First, the proportion of reimbursement for outpatient service of the new rural cooperative medical system
1, the reimbursement rate of rural health centers and health centers is 60%;
2. The reimbursement rate of urban hospitals is 40%.
3, the proportion of secondary hospitals accounted for 30%.
4. The reimbursement rate of tertiary hospitals is 20%.
5. The reimbursement limit for township-level cooperative medical clinics is 5,000 yuan/year.
Second, the proportion of reimbursement for hospitalization of the new rural cooperative medical system
1, 60% reimbursed by the town health center;
2, the secondary hospital reimbursement 40%;
3, tertiary hospital reimbursement of 30%.
Third, the proportion of reimbursement for serious illness in the new rural cooperative medical system
1. The proportion of township and village subsidies for outpatient co-ordination increased to 65% and 75% respectively.
2. If the hospitalization expenses of first-class medical institutions are below 400 yuan, there is no deductible.
3. Increase the subsidy ratio of secondary medical institutions to 75%~80%.
4. Increase the subsidy ratio of tertiary medical institutions to 55%~60%.
5. The subsidy ratio of provincial tertiary medical institutions will be increased to 55%.
6. 70% of the quota for 8 serious diseases such as congenital heart disease in children, and 70% of the quota for 2 serious diseases such as lung cancer/kloc-0.
20 17 reimbursement standard for hospitalization of new rural cooperative medical system
1, new EEG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, MRI and other auxiliary examination items will be reimbursed to 200 yuan.
2, the operation fee deductible line 1000 yuan according to national standards, more than 1000 yuan according to 1000 yuan.
3. The hospitalization expenses and nursing expenses of the elderly over 60 years old can be reimbursed every day 10 yuan, with the limit of 200 yuan.
20 17 reimbursement scope of the new rural cooperative medical system (the following contents are not included in the reimbursement scope of the new rural cooperative medical system)
1, self-purchased medicine fee;
2, beyond the "new rural cooperative medical care essential drugs directory" drug costs;
3. Registration fee, outpatient medical record fee, visiting fee, Chinese medicine decoction fee, ambulance fee, escort bed fee, bed reservation fee, intensive care unit fee, consultation fee, air conditioning (including heating) fee, TV fee, telephone fee, personal life cooking fee, care worker fee, etc.
4. Non-basic medical care (refers to special outpatient service, specialist outpatient service, bed fee of more than 35 yuan/day, medical beauty, family bed, etc.). );
5, fighting, alcoholism, drug abuse, detoxification, sexually transmitted diseases, work-related injuries and injuries in the process of engaging in labor services, traffic accidents, intentional self-injury, unproductive pesticide poisoning, occupational poisoning, medical accidents, illegal and other reasons caused by medical expenses;
6. Abortion;
7, all kinds of plastic surgery, plastic surgery, weight loss, correction of physical defects and various health care, prevention and treatment projects and drug costs;
8, organ and tissue transplantation, the installation of artificial organs need to buy organs or tissues;
9, without the approval of the price and health departments of medical services, inspection, treatment projects, as well as all the expenses incurred by raising the fees without authorization;
10, defrauding medical expenses by not being hospitalized or being hospitalized as an impostor;
1 1, which has been compensated by basic medical insurance for urban workers and other basic medical insurance for urban residents;
12, overseas medical expenses;
13, other provisions of the new rural cooperative medical system.
Compensation standard of new rural cooperative medical system 20 17
First, the outpatient compensation standard
1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.
2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan.
3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.
4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.
5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan.
6, the township cooperative medical outpatient compensation limit is 5000 yuan.
Two, the new rural cooperative medical system hospitalization compensation standard
1, drug cost: auxiliary examination: 200 yuan for ECG, X-ray fluoroscopy, photography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
2. The elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
Three, the new rural cooperative medical system compensation standard for serious illness
1, town risk fund compensation: all inpatients who participate in cooperative medical care will incur medical expenses exceeding 5,000 yuan at one time or within one year, that is, 500 1- 10000 yuan is 65%,10001-/kloc-0.
2. The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is1.654.38+0.000 million yuan.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.