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 in accordance with the Opinions of Beijing Municipal Health Bureau on Promoting the Overall Compensation of the New Rural Cooperative Medical System in 29 (J.W.N.Z. [28] No.21).

1. Scope of application

(1) Having residents of agricultural registered permanent residence in our district; Parents are agricultural registered permanent residents who are non-agricultural registered permanent residence students and preschool children; 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 nonlocal person who does not enjoy any medical insurance from the government in our district.

(2) Calculate the time to participate in the new rural cooperative medical insurance according to the fiscal year. If you participate in the year, you will benefit in the current year.

II. Participation in registration

Rural residents voluntarily participate in the new rural cooperative medical system on a family basis; The participating personnel shall be subject to territorial management, and the village committee where the household registration is located shall handle the handling procedures, and the nonlocal personnel who are married in our district shall go through the handling procedures with their spouses in the village committee where their household registration is located.

III. Sources of funds

(1) In 29, the municipal financial subsidy standard was 14 yuan per person per year; District financial subsidy standard 13 yuan per person per year; The town's financial subsidy standard is 85 yuan per person per year. In 21, the corresponding subsidy standards were increased according to relevant regulations.

(2) The village collectives provide financial support according to the standard of 5 yuan in the Year of Man. City, District Agricultural Committee to determine the economic difficulties of the village, the village collective support funds, by the district, town finance to pay, respectively, to bear 5% of the required support funds.

(3) In 29, each participant paid 6 yuan. In principle, the support funds for the towns and villages of Central African agricultural registered permanent residence immigrants in the reservoir area shall be paid by themselves, and each person shall pay 15 yuan. I will pay the support funds for the town and village of the nonlocal personnel who are married in our region, and each person will pay 15 yuan.

(4) the individual contributions of the minimum living security object and the special care personnel shall be paid by the district finance.

iv. risk fund

the risk fund of the new rural cooperative medical system is drawn according to the coefficient of 1%, and it will be used when the basic overall funds are overspent.

V. Scope of medical treatment

(1) Designated medical institutions in the region include various medical institutions at all levels under the district health system, 6655 military hospital, mental hospital, forensic hospital, Jingshun hospital and Beijing Xingyuan Jinfang Chinese Medicine Hospital; There are 17 first-class comprehensive medical institutions, 15 first-class specialized medical institutions and 5 first-class traditional Chinese medical institutions in the city (see Annex 1).

(2) If the patient is transferred to a designated third-class and first-class comprehensive medical institution for treatment due to illness, a certificate of referral and transfer shall be issued by a designated second-class medical institution. Because of 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 management center of the new rural cooperative medical system in the district within two weeks from the date of hospitalization and go through the relevant procedures, and transfer it to the designated medical institutions of the new rural cooperative medical system in the district for medical treatment in time after passing the critical period (in principle, not more than two weeks).

(3) According to the principle of minor illness in the community and serious illness in the hospital, insist on seeking medical treatment nearby.

VI. Reimbursement of expenses

(1) Reimbursement principle.

reimbursement for medical treatment is implemented for general outpatient service and hospitalization. General outpatient reimbursement funds are used for reimbursement of medical expenses of participating personnel in outpatient clinics of designated medical institutions; Hospitalization reimbursement funds are used for reimbursement of medical expenses for hospitalization and special disease outpatient treatment of participants.

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

The reimbursement rate of medical expenses varies with the level of the hospital.

the medical expenses of the participants who are hospitalized or treated for special diseases in the guarantee year are calculated cumulatively, and the approved expenses are paid in proportion and cumulatively.

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 28 (J.W.N.Zi [28] No.2) and the Opinions of Beijing Municipal Health Bureau on Promoting the Overall Compensation of New Rural Cooperative Medical System in 29 (J.W.N.Zi [28] No.21).

(2) reimbursement cycle.

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 will be reported at the top.

(3) reimbursement procedures.

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

the new rural cooperative medical management center in the district reports the reimbursement to the district finance bureau, and the district finance bureau will allocate the reimbursement funds to the new rural cooperative medical management offices. The new rural cooperative medical management offices will deliver the reimbursement funds to the reimbursement personnel through the new rural cooperative medical working group or directly in a safe, concise, convenient and appropriate form, and sign them step by step for the record.

(4) reimbursement standards.

1. The approved medical expenses of general outpatient department are reimbursed by 5% in the first-class hospital, 35% in the second-class and third-class hospitals, 4% in the district hospital of traditional Chinese medicine, and the actual reported funds are capped at 2,5 yuan.

2. The reimbursement of medical expenses for inpatients and special disease clinics is approved, with the first-class and second-class hospitals starting at , and the third-class hospitals starting at 1 yuan. The actual reported funds are capped at 18, yuan.

65% of the approved medical expenses of inpatients and special disease clinics in designated secondary medical institutions are reimbursed from to 2, yuan; 2 thousand yuan to 5 thousand yuan, 7% reimbursement; More than 5, yuan, 75% reimbursement.

3. 7% of medical expenses will be reimbursed for hospitalization and outpatient treatment of special diseases in designated first-class medical institutions.

4. The reimbursement rate of hospitalization and special disease outpatient in designated tertiary medical institutions is 1% lower than that in designated secondary medical institutions.

5. If the patient is transferred to hospital after emergency observation, the observation fee within seven days before hospitalization will be reimbursed together with the hospitalization fee.

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

7. For agricultural registered permanent residence students and preschool children who have not participated in Beijing medical insurance for serious illness of students and children, their hospitalization and special disease clinics are approved for reimbursement of medical expenses, with the deductible of first-class and second-class hospitals at , and the deductible of third-class hospitals at 65 yuan, with 7% reimbursed above the deductible.

8. The reimbursement of medical expenses for inpatients and special disease outpatients in 29 will be increased by 5 percentage points for those who have participated continuously since 24 and have not been reimbursed before 29.

(5) reimbursement voucher.

1. For reimbursement of general outpatient medical expenses, you must provide a special receipt for outpatient charges in Beijing, outpatient prescriptions and expense list.

2. For hospitalization reimbursement, you must provide a special receipt for hospitalization charges in Beijing, a detailed project, a list of expenses and a diagnosis certificate; For reimbursement of medical expenses for special disease clinics, special receipts for outpatient charges in Beijing, outpatient prescriptions, expense lists and corresponding diagnosis certificates must be provided.

3. For reimbursement of medical expenses of inpatients and special disease outpatients in designated tertiary comprehensive medical institutions, the certificate of referral and transfer issued by designated secondary medical institutions shall be provided at the same time.

4. For the medical expenses reimbursement of the personnel participating in the commercial medical insurance, in addition to the copies of the above reimbursement vouchers, the claim splitting sheet issued by the insurance company shall also be provided.

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

(6) Expenses not included in the reimbursement scope:

Expenses for seeing a doctor in a non-designated medical institution;

the expenses for going to a designated tertiary comprehensive medical institution without completing the transfer procedures;

Treatment expenses for suicide, self-mutilation and alcoholism;

expenses incurred in infertility, infertility, pregnancy check-up, delivery, family planning operation, etc.,

expenses incurred in animal injury, vaccination, physical examination, beauty and plastic surgery, etc.;

medical expenses incurred by various illegal acts such as fighting, fighting and drug abuse;

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

the treatment expenses of statutory occupational diseases;

treatment expenses abroad and in 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. Reimbursement items of the new rural cooperative medical system shall be implemented with reference to the Catalogue of Beijing Basic Medical Insurance Drugs, the Catalogue of Beijing Basic Medical Insurance Diagnosis and Treatment Items and the Catalogue of Beijing Basic Medical Insurance Medical Service Facilities.

(8) drug prices. 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 the city.

VII. Scope of exemption from "four fees"

Persons participating in the new rural cooperative medical system are exempt from registration fees, medical treatment fees, visiting fees and puncture fees (injections and infusions) at community health service stations.

VIII. Termination of Reimbursement

The time for submitting reimbursement documents within the year is January 1th of the following year. If you can't leave the hospital before December 31st, the medical institution in which you are hospitalized shall issue this year's settlement list. Any documents that are not submitted within the time limit shall be deemed as automatic waiver of reimbursement qualification.

IX. Organization and leadership

(1) The District New Rural Cooperative Medical Management Committee is responsible for the formulation and adjustment of new rural cooperative medical policies, the organization and coordination of work, and the inspection and assessment of the situation.

(II) The District New Rural Cooperative Medical Supervision Committee is responsible for the supervision of the income and expenditure of the new rural cooperative medical system and the implementation of the system.

(3) the district new rural cooperative medical management center is responsible for the collection and use of new rural cooperative medical funds, the audit and settlement of reimbursement vouchers, the supervision and inspection of designated medical institutions, the business training, work assessment and policy research of township-level agencies.

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

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

(6) The personnel funds and working funds of the new rural cooperative medical management institutions and agencies at all levels are included in the fiscal budget at the same level.

(7) The new rural cooperative medical system is implemented under the unified leadership of the district government, with strong support and close cooperation from all relevant departments.

(8) 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 coordination with relevant departments.

(9) District TV stations, radio stations and other publicity media set up special columns to publicize system policies and typical cases. Take appropriate measures to release the relevant information on the collection, operation and work progress of funds provided by the new rural cooperative medical service agencies in the district. The new rural cooperative medical service agencies in the district make and provide necessary publicity materials for towns and villages.

X. The Office of the New Rural Cooperative Medical Management Committee of the District shall be responsible for the interpretation of the Detailed Rules for Implementation.

Xi. These Detailed Rules shall come into force as of January 1, 29. The 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 (Shun Zhengfa [27] No.69) and the Notice of Shunyi District People's Government Office Forwarding the Supplementary Opinions of District Health Bureau on the Detailed Rules for the Implementation of the New Rural Cooperative Medical System in Shunyi District (Shun Zhengfa [27] No.77) issued by Shunyi District People's Government on December 1, 27 shall be abolished at the same time

. The total amount of medical expenses is 25, yuan, and the reimbursement formula is as follows: (25,-5 deductible-self-funded drugs) *2%. If self-funded drugs account for a large proportion, there is not much amount to be reimbursed.

in addition, it is important to go to a designated medical institution for medical treatment.

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