In order to continue to promote the construction of the new rural cooperative medical system, improve the overall health level of rural residents, promote the coordinated development of urban and rural areas, and promote the construction of a harmonious new Shunyi and a well-off society at a higher level, these detailed rules are formulated according to the Opinions of Beijing Municipal Health Bureau on Promoting the Overall Compensation of the New Rural Cooperative Medical System in 2009 (J.W. Neizheng Zi [2008]2 1No.).

I. Scope of application

(1) Having residents of agricultural registered permanent residence in our district; Non-agricultural registered permanent residence students and preschool children whose parents are agricultural registered permanent residence; Non-agricultural registered permanent residence people who do not enjoy any medical security from the government among the immigrants in the reservoir area; Marry a foreigner who doesn't enjoy any medical insurance in our district government.

(two) according to the financial year to participate in the new rural cooperative medical insurance time, annual participation, then benefit.

Second, participate in the registration

Rural residents voluntarily participate in the new rural cooperative medical system in families; The insured shall implement territorial management, and the village committee where the household registration is located shall go through the formalities, and the foreign personnel who get married in our district shall go through the formalities by their spouses in the village committee where the household registration is located.

Third, the source of funds.

(1) In 2009, the municipal financial subsidy standard was 140 yuan per person per year; The district financial subsidy standard is 130 yuan per person per year; The town's financial subsidy standard is 85 yuan per person per year. 20 10 raise the corresponding subsidy standards according to relevant regulations.

(two) the village collective to give financial support according to the standards of 5 yuan. City, District Agricultural Committee to determine the economic difficulties of the village, the village collective support funds, paid by the district, town finance, respectively, to bear 50% of the required support funds.

(3) In 2009, each participant paid 60 yuan. In principle, the funds for supporting villages and towns in agricultural registered permanent residence, a reservoir area of Central Africa, shall be paid by myself, and each person shall pay 150 yuan. The town and village support funds for foreigners married in our district shall be paid by myself, and each person shall pay 150 yuan.

(four) the minimum living security object and the individual contributions of the special care personnel are paid by the district finance.

Fourth, venture capital.

The risk fund of the new rural cooperative medical system is extracted according to the coefficient of 10% and used when the basic overall fund overspends.

Verb (abbreviation of verb) medical scope

(1) The designated medical institutions in the region include various medical institutions at all levels under the district health system, 66055 military hospital, mental hospital, forensic hospital, Jingshun hospital and Beijing Xingyuan Jinfang Chinese Medicine Hospital; There are seven comprehensive medical institutions 17, five specialized medical institutions 15, and five traditional Chinese medical institutions in the city (see annex 1).

(two) due to illness transferred to the designated tertiary comprehensive medical institutions for treatment, must be issued by the designated secondary medical institutions referral, referral certificate. Due to special reasons, it is too late to go through the formalities and seek medical treatment in public medical institutions outside the district. It is necessary to report to the new rural cooperative medical management center in the district within two weeks from the date of hospitalization and go through the relevant procedures. After passing the dangerous period (in principle, it will not exceed two weeks), it will be transferred to the designated medical institutions in the district for medical treatment in time.

(three) in accordance with the principle of minor illness in the community, serious illness to the hospital, adhere to the nearest medical treatment.

Reimbursement of intransitive verb expenses

(1) reimbursement principle.

Medical reimbursement includes general outpatient reimbursement and hospitalization reimbursement. General outpatient reimbursement funds are used to reimburse the medical expenses of the insured in the designated medical institutions; The hospitalization reimbursement funds are used to reimburse the medical expenses of the participants for hospitalization and outpatient treatment of special diseases.

Special disease clinic refers to anti-rejection drugs, aplastic anemia and hemophilia after radiotherapy and chemotherapy, renal dialysis and liver and kidney transplantation for children with malignant tumors.

The reimbursement of medical expenses is carried out in different levels of hospitals, and the reimbursement ratio is different.

The insured person's medical expenses for hospitalization or special disease treatment in the guarantee year are calculated cumulatively, and the approved expenses are paid cumulatively in sections.

The reimbursement of medical expenses for participating students and children shall be implemented in accordance with the relevant provisions of the Notice of Beijing Municipal Health Bureau on Adjusting the Compensation Policy for Rural Students and Children in 2008 (J.W.N.Zi [2008] No.2) and the Opinions of Beijing Municipal Health Bureau on Promoting the Overall Compensation of the New Rural Cooperative Medical System in 2009 (J.W.N.Zi [2008] No.21).

(2) Repayment period.

General outpatient medical expenses are reimbursed once a month; The medical expenses of hospitalization and special disease outpatient service shall be reimbursed once every half month and reported at the top.

(3) reimbursement procedures.

Within the prescribed reimbursement time, the participating patients or their families will submit the certificate and reimbursement voucher of the new rural cooperative medical system to the village working group. The working group of the new rural cooperative medical system will report all the vouchers that need to be reimbursed in the local area to the town's new rural cooperative medical system management office, and report them to the district's new rural cooperative medical system after being audited by the management office, and enter them into the reimbursement system to verify the reimbursement amount.

The new rural cooperative medical management center shall report it to the district finance bureau after the audit, and the district finance bureau shall allocate the reimbursement funds to the new rural cooperative medical management office. The management office of the new rural cooperative medical system will send the reimbursement funds to the reimbursement personnel through the new rural cooperative medical system working group or directly, and sign for the record step by step.

(4) reimbursement standards.

1. The general outpatient department approved medical expenses, and the first-class hospital reimbursed 50%, the second-and third-class hospitals reimbursed 35%, and the district Chinese medicine hospital reimbursed 40%. The actual reported funds were capped at 2,500 yuan.

2, hospitalization and special disease outpatient medical expenses reimbursement for examination and approval, the first and second level hospitals 0 deductible, tertiary hospitals deductible 1000 yuan. The upper limit of actual reported funds is 6,543,800 yuan+0.8 million yuan.

Designated secondary medical institutions for hospitalization and special disease outpatient medical expenses approved for reimbursement of 0 to 20 thousand yuan, reimbursement of 65%; 20 thousand yuan to 50 thousand yuan, 70% reimbursement; More than 50,000 yuan, 75% reimbursement.

3, in the designated level of medical institutions hospitalization and special disease outpatient treatment, the medical expenses reimbursement of 70%.

4. The reimbursement rate of hospitalization and special disease outpatient medical expenses in designated tertiary medical institutions is lower than that in designated secondary medical institutions by 10 percentage point.

5. If the patient is transferred to hospital for treatment after emergency observation, the observation expenses within seven days before hospitalization shall be reimbursed together with the hospitalization expenses.

6. If a patient dies during emergency observation, the observation expenses within seven days before his death shall be reimbursed according to the hospitalization expenses.

7. agricultural registered permanent residence students and preschool children who did not participate in the medical insurance for serious illness of students and children in Beijing were approved to reimburse medical expenses for their hospitalization and special disease clinics. The deductible line of the first-and second-level hospitals was 0, and the deductible line of the third-level hospitals was 650 yuan, and 70% of them were reimbursed above the deductible line.

8. For those who have been insured continuously since 2004 and have not been reimbursed for hospitalization and special disease outpatient medical expenses before 2009, the reimbursement ratio of hospitalization and special disease outpatient medical expenses in 2009 will be increased by 5 percentage points respectively.

(5) reimbursement voucher.

1. For reimbursement of general outpatient medical expenses, special receipts, outpatient prescriptions and expense lists of Beijing outpatient fees shall be provided.

2. Hospitalization reimbursement needs to provide special receipts for hospitalization expenses in Beijing, project details, expense list and diagnosis certificate; For reimbursement of outpatient medical expenses for special diseases, special receipts for outpatient fees in Beijing, outpatient prescriptions, expense lists and corresponding diagnosis certificates must be provided.

3, designated tertiary comprehensive medical institutions hospitalization and special disease outpatient medical expenses reimbursement, must also provide the designated secondary medical institutions issued by the referral, transfer certificate.

4 to participate in the reimbursement of medical expenses of commercial medical insurance personnel, in addition to providing a copy of the above reimbursement voucher, it is also necessary to provide a claim split form issued by the insurance company.

5. All other participants are required to provide original vouchers of medical expenses that have not been reduced or exempted by other medical insurance.

(six) expenses not included in the scope of reimbursement:

The cost of medical treatment in non-designated medical institutions;

Failing to perform the transfer procedures and jumping to the designated tertiary comprehensive medical institution for medical treatment;

Treatment expenses for suicide, self-mutilation and alcoholism;

Expenses for infertility, pregnancy test, delivery and family planning operation.

Expenses incurred in animal injury, vaccination, physical examination, beauty and plastic surgery;

Medical expenses incurred due to fighting, fighting, drug abuse and other illegal acts;

Medical expenses for traffic accidents, industrial accidents, medical accidents and other liability accidents;

Treatment expenses for statutory occupational diseases;

Treatment expenses in foreign countries, Hong Kong, Macao and Taiwan;

Other medical expenses that should be paid by individuals according to the relevant provisions of the state and this Municipality.

(7) Reimbursement items. The reimbursement project of the new rural cooperative medical system is implemented with reference to the Catalogue of Medicines for Basic Medical Insurance in Beijing, the Catalogue of Diagnosis and Treatment Projects for Basic Medical Insurance in Beijing and the Catalogue of Medical Service Facilities for Basic Medical Insurance in Beijing.

(8) Drug price. The price of drugs provided by designated medical institutions to the participants of the new rural cooperative medical system shall be subject to the bidding price of drugs in this Municipality.

Seven, free of "four fees" range.

Participants in the new rural cooperative medical system are exempted from registration fees, medical treatment fees, home visits and puncture fees (injection and infusion) at community health service stations.

VIII. Reimbursement at the end of the year

The time for submitting the reimbursement form of the current year is as of June 65438+ 10/0 of the following year. 65438+February 3 1 day can not be discharged from the hospital, the inpatient medical institution shall issue this year's settlement list. If it is not submitted within the time limit, it will be deemed as an automatic waiver of reimbursement eligibility.

Nine. organize

(a) the District New Rural Cooperative Medical Management Committee is responsible for the formulation and adjustment of the new rural cooperative medical policy, organizing and coordinating the work, and inspecting and evaluating the relevant situation.

(two) the new rural cooperative medical supervision committee is responsible for the supervision of the new rural cooperative medical fund revenue and expenditure and system implementation.

(III) District New Rural Cooperative Medical Management Center is responsible for raising and using the new rural cooperative medical fund, auditing and settlement of reimbursement vouchers, supervision and inspection of designated medical institutions, business training, work assessment and policy research of township-level agencies.

(IV) The town's new rural cooperative medical system working committee is responsible for organizing and mobilizing the town's new rural cooperative medical system participants, collecting and turning over the participating funds, publicizing reimbursement policies, accounting for reimbursement of medical expenses, receiving and distributing reimbursement funds, and conducting business training and work assessment for village-level staff.

(5) The working group of the new rural cooperative medical system is responsible for the collection and payment of the participating funds of the new rural cooperative medical system, the publicity of reimbursement policies, the collection of reimbursement vouchers, the distribution of reimbursement funds and the publicity of reimbursement, and its work is included in the publicity of village affairs on the Democratic Day.

(six) the personnel funds and working funds of the new rural cooperative medical management institutions and agencies at all levels shall be included in the financial budget at the same level.

(seven) the new rural cooperative medical system is implemented under the unified leadership of the district government, and all relevant departments strongly support and cooperate closely.

(eight) the problems encountered in the implementation of the new rural cooperative medical system shall be solved by the office of the district new rural cooperative medical system management Committee in conjunction with the relevant departments.

(nine) District TV stations, radio stations and other publicity media, set up special columns, publicity system policies and typical cases. Take appropriate measures to release relevant information such as fund raising, operation and work progress provided by the new rural cooperative medical service agencies in this area. The new rural cooperative medical service agencies in each district produce and provide necessary publicity materials for towns and villages.

Ten, the "implementation details" by the district new rural cooperative medical management committee office is responsible for the interpretation of.

XI. The Detailed Rules for Implementation shall come into force on June 1 2009. Notice of Shunyi District People's Government on Printing and Distributing the Implementation Opinions and Detailed Rules for Adjusting and Perfecting the New Rural Cooperative Medical System in Shunyi District (Shunfa [2007] No.69) and Notice of Shunyi District People's Government Office Forwarding the Supplementary Opinions of District Health Bureau on the Implementation Detailed Rules for the New Rural Cooperative Medical System in Shunyi District (Shunfa [2007])

If someone spends a total of 25,000 yuan on medical expenses, the reimbursement formula is as follows: (25,000-500 deductible-self-funded drugs) *20%. If self-funded drugs account for a large proportion, there is not much amount to be reimbursed.

In addition, it is also important to go to designated medical institutions for medical treatment.