Tell you the basic reimbursement rules of the new rural cooperative medical system.
1. Reimbursement of drugs at public expense is 60% (only drugs within the scope of the new rural cooperative medical system are reimbursed. There are differences between provinces and regions, depending on local policies)
2. Self-funded drugs are not reimbursed (most drugs are self-funded drugs, imported drugs and specific drugs, but drugs with high price, small side effects and good curative effect are not reimbursed. )
3. Other expenses: The reimbursement rates for hospitalization, examination and operation are different.
If 5000 yuan out of 20000 is a self-funded project, then 5000 yuan will not be reimbursed. The rest will be reimbursed in proportion. But I don't know the proportion of your other expenses, so I can't tell you how much you can reimburse.
Outpatient compensation
60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.
40% reimbursement for medical treatment in the town health center, with the limit of examination fee and operation fee for each visit, and the limit of prescription drug fee 100 yuan.
The reimbursement for medical treatment in secondary hospitals is 30%, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
Third-level hospitals will be reimbursed 20%, with the examination fee and operation fee for each visit limited to 50 yuan and prescription drug fee limited to 200 yuan.
Chinese medicine invoice with prescription, limit 1 yuan.
The annual compensation limit for rural cooperative medical clinics is 5000 yuan.
Hospitalization compensation
Reimbursement scope:
A. Drug expenses: auxiliary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic resonance, etc., limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
Serious illness compensation
Compensation from town risk fund: if the medical expenses of inpatients participating in cooperative medical care exceed 5,000 yuan at one time or for the whole year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan is 65%, and10001-8000 yuan is 75%.
The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.
The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis for severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental retardation; Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery. Other special diseases that can be reimbursed shall be subject to local specific policies.
Specific outpatient treatment of special diseases includes necessary supportive treatment and symptomatic treatment of systemic and local reactions during treatment, while general adjuvant treatment is not included in the scope of reimbursement.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.