: 2009 1 1.06 Source: Jinjiang New Rural Cooperative Medical System Publisher: Li Zhihui Click Times: 688 According to the Notice of Jinjiang Municipal People's Government on Printing and Distributing the Management Measures of Jinjiang New Rural Cooperative Medical System for 20 10 (J [2009] No.304) 20 10 Jinjiang New Rural Cooperative Medical System was hospitalized. Designated hospitals outside Jinjiang include national (except Hong Kong, Macao and Taiwan) public non-profit medical institutions, and they must be local designated medical institutions of the new rural cooperative medical system. 2. Compensation standard: the compensation is limited to the hospitalization of the participants in designated hospitals or the outpatient treatment of special diseases due to illness. The compensation scope of the new rural cooperative medical system in Jinjiang City includes treatment fee, medicine fee, laboratory fee, examination fee, operation fee, hospitalization fee and other expenses. The scope of compensation can basically refer to the provisions of the "Quanzhou basic medical insurance drug list, diagnosis and treatment items, service items and payment standards". Psychotropic drugs, medical treatment projects cancel the proportion of personal expenses, and all of them are included in the compensation scope of the new rural cooperative medical system in Jinjiang City. According to the relevant policies of the superior to support Chinese medicine, the proportion of individual self-funded expenses for Chinese medicine diagnosis and treatment (decoction pieces and Chinese medicine diagnosis and treatment projects) will be cancelled and all of them will be included in the scope of compensation. The compensation for the hospital bed fee of the participants shall be subject to the highest price limit, and the daily limit shall not exceed 20 yuan, that is, the hospital bed fee shall not exceed 20 yuan according to the facts, and those exceeding 20 yuan shall be reported according to 20 yuan. The new rural cooperative medical system hospitalization compensation set up deductible line and capping line. The actual compensation amount for each hospitalization of the participants is: the expenses within the compensation scope of the new rural cooperative medical system in Jinjiang City minus the corresponding deductible line, multiplied by the corresponding compensation ratio. The hospitalization compensation standard is as follows: the level of designated medical institutions can compensate medical expenses (yuan). The compensation ratio of first-class designated hospitals in Jinjiang (that is, township hospitals or street community health service centers, the list is attached) is above (%) 100; There are more than 300 secondary designated hospitals in Jinjiang (i.e. municipal hospitals, the list is attached); More than 800 hospitals in 65% outside Jinjiang; 40% cap. 3. Special object compensation (1) deductible object: there is no deductible for the compensation of hospitalization expenses for newborns (infants), and compensation is made according to the compensation ratio of hospitals at the same level. The medical expenses are combined with the mother, and the top line is calculated by one person. There is no deductible line for pregnant women to give birth in the first-and second-level designated hospitals in Jinjiang City, and compensation shall be made according to the compensation ratio of the hospitals at that level. There is no deductible for low-income residents to be hospitalized in the first-class and second-class designated hospitals in Jinjiang City, and the proportion of expenses compensation within the compensation range is increased to 100% and 85% respectively. (2) Designated hospitals at all levels1deductible line for children under 4 years old is within the scope of compensation, and the cost reaches 100 yuan. (III) Only-daughter, two-daughter ligation families (only husband and wife themselves, only-daughter and second-daughter) and rural family planning families with minimum living allowances will increase the compensation ratio by 20% on the basis of implementing the compensation standard. That is, the compensation ratio of the first-class and second-class designated hospitals in Jinjiang City and the designated hospitals outside the city increased to 100%, 85% and 60% respectively. (4) Quanzhou Hospital of Traditional Chinese Medicine paired up to help Jinjiang Purple Hat Health Center, and determined that all the participants in Jinjiang City were hospitalized in Quanzhou Hospital of Traditional Chinese Medicine. The outpatient expenses for special diseases were implemented according to the compensation standard of secondary designated hospitals in Jinjiang City. (5) Accidental injury to minors (non-third-party liability, non-illegal; Must provide valid proof) hospitalization expenses are included in the scope of compensation; (6) Causing injuries to others, traffic accidents or industrial accidents, which should be compensated by a third party according to law, but it is really impossible to obtain compensation; Courageous people injured hospitalization expenses failed to get compensation, by the village (community), town (street) and the public security organs issued relevant certificates, signed by the leaders in charge, the new rural cooperative medical service center audit, the situation is true, reported to the new rural cooperative medical management center for approval can be compensated. (7) If the participants are medical assistance targets for families with difficulties in urban and rural areas, they can still enjoy the approved medical assistance in addition to the compensation of the new rural cooperative medical system. (8) Extremely serious diseases: Six kinds of extremely serious diseases, such as malignant tumor resection, heart-related surgery, severe burn (scald) injury surgery, cochlear implantation, organ transplantation and therapeutic surgery for aplastic anemia, were hospitalized in tertiary hospitals outside Jinjiang, and the compensation standard for operation expenses was reported according to the hospitalization compensation standard for secondary hospitals inside Jinjiang. (9) Diseases subject to quota settlement: pneumonia, acute glomerulonephritis, acute bronchitis, acute gastroenteritis, bronchial asthma and normal delivery; Appendicitis surgery, cholecystitis and cholecystolithiasis surgery, hysteromyoma surgery, inguinal hernia surgery, cesarean section surgery, thyroid benign tumor surgery, cataract surgery, ovarian benign tumor surgery, hemorrhoids surgery's treatment and other 15 diseases are the limited settlement diseases. (For details, please refer to the Detailed Rules for the Implementation of Limit Settlement and Limit Reimbursement of Hospitalization Expenses for Single Disease of New Rural Cooperative Medical System in Jinjiang City (Trial)) (10) China Unicom Jinjiang Branch provides extra accidental death insurance for each participating family free of charge; Participants who hold real-name registration system registration certificate and register in China Unicom Company 1000. Step by step and continue online customer support to try to carry out the pilot program of general outpatient report compensation, with the maximum compensation amount of 120 yuan per person per year. 4. There is no compensation scope (1) for self-purchased drugs, non-special disease outpatient expenses, observation room medical expenses, rehabilitation medical expenses and drugs and related expenses that will not be reimbursed according to the relevant provisions of Quanzhou's basic medical insurance for urban workers; (2) Expenses for tooth washing, tooth cleaning, tooth planting, orthodontics, optometry and glasses, prosthetic limbs, hearing AIDS, beauty, cosmetic surgery, qigong, massage, family beds, health care and special care, expenses for physical examination and non-medical personal services, accompanying expenses, expenses for traditional Chinese medicine decoction, transportation expenses, and other miscellaneous expenses during medical treatment, consultation and hospitalization; (3) the expenses incurred by family sickbed, bed hanging treatment or impostor hospitalization; (four) medical expenses caused by illegal and criminal acts, injury to others, suicide, self-injury, fighting, drug abuse, drug rehabilitation, alcoholism, intentional violation of rules and regulations; Normal delivery and cesarean section without birth certificate in violation of the national family planning policy will not be compensated; (five) traffic accidents, medical accidents, industrial accidents and other medical expenses that should be borne by third parties according to law; (six) hospitalization expenses caused by nuclear radiation, nuclear explosion or nuclear pollution, war, riot or armed rebellion; (7) Medical expenses incurred during the period of not seeing a doctor in a designated medical institution or when the participant is abroad; (eight) medical expenses incurred in the event of serious natural disasters, sudden diseases and other sudden risks; (nine) the hospitalization expenses incurred by those who participate in the basic medical insurance for urban workers and enjoy social medical security such as free medical care within the validity period; (10) Medical expenses that have not been reported for more than two months in one year without special reasons; (1 1) Other expenses determined by Jinjiang New Rural Cooperative Management Committee that will not be compensated. 5. Example of compensation: Suppose that the total hospitalization expenses of an adult participant (non-subsistence allowances and family planning objects) are 3,000 yuan, and the expenses within the compensation scope of the new rural cooperative medical system are 2,000 yuan after deducting the non-reimbursable expenses, then he can get1.655 520 yuan for medical treatment in township hospitals or street community health service centers in Jinjiang, and1.655 for medical treatment in municipal designated hospitals in Jinjiang.

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