I have paid medical insurance for three years. When I went to see a doctor this year to reimburse my medical expenses, I didn’t have my medical insurance. I asked the village cadre about my medical in

I have paid medical insurance for three years. When I went to see a doctor this year to reimburse my medical expenses, I didn’t have my medical insurance. I asked the village cadre about my medical insurance.

Notice of the Cangnan County People's Government on the Cooperative Medical Insurance for Urban and Rural Residents in 2011

The township people's governments and the units directly under the county government:

For To further promote and improve the cooperative medical insurance system for urban and rural residents in our county, and effectively improve the level of medical security for urban and rural residents, in accordance with the spirit of relevant provincial and municipal documents and in combination with the actual situation of our county, we are hereby notifying you of matters related to the cooperative medical insurance for urban and rural residents in 2011 As follows:

1. Participating objects: Urban and rural residents with registered residence in our county who have not participated in urban employee medical insurance. The participation method is that urban and rural residents must "participate as a whole household" on a household basis to ensure that all the benefits are covered. Residents who have participated in the Urban Employee Basic Medical Insurance are not eligible to participate in the Urban and Rural Resident Cooperative Medical Insurance and cannot enjoy the reimbursement benefits of both insurances.

2. Financing standard: 360 yuan/person (excluding health examination funds), including 280 yuan/person from financial subsidies at all levels and 80 yuan/person from individuals. Five-guaranteed households, rural one-daughter households and two-daughter households with no illegal births (only including the daughter herself and her parents), demobilized soldiers in the countryside, and urban and rural residents with disabilities (only limited to intellectual, mental, and physical disabilities with level one or two) The individual payment part is borne by the county finance; 50% of the individual payment by the county finance is borne by the county finance; urban and rural subsistence allowance recipients are each borne by the county and township (town) government finances 50% (the township subsistence allowance recipients who implement "agency reimbursement" participate All funds are borne by the county finance).

3. Financing time: From December 1, 2010 to January 31, 2011, all towns and villages must complete the entry of participant information data before the end of February, make sure it is accurate and standardized, and report it to County joint medical office.

4. Insurance participation goal: the participation rate of each township must reach more than 90%.

5. Acceptance and write-off time: The implementation year for serious illness hospitalization and outpatient medical expense compensation for special diseases is from January 1 to December 31, and the deadline for acceptance is in principle the following year. At the end of February, if there are special circumstances, it can be extended appropriately, and the write-off standard will be based on the insurance participation time of the current year (implemented in accordance with Cangzhengban [2010] No. 161 document).

6. Reimbursement method: Implement a combination of reimbursement for hospitalization (including outpatient services for special diseases and medical expenses before hospitalization for emergency diseases) and general outpatient medical expenses. The special outpatient clinic adds "severe mental illness" to the original nine special diseases, and participating women who comply with the family planning policy are included in the scope of hospitalization reimbursement.

(1) Medical expense compensation for hospitalization (including outpatient services for special diseases and medical expenses for emergency illnesses before hospitalization) shall be written off using the method of "zero starting line, accumulation in the year". The specific write-off standards are:

1. The reimbursement rate for inpatient medical expenses at the central health center in the county is 80%, the reimbursement rate for inpatient medical expenses at designated county-level hospitals within the county is 70%, and the reimbursement rate for inpatient medical expenses at designated hospitals outside the county is 80%. The expense reimbursement rate is 50%.

2. The maximum cumulative write-off benefit limit for each participant in the year is 70,000 yuan, and the minimum write-off benefit is 80 yuan. Among them, the maximum cumulative write-off benefit limit for each participating primary and secondary school student in the current year is 90,000 yuan. Yuan.

(2) For reimbursement of general outpatient medical expenses, a real-time reimbursement system shall be implemented. Depending on the level of the hospital, the reimbursement ratio for general outpatient drugs (the reimbursable portion) in county-level hospitals is 20%, the reimbursement ratio for general outpatient drugs (the reimbursable portion) in central health centers is 35%, and the reimbursement ratio for general outpatient medical expenses in township health centers is 35%. %, and the reimbursement rate for using drugs in the National Essential Drug List will be increased by another 5% (implemented in accordance with the "Cangnan County Urban and Rural Resident Cooperative Medical Insurance General Outpatient Reimbursement Management Measures").

7. Scope of reimbursement: The scope of medication used by participants shall be implemented with reference to the "Guidelines for the Drug Catalog of Zhejiang Province Basic Medical Insurance" and the "National Essential Drug Catalog" and other relevant documents, and the standards for diagnosis and treatment items, medical service facilities, etc. "Cangnan County Urban and Rural Residents Cooperative Medical Insurance Diagnosis and Treatment Project Management Scope" is implemented.

8. Two-level write-off: The township medical office is responsible for the acceptance, review and write-off of the hospital medical expenses of participants with a valid bill amount of less than 25,000 yuan (inclusive) within their jurisdiction; the amount of valid bills Inpatient medical expenses and special outpatient medical expenses exceeding 25,000 yuan shall be submitted to the county medical office for verification within the specified working days after being accepted by the township medical office and passing the preliminary review.

9. Time limit for write-off: Establish a time-limited settlement system for compensation write-off. The township medical office will issue an acceptance notice to the parties at the same time as it accepts the write-off materials, clarifying the time limit for processing. If it complies with the "Cangnan County Urban and Rural Resident Cooperative Medical Insurance County and Township Level Verification Work Plan" and is below the limit of 25,000 yuan, the township will complete the settlement within 20 working days from the date of acceptance and submit it to the county cooperative medical office for verification , the county joint medical office will complete the review and transfer of compensation funds within 7 working days from the date of acceptance; for cases above the limit, the township joint medical office will send the write-off materials to the county joint medical office within 7 working days from the date of acceptance After review, the county joint medical office will complete the settlement, review and compensation fund transfer within 20 working days from the date of acceptance; for some cases where the bank book account has not been opened or the account error cannot be transferred, Cangnan Rural Cooperative Bank will be responsible for handling it.

10. Payment of reimbursement funds: In addition to providing the prescribed write-off materials, the party or agent (limited to direct relatives) must also provide the account number (card number) of the person (agent) at Cangnan Rural Cooperative Bank ), contact number and valid identification, and fill in the material confirmation form. After the county and township (town) joint medical office handlers carry out compensation settlement according to the relevant provisions on write-off, the county joint medical office financial staff will print and stamp the compensation fund distribution list, and submit it to Cangnan Rural Cooperative Bank for unified transfer to Cangnan Rural Cooperative Bank will notify the client or agent of the account of the party or agent via text message or phone call.

11. Fund management: The fund can only be used to write off the compensation for in-patient medical expenses of the participants and to pay for the general outpatient co-ordination fund, so that the funds can be used exclusively for special purposes. Withdraw 10% of the total fund as a risk fund, and set up a general outpatient overall fund based on 10% of the total fund. Townships are not allowed to temporarily deposit the funds raised in private accounts. The staff responsible for collecting the funds must deposit the funds into the county financial account within three days, or deposit them into the township government accounting account, and then the township will finally remit them to the county. Special financial account to ensure fund security.

12. Supervision and management: Establish a work supervision mechanism. Each handling agency must clarify its work responsibilities, implement responsibilities, provide people-oriented services, and effectively do a good job in cooperative medical insurance for urban and rural residents. The health department should strengthen the supervision of the service quality of designated medical institutions, establish and improve the access and exit mechanism of designated medical institutions, and implement dynamic management through agreements; the county government supervision office, county efficiency office and county correction office should regularly or irregularly monitor the quality of services provided by designated medical institutions. Supervise the cooperative medical insurance work for urban and rural residents of cooperative medical insurance agencies at all levels and designated medical units.

13. Reward and punishment assessment: Establish a work assessment mechanism. Every year, the county government conducts an annual work target responsibility system assessment on the performance of the cooperative medical insurance for urban and rural residents of each township government, and rewards and punishments are given based on the assessment results.

14. Relevant Requirements

(1) All towns and villages must effectively strengthen leadership, improve institutions, strengthen responsibilities, organize carefully, and hold mobilization meetings in a timely manner according to the unified arrangements of the county government. , Party members’ conferences, village committees and villagers’ congresses, and make full use of radio, television, banners, brochures, typical cases and other forms to carry out in-depth publicity activities and fund-raising mobilization work for urban and rural residents’ medical insurance, and organize the participation in insurance tasks at all levels Decompose it layer by layer and implement it to the area, village and person.

(2) Further implement the annual work target responsibility system for the cooperative medical insurance for urban and rural residents and strengthen accountability. The “top leaders” of the party and government in each township have overall responsibility for the cooperative medical insurance for urban and rural residents. The specific responsible persons must be clearly defined and the fundraising work must be included in the performance evaluation of the township cadres stationed in the village.

(3) All towns and villages should fully understand the importance of cooperative medical insurance for urban and rural residents, conscientiously do a good job in fundraising, and ensure that participation tasks are completed on time. The county health administrative department must play its functional role, serve as a good government consultant, strengthen business guidance and policy publicity, improve service quality, and effectively facilitate people's medical treatment. County news units should open a column on cooperative medical insurance for urban and rural residents and actively do a good job in publicity and reporting.

15. This notice will be implemented from January 1, 2011. The relevant provisions of the original "Cangnan County Urban and Rural Resident Cooperative Medical Insurance System Implementation Rules" (Cang Zhengfa [2008] No. 211) are in line with If the content of this notice is inconsistent, this notice shall prevail.

16. The county joint medical office is responsible for interpreting the specific provisions of this notice.

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