How to reimburse rural medical insurance

Question 1: What is the reimbursement process for rural cooperative medical insurance? To apply for insurance, it must be a district (county) level hospital or a high-level hospital. When you are admitted to the hospital, you will be asked and given a form. You should fill in the insurance type. You should keep the invoice for each payment and bring it with you when you are discharged. Submit the policy holder’s ID card and a copy of the household registration book, and take the invoice for reimbursement (I really want to bring half of the person’s ID card and a photocopy room) to the special window of the local hospital

Question 2: Rural Medical Insurance Reimbursement Is there a time limit? According to the provisions of the New Rural Cooperative Medical System: the time limit for hospitalization reimbursement and compensation shall not exceed 3 months in principle, and shall not exceed 6 months under special circumstances.

Question 3: How is rural medical insurance reimbursed? Medical insurance under the existing mechanism has already dealt with the proportion of self-payment and reimbursement when you pay. That is, when you pay, that is the part you need to deal with, but there is obviously a problem with the situation you describe. Problems may arise as follows: 1: The amount of your Project 2 also includes self-pay expenses, so in the end your payment amount accounts for a larger proportion of the total. 2: Pay attention to the list. Most of the examination fees need to be processed. If you go to the hospital mainly for examinations rather than injections and medicines, your processing costs will be higher.

If you have any questions about the reimbursement ratio and actual payment amount, it is best to go to the local Social Security Bureau or the village committee where you paid the medical insurance with the invoice to check. You can ask them to show you the calculation process.

Question 4: How much is reimbursed and how is the new rural cooperative medical system reimbursed? The minimum payment line for patients with the new rural cooperative medical care in town-level hospitals is 100 yuan/person, and the reimbursement ratio is 100 of the compliance expenses;

The minimum payment line for inpatient treatment at county-level designated secondary hospitals in the city is 600 yuan per person, and the reimbursement ratio is 80;

The minimum payment line for inpatient treatment at municipal-level designated secondary hospitals in the city is 1,000 yuan Yuan/person, the reimbursement ratio is 70;

The minimum payment line for inpatient treatment in municipal-level designated hospitals at the municipal level is 1,800 yuan/person, and the reimbursement ratio is 60;

Provincial level three The minimum payment line for inpatient treatment in designated hospitals is 3,000 yuan/person, and the reimbursement ratio is 55%;

The minimum payment line for inpatient treatment in provincial level two designated hospitals is 2,000 yuan/person, and the reimbursement ratio is 65%;

The reimbursement ratio of designated private hospitals in the city is reduced by 5 percentage points compared with the reimbursement ratio of municipal second-level designated hospitals. The reimbursement ratio of undesignated hospitals in the city is reduced by 10 percentage points compared with the reimbursement ratio of municipal designated hospitals. The minimum payment line remains unchanged.

New Rural Cooperative Medical System hospitalization reimbursement process:

1. Diagnosis by an outpatient doctor or an inpatient doctor, and a hospitalization certificate issued;

2. Arrive with the Rural Cooperative Medical System certificate Pay at the hospitalization fee window and register online;

3. Hold the hospitalization certificate and payment slip to the hospitalization registration window to register, and receive medical records and supplies;

4. Go to the corresponding specialist for medical treatment Hospitalization examination and treatment;

5. When you are discharged, ask your doctor in charge to issue a discharge certificate, diagnosis certificate, and resident identity check sheet;

6. Arrive at the hospital with your personal payment slip Go through the discharge procedures at the settlement window;

7. Take the discharge settlement receipt to the nurse station of the department where you are staying, hand over the settlement coupon, get back the bed deposit slip, check the bed unit and other items, and then go to the discharge settlement office to take out the settlement Invoice, get back the bed deposit, and go to the printing office to print out the list summary;

8. With the settlement invoice, the original and copy of the rural cooperative medical certificate, ID card and household registration book, the diagnosis certificate, and the identity of the resident Please submit the summary list of single and hospitalization expenses to the Rural Cooperative Medical System direct subsidy window for reimbursement and receive the subsidy.

Question 5: What is the reimbursement scope of rural medical insurance and how much can be reimbursed? However, the reimbursement rate depends on the region and the level of the hospital for hospitalization.

Just like here, the New Rural Cooperative Medical Care can reimburse up to 8,000 yuan. The reimbursement rate for treatment in townships is 80, the reimbursement rate for treatment in counties is 50, and the reimbursement rate for treatment in city hospitals is 30-40

Question 6: What are required for rural medical insurance reimbursement? 1. Documents required for reimbursement

1. Documents required for outpatient reimbursement: outpatient invoice, cooperative medical certificate calendar (or medical record).

2. Documents to be carried for hospitalization reimbursement: hospitalization invoice, cooperative medical certificate calendar (or medical record), detailed list of expenses, discharge summary, and other relevant certificates.

3. Documents required for outpatient special disease reimbursement: outpatient invoice, special disease cooperative medical certificate calendar.

4. Bring documents for special diseases: outpatient treatment recommendations for special diseases, cooperative medical certificate, medical records, relevant laboratory reports, and two photos.

2. Reimbursement process:

The insured household will prepare the required information for reimbursement and submit it to the village (community) cooperative medical liaison officer for review. The township cooperative medical liaison officer will submit the reimbursement to the district Nongyi Office Complaint Center for reimbursement.

Direct reimbursement by the hospital:

When going through hospitalization procedures due to illness, a new rural cooperative medical certificate must be issued to the hospital to directly participate in reimbursement.

Account reimbursement from the town’s new rural cooperative medical office:

The reimbursement materials are brought to the new rural cooperative medical office by the individual, and are submitted by the town agricultural medical office to the county agricultural medical office for reimbursement. The medical office will call you to come and collect reimbursement fees.

Required materials: discharge certificate, official invoice, expense list, household register, ID card, rural cooperative medical care certificate.

If you are hospitalized out of town, you must also prepare: hospitalization summary, first hospitalization course record, and discharge record.

If you are hospitalized outside the district, you must also prepare: admission records and discharge records.

If you are hospitalized for trauma, you must also prepare: trauma certificate and admission record.

Question 7: What are the reimbursement conditions of rural cooperative medical insurance? What are the reimbursement conditions of rural cooperative medical insurance?

The conditions for reimbursement are as follows:

(1) Medical treatment at designated cooperative medical institutions;

(2) Original invoice

(3) Medical insurance card and personal ID card

In addition, no You need to bring your medical insurance card, and you only need to show relevant documents when reimbursing. Remember: private hospitals do not support reimbursement.

Question 8: How to reimburse for rural medical insurance and how to pay for rural social pension insurance 1. New rural cooperative medical insurance. It is a kind of medical insurance focusing on critical illness assistance that is jointly borne by individuals, collectives, and the state finance. It is a project sponsored by the government to benefit the people. Individual payments are generally handed over to the town cooperative medical management committee office by the village group at the beginning of the year (in some areas, in the health center), and the funds are coordinated and managed at the city (county) level. There are two types of reimbursement expenses: one is to go to the town cooperative medical management office regularly to review the reimbursement; the other is that in areas with conditions (meaning real-time network information transmission is possible), reimbursement can be directly made during outpatient or hospitalization settlement.

2. For pension insurance, you can participate in the "Rural Social Pension Insurance" organized by the civil affairs department. You can pay it personally and go to the town civil affairs office. They will hand over the funds to the county agricultural insurance office and apply for a payment certificate. This insurance implements a "personal account system", that is, the more you pay, the more you get, the less you pay, the less you get. The amount of the pension depends on how much you pay, and you can pay it every year or in one lump sum. When you reach retirement age, calculate the monthly amount you receive and issue a "receipt certificate". In short, it is more stable and more profitable than commercial insurance. You can go to the agricultural insurance department for consultation on the calculation of the specific payment amount.

Question 9: How to calculate the reimbursement ratio of rural medical insurance? Hello, the reimbursement of the New Rural Medical Insurance depends on the hospital level:

The reimbursement ratio of the township hospital is 240 yuan and the reimbursement ratio is 90; the reimbursement ratio of the county-level hospital is 90 The reimbursement ratio for line 500 yuan is 75;

The reimbursement ratio for line 700 for third-level municipal hospitals is 60; the reimbursement ratio for 500 yuan for level 2 municipal hospitals is 65;

Provincial level The hospital’s reimbursement ratio for 1,000 yuan is 55; for other medical institutions, the reimbursement ratio for 1,000 yuan is 35.

Question 10: What exactly can be reimbursed by the new rural cooperative medical care? How much and how to reimburse the scope and standards of compensation

1. Outpatient compensation:

(1) Village clinics and village center clinics are reimbursed 60 yuan, with a limit of 10 yuan for prescription drugs per visit, and a limit of 50 yuan for prescription drugs for temporary rehydration by doctors at the health center.

(2) The town health center reimburses RMB 40 for a visit, the examination fee and surgical fee limit for each visit is RMB 50, and the prescription drug fee is limited to RMB 100.

(3) A visit to a secondary hospital will be reimbursed at RMB 30, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 200 for prescription drugs.

(4) A visit to a tertiary hospital will be reimbursed at RMB 20, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 200 for prescription drugs.

(5) There is a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice.

(6) The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.

2. Hospitalization compensation

(1) Scope of reimbursement:

A. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, The fee limit for various examinations such as laboratory tests, physical therapy, acupuncture, CT, MRI, etc. is 200 yuan; the operation fee (referring to national standards, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

B. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

(2) Reimbursement ratio: the town health center will reimburse 60; the second-level hospital will reimburse 40; the third-level hospital will reimburse 30.

3. Compensation for serious illnesses

(1) Town risk fund compensation: All inpatients who participate in cooperative medical care will be compensated in stages if their one-time or annual cumulative medical expenses exceed 5,000 yuan. , that is, 65 yuan will be compensated for 5,001-10,000 yuan, and 70 yuan will be compensated for 10,001-18,000 yuan.

The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, and tumor outpatient radiotherapy and chemotherapy is 11,000 yuan.

Not included in the scope of reimbursement

1. Seeking medical treatment on one's own (without specifying a hospital or not applying for a referral), self-purchased drugs, drugs that cannot be reimbursed under public medical regulations and drugs that do not comply with the plan Medical expenses for childbirth;

2. Outpatient treatment fees, consultation fees, hospitalization fees, meals, accompanying guests, nutrition fees, blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations), cold storage Heating fees, ambulance fees, special care fees and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents and medical accidents;

4. Orthopedics, Plastic surgery, dentures, prostheses, organ transplants, surgical fees, consultation fees, etc.;

5. Within the scope of reimbursement, the portion beyond the limit.

Compensation scope:

(1) Pay the patient’s hospitalization expenses due to illness. Mainly include: drug fees, surgical fees, material fees, hospitalization fees, treatment fees, laboratory fees, examination fees, etc. incurred during hospitalization.

(2) Pay the outpatient treatment costs for patients with chronic diseases.

Chronic diseases mainly refer to: hypertension (stage II), heart disease complicated by cardiac insufficiency, cerebral hemorrhage and cerebral infarction recovery period, rheumatoid arthritis, chronic active hepatitis, chronic obstructive pulmonary emphysema and pulmonary heart disease, epilepsy, liver beans nucleolar degeneration, decompensated cirrhosis, ineffective diet control, diabetes, chronic nephritis, Parkinson's disease, systemic lupus erythematosus, intervertebral disc herniation, chronic pelvic inflammatory disease and adnexitis, and the District New Rural Cooperative Medical Care Chronic Disease Expert Committee, District Other chronic diseases reviewed by the Management Center. Extremely large outpatient expenses such as radiotherapy and chemotherapy for malignant tumors, dialysis treatment for chronic renal insufficiency, aplastic anemia, leukemia, hemophilia, schizophrenia, and anti-excretion treatment for organ transplantation are included in hospitalization compensation.

Participating farmers who suffer from the above chronic diseases must apply in person, with the diagnosis certificate materials from a second-class hospital, be authenticated by the District New Rural Cooperative Medical Care Chronic Disease Expert Committee, and report to the district management center for approval before receiving the "Chronic Disease Treatment Certificate" 》, the certificate is reviewed by the district management center at the beginning of each year.

(3) Pay for special examination fees when the patient is hospitalized due to illness. Mainly refers to CT, cardiac and angiography X-ray machines, electronic gastroscopy, color Doppler, hyperbaric oxygen chamber, extracorporeal shock wave lithotripsy, hemodialysis, organ transplantation and other high-cost medical projects. For patients who need to check the above items, the designated hospital will provide opinions, apply in person, and report to the district management center for approval.

(4) Those who meet the childbirth conditions must go to a second-level or above hospital, a designated medical institution, or a designated delivery point to give birth.

(5) No other party is responsible for accidental injuries (excluding items that are not paid) that occur during the production, living and learning process of farmers; if there is other party's responsibility, the other party shall be responsible. Accidental injury compensation must be publicized within a certain range for more than one month. No compensation can be paid until there are no objections, no reports, or investigation and confirmation.

(6) Participating farmers... .gt;gt;