I'm from Gaocheng rural area, and I had cataract surgery in the First Hospital of Shijiazhuang Medical University. How to reimburse rural cooperative medical care? What is the reimbursement rate?

Compensation proportion of medical institution level deductible line (yuan) (%)

Township fixed point 200 75

County (city) level fixed point 400 65

Municipal fixed point 1200 55

Provincial fixed-point 2000 45

Other non-profit organizations 3000 45

Gaocheng 20 10 new rural cooperative medical system overall compensation scheme.

First, the basic model

Hospital overall planning+large outpatient overall planning for special diseases+compensation for large medical expenses in hospital+outpatient overall planning.

Second, the whole fund.

Participating farmers pay 20 yuan every year; The provincial, municipal and county finances give 60 yuan subsidies to each participating farmer every year; The central government subsidizes each participating farmer 60 yuan every year.

Third, the allocation of funds.

(a) outpatient co-ordination fund

The outpatient co-ordination fund is included in the 25 yuan of each participating farmer (accounting for 18% of the total fund).

(2) Serious illness pooling fund

The serious illness pooling fund was established after deducting outpatient pooling fund and risk fund from the total fund raised in that year. The serious illness co-ordination fund is divided into four parts: hospitalization co-ordination fund, special disease large-scale outpatient fund (5%), hospitalization large-scale medical expenses compensation (3%) and normal birth hospitalization childbirth subsidy fund (0.5%), which are used for farmers' hospitalization compensation, special disease large-scale outpatient compensation, hospitalization large-scale medical expenses compensation and normal birth hospitalization childbirth subsidy respectively.

(3) risk fund

In 20 10, the fund-raising standard of the new rural cooperative medical system is improved, so it is necessary to increase the risk fund reserve, and the risk fund scale should reach 10% of the total fund in that year.

Fourth, compensation for medical expenses.

Compensation shall be made in accordance with the Catalogue of Essential Drugs for New Rural Cooperative Medical System in Hebei Province and the Compensation Provisions for New Rural Cooperative Medical System in Hebei Province (Trial).

(A) outpatient expenses compensation

Outpatient compensation is limited to designated medical institutions at the township and village levels. There is no deductible for outpatient fee compensation. The compensation ratio is 30% at village level and 25% at township level; Each participating farmer's annual outpatient co-ordination compensation capping line is 40 yuan. In order to ensure the rational and effective use of the outpatient co-ordination fund and ensure the safe operation of the fund, the total compensation for outpatient co-ordination is controlled, the average outpatient expenses in rural areas are controlled, and the maximum compensation limit for a single outpatient service is controlled. (Specific compensation measures shall be implemented according to the implementation plan of Gaocheng New Rural Cooperative Medical System. ) The original family account Fund can be used to pay for the out-patient co-ordination fee, which will be used by the whole family until it is used up.

(2) Overall compensation for hospitalization

Medical institution level

Deductible line (yuan)

Salary ratio (%)

Township fixed point

200

75

County (city) level fixed point

celebrity

65

Municipal fixed point

1200

55

Provincial fixed point

2000

45

Other non-profit organizations

3000

45

1, if the same farmer is hospitalized again in the same year, the deductible expenses will be deducted again (except for patients with malignant tumors who have been hospitalized for multiple times for chemotherapy).

2. If the participating farmers are transferred from higher medical institutions to lower medical institutions for continuous hospitalization due to the same disease, the deductible line for hospitalization of lower medical institutions will not be deducted; If the hospitalization from a lower medical institution is transferred to a higher medical institution for further hospitalization, the deductible expenses of the lower medical institution shall be deducted from the deductible expenses of the higher medical institution.

3. Participating farmers suffering from infectious diseases are hospitalized in designated medical institutions above the city level with legal infectious disease diagnosis and treatment qualifications, migrant workers are hospitalized in designated hospitals for migrant workers in Shijiazhuang City (Shijiazhuang Second Hospital), and special pregnant women are hospitalized in designated medical institutions with legal infectious disease delivery qualifications. In accordance with relevant regulations, the compensation ratio is implemented according to the county deductible line.

4. Newborns are not within the payment time limit when they are born, but their parents have already participated in the new rural cooperative medical system. Newborns are automatically included in the new rural cooperative medical system from the date of birth, and the compensation for medical expenses incurred is merged with the mother until the local one-person maximum capping line. Newborns will no longer pay the personal participation fee in that year, nor will they be included in the number of participants in the new rural cooperative medical system in that year, and governments at all levels will no longer add corresponding subsidies.

5, within the administrative area of Shijiazhuang City, the designated medical institutions that implement the "one card" management shall be subject to the list of designated medical institutions in Shijiazhuang New Rural Cooperative Medical System; If you are hospitalized outside the administrative area of Shijiazhuang, refer to the deductible line and compensation ratio of other non-profit organizations in the table.

6 Hebei province, the new rural cooperative medical system basic drug list, which belongs to the national basic drug list (basic medical and health institutions are equipped with the use of) drug costs, in accordance with the provisions of this program to compensate for the proportion of compensation. The proportion of compensation for medical expenses of the new rural cooperative medical treatment project in Hebei Province (for Trial Implementation) and the list of basic drugs of the new rural cooperative medical care in Hebei Province was reduced by 5 percentage points.

(3) Large outpatient compensation for special diseases

The diseases with large outpatient expenses for special diseases include: various heart diseases complicated with chronic heart failure, high-risk and high-risk hypertension in the third stage, sequelae of cerebrovascular disease (accompanied by severe neurological, mental and limb dysfunction), chronic moderate and severe viral hepatitis (decompensated liver function), liver cirrhosis (decompensated liver function), uremic renal dialysis, diabetes (complicated with serious complications), radiotherapy and chemotherapy for malignant tumors, leukemia, hemophilia and aplastic anemia. Rheumatoid arthritis (with severe limb dysfunction), organ transplantation using anti-rejection immunomodulators, psychosis (unable to take care of themselves), systemic lupus erythematosus and other 15 diseases.

The deductible line for large outpatient compensation for special diseases is 200 yuan, and the reimbursement rate is 60%. Anti-rejection immunomodulators are used for radiotherapy and chemotherapy of malignant tumors, leukemia, hemophilia and aplastic anemia, organ transplantation, renal dialysis for uremia (hemodialysis and peritoneal dialysis) capped at 20,000 yuan, and other special diseases capped at 2000 yuan.

The identification and management of special diseases shall be carried out in strict accordance with relevant documents.

(4) Allowance for normal delivery in hospital

Allowance for normal delivery in planned hospital 100 yuan per case.

(5) Top line

The top line is 45,000 yuan per farmer, regardless of the level of medical institutions, and the annual cumulative calculation (including hospitalization compensation, hospitalization childbirth subsidy, large outpatient compensation for special diseases and secondary compensation for hospitalization) excludes large medical expenses compensation for hospitalization.

(six) compensation for large medical expenses in hospital

The compensation object of large hospitalization medical expenses is the large hospitalization medical expenses incurred by the participating farmers who have enjoyed the compensation of the new rural cooperative medical system; Hospitalization medical expenses shall be subject to the items in the catalogue, and the hospitalization shall be calculated cumulatively during the year.

Hospitalization medical expenses, if the project expenses in the catalogue exceed 45,000 yuan, the reimbursement ratio is 30%, and the capping line is 50,000 yuan.

Compensation for large hospitalization expenses = (the total hospitalization expenses belong to the items in the catalogue-45,000) ×30%.

For those who are hospitalized outside the administrative area of Shijiazhuang, the proportion of compensation for large medical expenses is 25%.

The compensation procedure for large medical expenses in hospital shall be implemented according to the documents of Gaocheng Municipal Health Bureau.

(7) Secondary compensation

In order to make full and effective use of the cooperative medical fund and ensure that the participating farmers can benefit to the maximum extent, by the end of the year, if the balance of the overall fund (including risk funds, the same below) exceeds 15% or the accumulated balance of the overall fund over the years exceeds 25%, a secondary compensation scheme should be formulated according to the balance, and the participating farmers who received serious illness compensation in that year should be compensated for the second time. The second compensation plan should be reported to the health administrative department of Gaocheng City for review. After being approved by Gaocheng New Rural Cooperative Medical Management Committee, it was promulgated and implemented. Before the implementation of the second compensation, the compensation scheme should be publicized to the public and publicity work should be done well. After the implementation of the second compensation, the results of the second compensation shall be publicized and carried out in an open, just and fair manner. The second compensation should be completed within this year. Through the second compensation, the utilization rate of the overall fund reached more than 85% in that year, and the balance rate of the overall fund was controlled within 25% over the years.