Answer: Participants will go to designated medical institutions (municipal hospitals, state hospitals, township hospitals) with cooperative medical certificate, ID card or household registration book (village clinics can only provide outpatient treatment).
2. Can the individual account of the Cooperative Medical Certificate held by the participating farmers be used for hospitalization expenses?
Answer: It can be used to pay the individual self-paid part of hospitalization expenses within the Qifubiaozhun.
Three, the participating farmers in our hospital outpatient treatment, according to the provisions of whether there is special care?
Answer: According to the document No.53 of Xingfutong [2006], there is no deductible line for outpatient service, and the top line is the total amount of family account Fund. After the family account Fund is used up, the outpatient expenses incurred by the participants due to illness shall be paid by myself. Therefore, outpatient treatment, city and state hospitals have no special care.
4. What is the deductible for hospitalization of participating farmers, and what is the reimbursement ratio? What is the maximum amount of each reimbursement?
Answer: All expenses below the hospitalization deductible are paid by the patients themselves, and expenses above the deductible are reimbursed in proportion.
Pay line standard:
1, township health centers: every hospitalization in 30 yuan;
2. Municipal hospitals: each hospitalization 100 yuan;
3. State hospital: each hospitalization 100 yuan;
4. Referral to provincial-level designated hospitals: hospitalization in 500 yuan every time;
5. Referral from public hospitals outside the province: each hospitalization 1000 yuan;
Reimbursement ratio:
1, township hospitals: 50%;
2. Municipal hospitals: 40%;
3. National hospitals: 40%;
4. Referral to provincial hospitals: 30%;
5. Referral from public hospitals outside the province: 30%.
Top line of each reimbursement;
1, township hospitals: 3,000 yuan;
2. Municipal hospitals: 20,000 yuan;
3. State hospital: 20,000 yuan;
4. Referral to a provincial-level designated hospital: 25,000 yuan;
5. Referral from public hospitals outside the province: 25,000 yuan.
5. What is the reimbursement rate of hospitalization expenses incurred by the insured in this city due to illness in public hospitals during their employment outside the province? Reimbursement procedures?
Answer: Within 100 yuan (including 100 yuan), the portion above 100 yuan will be reimbursed by 20% after examination, and the reimbursement will be capped at 3,000 yuan each time, with prescription, medical record copy, hospitalization invoice, discharge certificate and temporary residence permit.
6. How much is the reimbursement for pregnant women's hospital delivery?
A: Participants must give birth in the hospital with relevant certification materials issued by the population and family planning department.
1, each case of natural childbirth in township (street) hospitals shall be reimbursed to 200 yuan;
2, city, state-level designated medical institutions for each case of natural childbirth reimbursement 250 yuan;
3, township (street) health centers for each case of cesarean section reimbursement 400 yuan;
4, city, state-level designated medical institutions for each case of cesarean section reimbursement 600 yuan.
7. What expenses incurred by the participants during the medical treatment are not included in the reimbursement scope?
A: The following expenses are not included in the reimbursement scope:
1, medical expenses for medical treatment behaviors that do not meet the requirements of the new rural cooperative medical system, such as not seeking medical treatment in designated medical prevention and health care institutions or transferring to other hospitals without approval;
2, not included in the "Xingyi new rural cooperative medical care project" medical expenses;
3, not included in the "Xingyi new rural cooperative medical drug list" of medical expenses;
4, fighting, intentional suicide, self-mutilation, alcoholism, drug abuse, illegal crime, unproductive pesticide poisoning and other human factors caused personal injury medical expenses;
5. Medical expenses caused by traffic accidents, personal injury accidents in production safety, natural disasters, personal injury accidents, medical accidents and other injuries;
6. Various cosmetic, plastic and dental expenses; Expenses for assembling artificial eyes, artificial limbs, wigs, dentures, glasses, hearing AIDS and other health care AIDS;
7, induced abortion, intrauterine device, infertility (pregnancy) and sexual dysfunction treatment and other medical expenses;
8, medical travel expenses, ambulance fees, out-of-hospital consultation fees, medical staff visits and travel expenses, roll call surgery surcharge and other expenses;
9. During hospitalization, escort bed fee, nursing fee, high quality and good price service fee, safety insurance fee for surgical patients and other expenses; Medical expenses for sexually transmitted diseases, AIDS and mental illness; Expenses of various preventive and health care drugs;
10, the medical expenses of corresponding diseases caused by not receiving planned immunization;
1 1, medical expenses for fraudulent acts such as false hospitalization or false hospitalization;
12. Expenses of "other" items in the medical report.
8. Can farmers from other places seek medical treatment in our hospital?
Answer: Yes, when the patient leaves the hospital, he will bring the medical record summary, hospitalization bill and detailed list of medical treatment to the local agricultural cooperative management station (bureau) for reimbursement.
9. What should I do if the participating farmers are dissatisfied with our service attitude, service quality, business technology and fees?
Answer: You can report to the Agricultural Cooperative Management Office of our college (tel: 32970 13) or the Financial Supervision Office (tel: 3297080), or to Xingyi Agricultural Cooperative Bureau (tel: 3235 120).
X. what should I do if there is a dispute in the implementation?
A: Please explain it to Xingyi Agricultural Cooperative Bureau.