Proportion of reimbursement for new rural cooperative medical system in the First Affiliated Hospital of Zheng Da

First, Zhengda First Affiliated Hospital is a provincial-level medical institution, with a deductible of 2,000 yuan, and an itemized reimbursement model. 2,000 yuan and 7,000 yuan account for 65%. For the participating patients whose hospitalization expenses exceed 50,000 yuan within the one-time policy, the new rural cooperative medical system will implement subsection compensation, and the part within 50,000 yuan (including 50,000 yuan) will be compensated according to the proportion stipulated by the corresponding medical institutions, the part between 50,000 yuan and 80,000 yuan (including 80,000 yuan) will be compensated by 80%, and the part above 80,000 yuan will be compensated by 90%. During the year, the cumulative capping line was 200,000 yuan.

Second, the outpatient reimbursement process

1. Insured persons go to the cooperative medical point for medical treatment.

2. Pay by prescription and examination to the outpatient inpatient department, and pay by yourself first.

3. After seeing a doctor, take the medical certificate, ID card and household registration invoice to the new rural cooperative medical system window for review, reimbursement and reimbursement.

Third, the hospitalization reimbursement process

1. Go to the cooperative medical center for medical treatment.

2. Go to the new rural cooperative medical system window for discharge registration.

3. During the treatment, treat at one's own expense.

4. After the treatment, take out the hospital certificate, hospitalization invoice, diagnosis certificate, ID card and household registration book, and go to the new rural cooperative medical system window for review, reimbursement and reimbursement.

legal ground

Opinions of the Ministry of Health on Adjusting and Formulating the Drug List for Reimbursement of New Rural Cooperative Medical System

Second, the basic principles

The following principles should be followed in adjusting and formulating the reimbursement drug list of the new rural cooperative medical system:

(a) to adapt to the rural economic and social development, the new rural cooperative medical care financing level, farmers' health needs, is conducive to consolidating and developing the new rural cooperative medical care.

(two) based on the national list of essential drugs, combined with the actual situation, to determine the appropriate scope of the directory.

(3) Drugs should be selected according to the principles of clinical necessity, safety, effectiveness, reasonable price and convenient use.

(four) both western medicine and traditional Chinese medicine (ethnic medicine), taking into account the preparations of medical institutions, effectively covering common diseases and frequently-occurring diseases in rural areas.