First, rural medical insurance reimbursement.

1, outpatient compensation:

(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.

(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.

(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.

(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.

2, hospitalization compensation

(1) Reimbursement scope:

A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are 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.

(2) Reimbursement ratio:

60% reimbursement for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

The following are not included in the scope of reimbursement of rural cooperative medical insurance:

1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;

2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;

4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;

5, within the scope of reimbursement, beyond the limit.

Second, urban medical insurance reimbursement

The reimbursement scope of urban medical insurance refers to all employers in cities and towns, as shown in the following figure:

1, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). );

2, organs, institutions, social organizations, private non enterprise units and their employees, to participate in the basic medical insurance;

3. Some towns and villages stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually incorporated into the basic medical insurance coverage (the last one depends on different local policies), so that they can enjoy medical reimbursement.

Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, with large project scale and coverage, but limited compensation for major diseases or accidents. At this point, the author suggests that the insured can purchase commercial supplementary medical insurance and social security to reduce their economic losses.

Extended data:

Employee medical insurance reimbursement

First, the basic insurance does not pay the cost of the scope of medical treatment projects.

(1) service items

1, registration fee, out-of-hospital consultation fee, medical record fee, etc.

2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.

(2) Non-disease treatment projects

1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;

2. Various weight loss, weight gain and height increase projects;

3. Various health checks;

4, all kinds of prevention and health care projects; Registration fee, out-of-hospital consultation fee, medical record fee, etc. ;

(3) Diagnostic equipment and medical materials.

1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;

2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;

3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.

(4) Treatment items

1, the organ source or tissue source of various organ transplants or tissue transplants;

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;

3. Orthopedic surgery for myopia;

4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.

(5) Others

1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;

2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;

References:

Baidu encyclopedia-medical insurance reimbursement scope