purpose of the integration of urban and rural medical insurance is to realize that rural residents can enjoy the same medical insurance benefits as urban residents, and the types of drugs that can be reimbursed by the new rural cooperative medical system have also increased. At the same time, the reimbursement rate has also increased. It must be mentioned that while farmers enjoy these rights and interests, the individual payment standard has not improved.
4. Poor farmers can see a doctor first and then pay.
After the implementation of the new medical insurance policy, poor farmers such as five-guarantee households and low-guarantee households can take the way of seeing a doctor first and then paying. Moreover, with such a policy of benefiting farmers, farmers can also be reimbursed for seeing a doctor in a big city hospital, and the highest reimbursement rate can reach 75%.
I hope the above content can help you. If in doubt, please consult a professional lawyer.
Legal basis:
Article 26 of People's Republic of China (PRC) Social Insurance Law
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.