How to reimburse the rural cooperative medical system?

The rural cooperative medical system is a mutual aid medical security system created by Chinese farmers themselves. it has played an important role in ensuring farmers' access to basic health services, alleviating farmers' poverty caused by illness and returning to poverty because of illness. The scope of reimbursement roughly includes outpatient compensation, hospitalization compensation and serious illness compensation. Let's take a look at how the rural cooperative medical system is reimbursed.

Reimbursement scope of new rural cooperative medical system

The reimbursement scope of the new rural cooperative medical system shall be the medical expenses, examination fees, laboratory fees, operation fees, treatment fees, nursing expenses and other expenses incurred by the participants in the designated hospital during the overall planning period, which are in line with the reimbursement scope of medical insurance for urban workers (that is, effective medical expenses), the fund payment shall set up the starting payment standard and the maximum payment limit, and the hospitalization expenses below the annual payment standard of the hospital shall be paid by the individual. The hospitalization expenses incurred by two or more hospitalizations that reach the starting payment standard within the same overall planning period may be reimbursed cumulatively. The hospitalization expenses exceeding the starting payment standard shall be calculated by sections and reimbursed accumulatively, with a maximum amount of reimbursement per person per year.

Reimbursement process of new rural cooperative medical system

1. The insured patients of the new rural cooperative medical system must rely on their own medical card and valid ID card (with a household registration book without an ID card). After confirming their identity, the designated medical institutions at the township level general outpatient clinics in the area can be reimbursed by card directly, hospitalized in designated medical institutions in the area and outside the district, and reimbursed by card directly when discharged.

2. Insured patients who are hospitalized in hospitals of second-level or above public medical institutions outside the city shall, within three months after discharge, The insured or his family members shall bring the original invoice of medical expenses (the photocopy is invalid), the summary list of medical expenses in hospital, the summary of discharge and outpatient medical records, the patient's ID card, medical card, household registration book, and manager's ID card to the new rural cooperative medical window No. 14 and 15 on the first floor of the district administrative service center to be reimbursed for medical expenses.

3. Outpatient reimbursement for special diseases may hold medical records, relevant examination, laboratory reports and other relevant materials issued by designated medical institutions at or above the second level, as well as certificates of medical institutions, and the "examination and approval form for outpatient treatment of Special Diseases of the New Rural Cooperative Medical system in Huangyan District" applies to the new rural cooperative medical management center, which is examined and approved by the new rural cooperative office in the district. Its outpatient medical expenses (excluding medical expenses for supporting therapy, adjuvant treatment or treatment of other diseases) may be included in the reimbursement scope of the NCMS fund and shall be reimbursed on an annual basis according to the hospitalization reimbursement standard.

4. Hospitalized patients due to accidental injury shall also submit a certificate of confirmation of the cause caused by the accidental injury signed and sealed by the village (residence) where the registered permanent residence is located, as well as the medical records of the hospital after discharge. Those who are unable to provide valid certificates and records will not be accepted.

Matters needing attention in reimbursement of rural cooperative medical system

1. Outpatient medical expenses of designated hospitals outside the area (except for outpatient treatment expenses for special diseases), expenses arising from not seeking medical treatment in accordance with the regulations and purchasing drugs by themselves shall not be included in the scope of reimbursement of the new rural cooperative medical system.

2. The expenses required for family planning measures and medical expenses that violate the family planning policy shall not be included in the reimbursement scope of the new rural cooperative medical system.

3. Dental inserts, orthodontics, optometry, hearing aids, artificial organs, cosmetic treatment, cosmetic and orthopedic surgery, rehabilitation medical care, as well as all kinds of accompanying expenses, transportation expenses, visiting expenses and other miscellaneous expenses during hospitalization are not included in the reimbursement scope of the new rural cooperative medical system.

4. In the case of the existence of third-party liability, the medical expenses caused by personal injury shall be borne by the third party in accordance with the law, such as traffic accidents, medical accidents, industrial injuries, etc. shall not be included in the reimbursement scope of the new rural cooperative medical system.

5. Medical expenses caused by illegal acts such as suicide, self-harm, taking drugs, taking drugs, fighting, and intentional acts of their families shall not be included in the scope of reimbursement of the new rural cooperative medical system.

6. Medical expenses incurred during going abroad or in Hong Kong, Macao and Taiwan shall not be included in the scope of reimbursement of the new rural cooperative medical system.

7. According to the medical insurance system for urban workers, drugs and items that are not reimbursed shall not be included in the scope of reimbursement of the new rural cooperative medical system.

8. Other non-reimbursable expenses determined by the District Medical Administration Commission.