In 21, the compensation basis for hospitalization report of the new rural cooperative medical system in Jinjiang was released on November 6, 29. Source: Jinjiang New Rural Cooperative Medical System Publisher: Li Zhihui Click Number: 688 According to the notice of Jinjiang Municipal People's Government on printing and distributing the management measures for the new rural cooperative medical system in Jinjiang in 21 (Jin Zhengwen [29] No.34), In 21, the compensation basis for hospitalization report of the new rural cooperative medical system in Jinjiang was arranged as follows: 1. Hospital scope: The list of designated hospitals in Jinjiang city and the telephone number of the stationed window are attached. The designated hospitals outside Jinjiang city include public non-profit medical institutions nationwide (except Hong Kong, Macao and Taiwan) and must be local designated medical institutions of the new rural cooperative medical system. 2. Compensation standard: the compensation is limited to the participant's hospitalization in a designated hospital or outpatient treatment for special diseases due to illness. The compensation scope of the new rural cooperative medical system in Jinjiang City includes treatment fees, medicine fees, laboratory fees, examination fees, operation fees, hospitalization fees and other expenses. The scope of compensation can basically refer to the provisions of the drug list, diagnosis and treatment items, service items and payment standards of the basic medical insurance for urban workers in Quanzhou City in the current year. Psychotropic drugs, diagnosis and 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 of Chinese medicine diagnosis and treatment expenses (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 hospitalization bed fee of the participants shall be subject to the highest price limit, and the daily limit shall not exceed 2 yuan, that is, if the hospitalization bed fee does not exceed 2 yuan, it shall be reported according to the actual amount, and if it exceeds 2 yuan, it shall be reported according to 2 yuan. The new rural cooperative medical system hospitalization compensation set up deductible line and capping line. The actual amount of compensation for each hospitalization of the participants is: subtract the corresponding deductible from the expenses within the scope of compensation for the new rural cooperative medical system in Jinjiang City and multiply it by the corresponding compensation ratio. The hospitalization compensation standard is as follows: the level of designated medical institutions can compensate medical expenses (yuan). Compensation ratio (%) First-level designated hospitals in Jinjiang City (that is, township hospitals or street community health service centers, the list is attached) is more than 1%. Second-level designated hospitals in Jinjiang City (that is, municipal hospitals, the list is attached) is more than 3%. More than 8% and 4% of designated hospitals outside Jinjiang City are capped: every year. 3. Compensation for special objects (1) deductible-free objects: there is no deductible line for the compensation for hospitalization expenses of newborns (infants), and compensation is made according to the compensation ratio of hospitals at this level. The medical expenses are calculated with the mother, and the top line is calculated by one person. There is no deductible line for pregnant and lying-in women to give birth in the first-class and second-class designated hospitals in Jinjiang City, and compensation is made according to the compensation ratio of the hospitals at that level. The minimum living allowance object is hospitalized in the first-class and second-class designated hospitals in Jinjiang City without a deductible line, and the compensation ratio of expenses within the compensation range is increased to 1% and 85% respectively. (2) The deductible line for children under the age of 14 in designated hospitals at all levels is within the scope of compensation, and the expenses reach 1 yuan. (3) The rural family planning families with only one daughter, two female ligation families (only the husband and wife themselves, the only daughter and the second daughter) and the subsistence allowances will increase the compensation ratio by 2% 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 will be increased to 1%, 85% and 6% respectively. (4) Quanzhou Hospital of Traditional Chinese Medicine paired up to help Jinjiang Purple Hat Health Center, and determined that all participants from Jinjiang City would go to Quanzhou Hospital of Traditional Chinese Medicine for hospitalization and outpatient expenses for special diseases according to the compensation standard of secondary designated hospitals in Jinjiang City. (5) Accidental injury of minors (non-third-party liability, non-illegal behavior; Must provide valid proof) hospitalization expenses are included in the scope of compensation; (6) The person responsible for the injury, traffic accident or industrial accident of others should be compensated by the third party according to law, but it is really impossible to obtain compensation; Courageous person injured hospitalization expenses failed to get compensation, by the village (community) and town (street) and public security organs issued relevant certificates, signed by the leaders in charge, audited by the new rural cooperative medical service center, the case 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 poor families 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) Extra-large diseases: Six extra-large diseases, such as malignant tumor excision, 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 with reference to the hospitalization compensation standard of secondary hospitals inside Jinjiang. (9) Diseases subject to quota settlement: pneumonia, acute glomerulonephritis, acute bronchitis, acute gastroenteritis, bronchial asthma and normal delivery; Fifteen diseases, including appendicitis surgery, cholecystitis and gallstone surgery, hysteromyoma surgery, inguinal hernia surgery, cesarean section surgery, thyroid benign tumor surgery, cataract surgery, ovarian benign tumor surgery, and hemorrhoids surgery's treatment, are the diseases for quota settlement. (For details, please refer to the Implementation Rules for Limit Settlement and Limit Reimbursement of Hospitalization Expenses for Single Diseases in Jinjiang New Rural Cooperative Medical System (Trial)) (1) China Unicom Jinjiang Branch provides 2 yuan additional accidental death insurance for each participating household free of charge; Participants who hold real-name registration system registered in China Unicom Company'sNo. segment and continue to be online customers are funded to try to carry out a pilot program of general outpatient report compensation, with the maximum compensation amount of 12 yuan per person per year. 4. No scope of compensation (1) Self-purchased drugs, outpatient expenses for non-special diseases, medical expenses for observation rooms, rehabilitation medical expenses and drugs and related expenses that are not reimbursed according to the relevant provisions of Quanzhou's basic medical insurance for urban employees; (2) Expenses for tooth cleaning, tooth cleaning, dental implants, orthodontics, optometry and glasses, artificial limbs, hearing AIDS, beauty treatment, cosmetic and orthopedic surgery, qigong, massage, family sickbed, health care and special care, expenses for physical examination and non-medical personal services, expenses for escort, Chinese medicine decoction, transportation expenses, visits, consultations and other miscellaneous expenses during hospitalization; (3) the expenses incurred by family sickbed, bed hanging treatment or impostor hospitalization; (4) Medical expenses caused by illegal and criminal acts, injury to others, suicide, self-injury, fighting, drug abuse, drug rehabilitation, alcoholism, deliberate violation of regulations and other circumstances in violation of laws and regulations; Normal delivery and cesarean section that violate the national family planning policy without birth certificate will not be compensated; (5) Medical expenses that should be borne by a third party according to law, such as injuries caused by traffic accidents, medical accidents and industrial accidents; (6) Hospitalization medical 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; (8) Medical expenses incurred in the event of unexpected risks such as serious natural disasters or disease outbreaks; (9) The hospitalization expenses incurred by those who have participated in the basic medical insurance for urban workers and enjoyed free medical care and other social medical security within the validity period; (1) medical expenses that have not been reported for more than two months and have no special reasons; (11) Other expenses not compensated as determined by Jinjiang New Rural Cooperative Medical Management Committee. 5. Example of compensation: Suppose that the total hospitalization expenses of an adult participant (non-subsistence allowance and family planning object) are 3, yuan, and the expenses within the compensation scope of the new rural cooperative medical system are 2, yuan after deducting the non-reimbursable expenses, then after deducting the payment line, he can get 1,52 yuan for medical treatment in township hospitals or street community health service centers in Jinjiang, 1,15 yuan for medical treatment in municipal designated hospitals in Jinjiang, and only 48 yuan compensation for medical treatment in designated hospitals outside Jinjiang.

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