The accident caused by the third party is not within the scope of reimbursement of the new rural cooperative medical system. The reimbursement scope of the new rural cooperative medical system is: medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses and nursing expenses incurred by the insured in designated hospitals due to illness during the overall planning period, which meet the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses). For the participating patients whose hospitalization medical expenses exceed 50,000 yuan, 80% of them are partially reimbursed from 50,000 yuan to 80,000 yuan (including 80,000 yuan), and 90% are partially reimbursed above 80,000 yuan.
The differences between the new rural cooperative medical insurance and urban medical insurance are as follows:
1, different people. Medical insurance for urban residents mainly covers urban registered residents, and the new rural cooperative medical system mainly covers rural registered residents;
2. Different management departments. The medical insurance for urban residents is mainly managed by the human and social departments, and the new rural cooperative medical system is managed by the health department in most places;
3. The purchase method is different. The new rural cooperative medical system is to buy rural hukou, and residents' medical insurance is to buy non-agricultural registered permanent residence;
4. The reimbursement rate is different. The reimbursement rate of medical insurance for urban residents is 85%. According to different hospital levels, the reimbursement rate of the new rural cooperative medical system ranges from 10% to 80%.
5. The drugs reimbursed are different. The list of drugs that can be reimbursed by the new rural cooperative medical system is less than that of urban medical insurance, and the reimbursement rate of the new rural cooperative medical system in township hospitals is high. The average reimbursement rate of municipal hospitals is lower than that of urban medical insurance 10%-20%, and the highest back cover is also less than that of urban medical insurance.
6. The emphasis of safety treatment is different. Medical insurance for urban residents mainly covers both inpatient and outpatient serious diseases, so the treatment of inpatient and outpatient serious diseases is higher than that of the new rural cooperative medical system. In addition, the outpatient treatment level of the new rural cooperative medical system is generally higher than that of urban residents' medical insurance.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 24 The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Article 58 An employing unit shall, within 30 days from the date of employment, apply to the social insurance agency for social insurance registration for its employees. If the social insurance has not been registered, the social insurance agency shall verify the social insurance premium it should pay. Employees-free individual industrial and commercial households who voluntarily participate in social insurance, part-time employees who do not participate in social insurance in the employing unit and other flexible employees shall apply to the social insurance agency for social insurance registration. The state establishes a national unified personal social security number. Personal social security number is a citizen's identity number.