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Detailed Rules for the Implementation of the New Rural Cooperative Medical System in Shunyi District
www . bjshy . gov . cn/zhuan txx/hzyl/zhenge/2008 12/2 15 15 . html

You can refer to the website above.

In addition, there have been some changes in 2009. If children are given cooperative medical care, both parents must be agricultural registered permanent residence. In 2009, each participant paid 60 yuan. You can pay in your village committee or community. The individual contributions of the minimum living security object and the special care personnel shall be paid by the district finance.

Medical reimbursement includes general outpatient reimbursement and hospitalization reimbursement. General outpatient reimbursement funds are used to reimburse the medical expenses of the insured in the designated medical institutions; The hospitalization reimbursement funds are used to reimburse the medical expenses of the participants for hospitalization and outpatient treatment of special diseases.

Special disease clinic refers to anti-rejection drugs, aplastic anemia and hemophilia after radiotherapy and chemotherapy, renal dialysis and liver and kidney transplantation for children with malignant tumors.

The reimbursement of medical expenses is carried out in different levels of hospitals, and the reimbursement ratio is different.

The insured person's medical expenses for hospitalization or special disease treatment in the guarantee year are calculated cumulatively, and the approved expenses are paid cumulatively in sections.

The reimbursement of medical expenses for participating students and children shall be implemented in accordance with the relevant provisions of the Notice of Beijing Municipal Health Bureau on Adjusting the Compensation Policy for Rural Students and Children in 2008 (J.W.N.Zi [2008] No.2) and the Opinions of Beijing Municipal Health Bureau on Promoting the Overall Compensation of the New Rural Cooperative Medical System in 2009 (J.W.N.Zi [2008] No.21).

(4) reimbursement standards.

1. The general outpatient department approved medical expenses, and the first-class hospital reimbursed 50%, the second-and third-class hospitals reimbursed 35%, and the district Chinese medicine hospital reimbursed 40%. The actual reported funds were capped at 2,500 yuan.

2, hospitalization and special disease outpatient medical expenses reimbursement for examination and approval, the first and second level hospitals 0 deductible, tertiary hospitals deductible 1000 yuan. The upper limit of actual reported funds is 6,543,800 yuan+0.8 million yuan.

Designated secondary medical institutions for hospitalization and special disease outpatient medical expenses approved for reimbursement of 0 to 20 thousand yuan, reimbursement of 65%; 20 thousand yuan to 50 thousand yuan, 70% reimbursement; More than 50,000 yuan, 75% reimbursement.

3, in the designated level of medical institutions hospitalization and special disease outpatient treatment, the medical expenses reimbursement of 70%.

4. The reimbursement rate of hospitalization and special disease outpatient medical expenses in designated tertiary medical institutions is lower than that in designated secondary medical institutions by 10 percentage point.

5. If the patient is transferred to hospital for treatment after emergency observation, the observation expenses within seven days before hospitalization shall be reimbursed together with the hospitalization expenses.

6. If a patient dies during emergency observation, the observation expenses within seven days before his death shall be reimbursed according to the hospitalization expenses.

7. agricultural registered permanent residence students and preschool children who did not participate in the medical insurance for serious illness of students and children in Beijing were approved to reimburse medical expenses for their hospitalization and special disease clinics. The deductible line of the first-and second-level hospitals was 0, and the deductible line of the third-level hospitals was 650 yuan, and 70% of them were reimbursed above the deductible line.

8. For those who have been insured continuously since 2004 and have not been reimbursed for hospitalization and special disease outpatient medical expenses before 2009, the reimbursement ratio of hospitalization and special disease outpatient medical expenses in 2009 will be increased by 5 percentage points respectively.

(5) reimbursement voucher.

1. For reimbursement of general outpatient medical expenses, special receipts, outpatient prescriptions and expense lists of Beijing outpatient fees shall be provided.

2. Hospitalization reimbursement needs to provide special receipts for hospitalization expenses in Beijing, project details, expense list and diagnosis certificate; For reimbursement of outpatient medical expenses for special diseases, special receipts for outpatient fees in Beijing, outpatient prescriptions, expense lists and corresponding diagnosis certificates must be provided.

3, designated tertiary comprehensive medical institutions hospitalization and special disease outpatient medical expenses reimbursement, must also provide the designated secondary medical institutions issued by the referral, transfer certificate.

4 to participate in the reimbursement of medical expenses of commercial medical insurance personnel, in addition to providing a copy of the above reimbursement voucher, it is also necessary to provide a claim split form issued by the insurance company.

5. All other participants are required to provide original vouchers of medical expenses that have not been reduced or exempted by other medical insurance.

(six) expenses not included in the scope of reimbursement:

The cost of medical treatment in non-designated medical institutions;

Failing to perform the transfer procedures and jumping to the designated tertiary comprehensive medical institution for medical treatment;

Treatment expenses for suicide, self-mutilation and alcoholism;

Expenses for infertility, pregnancy test, delivery and family planning operation.

Expenses incurred in animal injury, vaccination, physical examination, beauty and plastic surgery;

Medical expenses incurred due to fighting, fighting, drug abuse and other illegal acts;

Medical expenses for traffic accidents, industrial accidents, medical accidents and other liability accidents;

Treatment expenses for statutory occupational diseases;

Treatment expenses in foreign countries, Hong Kong, Macao and Taiwan;

Other medical expenses that should be paid by individuals according to the relevant provisions of the state and this Municipality.

Seven, free of "four fees" range.

Participants in the new rural cooperative medical system are exempted from registration fees, medical treatment fees, home visits and puncture fees (injection and infusion) at community health service stations.

VIII. Reimbursement at the end of the year

The time for submitting the reimbursement form of the current year is as of June 65438+ 10/0 of the following year. 65438+February 3 1 day can not be discharged from the hospital, the inpatient medical institution shall issue this year's settlement list. If it is not submitted within the time limit, it will be deemed as an automatic waiver of reimbursement eligibility.