1. The outpatient expenses of the participants shall be reimbursed according to the following regulations: village clinics and town and street health centers shall be reimbursed by 25%, with the maximum outpatient compensation per person per year 15 0 yuan. Outpatient medical expenses of designated medical institutions above Grade II (inclusive) shall not be reimbursed.

Two, hospitalization reimbursement according to the following provisions:

(1) pay line. First-class designated medical institutions 100 yuan, medical expenses below the deductible line will not be reimbursed. Two or three designated medical institutions do not set deductible.

(2) Reimbursement ratio. The first-class designated medical institutions do not implement segmented compensation for hospitalization, and the proportion of medical expenses compensation within the scope of reimbursement is 65%. Second, third-level designated medical institutions will compensate by stages, which are divided into three sections (less than 5000 yuan (including 5000 yuan), more than 5000 yuan to 10000 yuan (including 10000 yuan) and more than 10000 yuan (the same below). The medical expenses within the reimbursement scope shall be reimbursed according to the following proportions: 50% for the part below 5,000 yuan, 55% for the part between 5,000 yuan and 1 10,000 yuan, and 60% for the part above 1 10,000 yuan; Third-level designated medical institutions shall be reimbursed by 35% for the part below 5,000 yuan, 40% for the part between 5,000 yuan and 1 10,000 yuan, and 45% for the part above 1 10,000 yuan. The first-level designated medical institutions include town street hospitals and district-level specialized medical institutions, the second-level designated medical institutions include district-level general hospitals and municipal specialized medical institutions, and the third-level designated medical institutions include municipal-level and above general hospitals and municipal-level specialized medical institutions. The implementation of the mutual recognition system of the designated medical institutions of the new rural cooperative medical system in the province, and the treatment of the designated medical institutions of the new rural cooperative medical system confirmed by other health administrative departments at or above the county level in the province shall be reimbursed according to the compensation ratio of the designated medical institutions at the same level as stipulated by the local authorities.

(3) the capping line. The total reimbursement for hospitalization can reach up to 40,000 yuan per person per year.

Three, uremia dialysis, radiotherapy (chemotherapy) for tumor patients, lupus erythematosus, organ transplantation and anti-rejection treatment of outpatient expenses according to the proportion of hospitalization reimbursement of designated medical institutions at the same level, and the deductible line is calculated every time the reimbursement is settled.

Four, in the designated medical institutions according to the policy of delivery, each person to give 300 yuan a one-time compensation. For the medical expenses incurred by newborns between the new rural cooperative medical system financing payment period and the next financing payment period, their mothers can enjoy the new rural cooperative medical system compensation policy in the name of their mothers.

Five, migrant workers and their children with their parents or parents living outside with their children for a long time, due to illness in the designated medical institutions held by the local government for hospitalization, by proof of work unit, proof of household registration, proof of diagnosis of medical institutions, home page of hospitalization medical records, expense vouchers and other information, after the audit of the district cooperative medical management office, to the account where the cooperative medical management office for reimbursement.

Six, participants can choose the designated medical institutions in the city. Reimbursement in the designated medical institutions in the city shall be paid in advance by the designated medical institutions, and then audited and allocated to realize immediate reimbursement.

Seven, to the designated medical institutions organized by the government outside the city, you need to go through the registration and audit procedures at the District Cooperative Medical Management Office. Go to the cooperative medical management office where the account is located for reimbursement.

Eight, the participants should complete the settlement of the previous year's reimbursement within one month of the following year, and those who fail to handle it are deemed to have given up the reimbursement automatically. If the designated medical institution fails to handle the settlement in time, the compensation fee shall be borne by the designated medical institution.

Nine, participants to reimburse medical expenses, should hold my cooperative medical certificate, original medical bills, outpatient medical records, reimbursement prescription (outpatient double prescription system); For reimbursement of medical expenses, the inpatient should also hold hospitalization list, diagnosis certificate, discharge certificate, home page of hospitalization medical records and other materials.

Ten, medical expenses reimbursement before disbursement, the town street cooperative medical management office and designated medical institutions to organize and review the relevant materials provided by the applicant, the preparation of cooperative medical reimbursement vouchers, according to the specified time every month to the district cooperative medical management office for review; Timely disbursement of cooperative medical fund to those who pass the review, and reimbursement expenses beyond the scope of reimbursement shall be borne by designated medical institutions.

Eleven, one of the following circumstances, no reimbursement:

(a) the medical expenses of the personnel who did not participate in the rural cooperative medical system;

(2) All family members should participate, but not all;

(3) Medical expenses for vaccines and other vaccines within the coverage of planned immunization;

(four) family planning medical expenses and various assisted reproductive technologies (artificial insemination, test-tube baby, surrogate mother) and other related medical expenses;

(5) Examination expenses not necessary for diagnosis;

(6) Registration fee, decocting fee, hospitalization food fee, visiting fee, ambulance fee, intensive care fee, disposable non-medical sanitary articles, air conditioning fee, heating fee, medical treatment fee, health fee, private room fee, escort fee, etc. ;

(seven) health examination, blood transfusion, the installation of artificial limbs and eyes, dental implants and all kinds of beauty, plastic surgery, correction, medical consultation (mental health consultation) and other expenses;

(eight) medical expenses for traffic accidents caused by alcoholism, fighting, illegal crimes, self-injury, medical accidents and other party responsibilities;

(nine) medical expenses outside the list of basic drugs for cooperative medical care;

(ten) medical expenses for productive injuries and accidental injuries caused by paid services;

(eleven) other circumstances shall not be compensated according to the relevant provisions of the basic medical insurance for urban workers.

Twelve, forged, altered cooperative medical bills, cooperative medical certificate lent to others for medical expenses will not be reimbursed; If the reimbursement is fraudulently obtained, the payment shall be recovered, the household's eligibility for reimbursement in the current year shall be cancelled, and the responsibility shall be investigated according to relevant regulations.

Your situation: Note: In any of the following circumstances, it will not be reimbursed: (8) Medical expenses caused by traffic accidents caused by alcoholism, fighting, illegal crimes, self-injury, medical accidents and other parties' responsibilities;