Reimbursement scope of rural cooperative medical system

The new rural cooperative medical system refers to the peasant medical mutual aid system organized, guided and supported by the government, voluntarily participated by farmers, raised funds by individuals, collectives and the government, and co-ordinated as a whole for serious illness. the scope of reimbursement roughly includes outpatient compensation, hospitalization compensation and serious illness compensation. let's take a look at what the scope of rural cooperative medical reimbursement is.

Outpatient reimbursement of rural cooperative medical system

1. The reimbursement for medical treatment in the village clinic and the village center clinic is 60%, the prescription fee limit for each visit is 10 yuan, and the medicine fee limit for temporary rehydration prescriptions for doctors in health centers is 50 yuan.

2. The town health center has a reimbursement of 40%, a limit of 50 yuan for each examination and operation fee, and a limit of 100 yuan for prescription and medicine.

3. The reimbursement for medical treatment in the second-level hospital is 30%, the limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 200 yuan.

4. The reimbursement for medical treatment in the tertiary hospital is 20%, the limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 200 yuan.

Note: the prescription limit of 1 yuan per paste is attached to the invoice of traditional Chinese medicine, and the annual compensation limit of township cooperative medical clinic is 5000 yuan.

Hospitalization reimbursement of rural cooperative medical system

1. Scope of reimbursement

① drug fee: auxiliary examination: ECG, X-ray, film, laboratory, physiotherapy, acupuncture, CT, MRI and other examination fees, the limit is 200RMB.

② operation fee (according to the national standard, if it exceeds 1000 yuan, it will be reimbursed as 1000 yuan).

People over the age of 60 in ③ are hospitalized in the town health center, and the treatment and nursing expenses are compensated for 10 yuan per day, with a limit of 200 yuan.

2. Reimbursement ratio: 60% for town hospitals, 40% for secondary hospitals and 30% for tertiary hospitals.

Reimbursement for serious illness of rural cooperative medical system

1. Where the one-time or annual cumulative medical expenses of inpatients participating in the cooperative medical system exceed 5000 yuan, that is, 500110,000 yuan compensation 65% 1,000118000 yuan compensation 70%.

2. The annual limit of compensation for hospitalization of town-level cooperative medical system and uremia outpatient clinic for hemodialysis, oncology outpatient radiotherapy and chemotherapy is 11000 yuan.

3. Reimbursement of the new rural cooperative medical fund for special diseases including malignant tumor chemotherapy and radiotherapy, hemodialysis and abdominal dialysis for severe uremia, anti-rejection treatment after tissue or organ transplantation, schizophrenia with mental decline, systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system), aplastic anemia, anticoagulation therapy after cardiac surgery The other special diseases that can be reimbursed shall be subject to the specific local policies.

4. the specific outpatient treatment of special diseases includes supportive therapy and symptomatic treatment of systemic and local reactions during the treatment period, and general adjuvant therapy is not included in the scope of reimbursement.