② The deductible line for hospitalization reimbursement of Qingdao municipal designated medical institutions is 500 yuan;
On the basis of 20 1 1, adjust and increase the reimbursement ratio of hospitalization expenses to ensure that the hospitalization compensation ratio reaches more than 75% within the policy scope during the year.
In the town (branch) hospitals that implement the basic drug system, the reimbursement rate of basic drugs, Chinese medicine and Chinese medicine diagnosis and treatment projects is 90%, and the reimbursement rate of other expenses is 80%;
② The reimbursement rate of specialized hospitals is 80%, private hospitals are 70%, municipal traditional Chinese medicine hospitals are 65%, Qingdao jiaozhou city Central Hospital is 60%, Qingdao designated medical institutions are 55%, and medical institutions outside Qingdao are 50%;
③ If the insured residents seek medical treatment outside the administrative area of this Municipality or in non-designated medical institutions for special reasons such as urgency, danger, severity or first aid, and handle the filing according to the regulations, the proportion of hospitalization reimbursement is 50%.
(3) Compensation for other expenses
① Accidental injury hospitalization compensation: The hospitalization expenses incurred by insured residents due to accidental injury can be included in the reimbursement scope of the new rural cooperative medical system if there is no other compensation and it is not caused by illegal crime. Be hospitalized in a designated medical institution in Qingdao
, in accordance with the "Qingdao municipal designated medical institutions immediate reporting and cost settlement measures"; If you are hospitalized in a designated medical institution in this city, you must fill in the application form for trauma investigation within 3 working days;
② Outpatient treatment of leukemia, uremia, aplastic anemia, hemophilia, organ transplant rejection, etc. of insured residents can be reimbursed with outpatient documents and medical records of dialysis and blood transfusion.
(3) The participating residents died because of emergency rescue, or were directly transferred from emergency observation to hospitalization in the same designated medical institution. The medical expenses for emergency observation shall be reimbursed and compensated according to the proportion of hospitalization;
④ Hospitalization compensation for major diseases: anyone suffering from congenital heart disease (congenital atrial septal defect, congenital ventricular septal defect, congenital patent ductus arteriosus, congenital pulmonary valve stenosis, other complex congenital heart diseases, etc.). )
0- 14 years old (including 14 years old) children with tetralogy of Rockwell's disease and acute leukemia (acute lymphoblastic leukemia and acute promyelocytic leukemia) and children with severe mental illness, breast cancer, cervical cancer and terminal illness.
The reimbursement rate of participating residents with stage nephropathy, hemophilia, multidrug-resistant tuberculosis and opportunistic infection of AIDS is 75%;
⑤ If the participating patients were hospitalized continuously and participated in the new rural cooperative medical system in the first year of hospitalization and the year of discharge, all medical expenses will be reimbursed according to the proportion of the new rural cooperative medical system policy in the year of discharge; In other cases, only the medical expenses of the insured year will be reimbursed;
⑥ Hospitalization compensation for diseases that enjoy preferential policies: diseases that enjoy preferential policies and financial subsidies according to policies, such as "hospital delivery of rural pregnant women (cesarean section)" and "prevention of AIDS".
For public health projects such as treatment, tuberculosis prevention, schistosomiasis control and chronic disease prevention, the medical expenses shall be implemented in accordance with the relevant provisions of the special financial subsidy policy or the use of funds, and the remaining medical expenses shall be taken care of by themselves.
Use and then compensate according to the new rural cooperative medical system.
3, outpatient and inpatient reimbursement scope
(1) Medical expenses that meet the following three criteria are included in the scope of reimbursement:
① disease catalogue: refer to ICD- 10 disease code;
(2) Drug List: According to Qingdao New Rural Cooperative Medical System Drug List (20 10 Edition) (Wei Qing Nongshe Zi [20 10]No. 12) and supplementary documents;
(3) Diagnosis and treatment catalogue: according to the Catalogue of Diagnosis and Treatment Projects of New Rural Cooperative Medical System in Qingdao (Wei Qing Nongshe Zi [201]No. 15);
The expenses beyond the scope of the above three catalogues shall be borne by individuals. If the catalogue of medical institutions is incorrect, the relevant expenses shall be borne by the medical institutions.
(2) Items and scope of non-compensation:
(1) If you go to a medical institution outside the city without approval, the related expenses will not be compensated;
(2) medical expenses incurred within the scope of public health services (such as vaccination, pre-marital medical examination, preventive health care, health education, etc.). ) special funds are arranged by the government;
(3) Blood and blood products (except for special diseases), various expenses incurred by non-disease clinics such as beauty, non-functional plastic surgery, orthopedic surgery, weight loss, height increase, optometry, optometry, hearing AIDS, artificial limbs, etc.;
(4) Registration fee, home visit fee, ambulance fee, air conditioning fee, consulting fee, escort fee, transportation fee, self-purchased drugs and materials, fees marked with the word "other" in the bill of charges, and personal daily necessities;
(5) Due to industrial accidents, medical accidents, traffic accidents, fights and other obvious responsible parties, self-injury due to drunk driving, driving without a license, theft and robbery, self-injury, suicide, drug abuse, etc. ;
6. Expenses incurred by family planning measures such as abortion and abortion;
⑦ Medical expenses incurred in Hong Kong Special Administrative Region, Macao Special Administrative Region, Taiwan Province Province and outside China;
(8) Medical expenses that have not been reimbursed within 3 months of the New Year's Eve;
Pet-name ruby other expenses stipulated by the health administrative department at or above the municipal level shall not be reimbursed.
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