How to Participate in Rural Cooperative Medical Care and How to Reimbursement Medical Expenses 5

The reimbursement procedure for rural cooperative medical care is:

1.Reimbursement procedures for medical treatment outside the county**.

When seeking medical treatment outside the county**, you can choose a public hospital** independently, and you need to prepare an invoice (original), a discharge summary, a certificate of illness, and a general list of hospitalization expenses when you are discharged, and the above vouchers must be stamped with the hospital seal. Pregnant women need to present a medical birth certificate, and the compensation recipient can go to the center for verification with the above materials and personal ID card, medical certificate, and household registration booklet for compensation. If you are not in good health or have difficulty moving, you can entrust someone else to handle it, but you must provide the patient's personal and wound cleaning imaging data (mobile phone video or **).

2.Procedures for hospitalization compensation in the prefecture.

The procedure for hospitalization compensation in the county is: independently choose the designated medical institution in the county to be hospitalized**, register with the cooperative medical reimbursement center of the hospital where you are staying within 24 hours of admission with the patient's ID card, medical certificate and household registration booklet, and be directly reimbursed when discharged.

3.If I don't register within 24 hours of hospitalization, can't I get reimbursed?

If you do not register within 24 hours, according to the regulations of the Municipal Health Bureau, the new rural cooperative medical insurance system, automatic locking, can not be registered and reimbursed, if you want to be reimbursed, the hospital must go through the relevant application approval procedures, the procedures and the process is more troublesome, and all the drug cost list must be re-entered, adding a lot of difficulties to the hospital, but in order for farmers to be compensated, there can still be a remedy, can be reimbursed, I hope that the masses can bring all the relevant documents to submit to the hospital when they see a doctor, In this way, we can reduce unnecessary troubles for both parties.

The policies implemented by provinces and municipalities across the country are inconsistent, so it is best to consult the local staff in detail.

As far as I know, there are generally the following reimbursement models.

Serious Illness Co-ordination + Chronic Disease Outpatient This refers to the reimbursement treatment for hospitalization and severe chronic diseases.

Serious Illness Co-ordination + Chronic Disease Outpatient + Small Outpatient Co-ordination This refers to the reimbursement of hospitalization and severe chronic diseases and small outpatient expenses.

Serious illness co-ordination + small outpatient (family account) This refers to hospitalization reimbursement, and the small outpatient expenses are paid by the cooperative medical funds you pay, and the proportion of payment varies from city to city, with individuals in some areas paying 10 yuan, and individuals in some areas paying up to 50 yuan.

It is best that the people in the county or city can choose freely, as long as they can be hospitalized in designated medical institutions, and then go through the referral procedures when they are hospitalized in the county or city.

Have you done it, and if so, the person who handled it should tell you what the procedure is.

Legal analysis: 1. Patients who have participated in the new rural cooperative medical insurance can directly swipe the card for reimbursement in the designated medical institutions of township-level general outpatient clinics in the district with their valid certificates and medical cards, and can be directly reimbursed by swiping the card when they are discharged from the hospital and after confirming their identity. 2. Insured patients who are hospitalized in public hospitals of level 2 or above outside the city shall, within 3 months after discharge, be reimbursed by the insured or their family members with the original invoice of medical expenses, the summary and detailed list of inpatient medical expenses, the discharge summary, outpatient medical records, medical cards, patient ID cards, household registration booklets, and the ID card of the person in charge to the NCMS window of the district administrative service center.

3. The reimbursement of outpatient services for special diseases can be submitted to the NCMS Industry Management Center with the cases issued by the designated medical institutions of level 2 and above, as well as relevant examinations, laboratory reports, certificates of medical institutions, etc., as well as the approval form for outpatient clinics of special diseases of new rural cooperative medical care. 4. Hospitalized patients who are injured due to accidents need to submit a certificate confirming the cause of the accidental injury with the signature and seal of the village (residence) where the household registration is located and the medical records of the hospital after being discharged. Those who cannot provide valid proof and records will not be accepted.

Once the NCMS has been investigated and audited, it will be reimbursed once it is true. If the liability is borne by a third party, no reimbursement will be made.

Legal basis: "Detailed Rules for the Implementation of the Social Insurance Law of the People's Republic of China" Article 8 The medical expenses incurred by the insured persons in the agreed medical institutions shall be paid from the basic medical insurance in accordance with the provisions of the State if they meet the standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities.

If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue purposes may be appropriately relaxed. The specific management measures for medical services for emergency and rescue of insured persons shall be formulated by the overall planning area according to the actual local situation.

Legal analysis: 60% reimbursement for visits to the village clinic and Changsong Fangfang Village Central Clinic, the limit of prescription drugs for each visit is 10 yuan, and the limit of prescription drugs for temporary rehydration by doctors in the health center is 50 yuan. The reimbursement of 40% for the treatment of the Nai Xian Town Health Center, the limit of examination fees and surgery fees for each visit is 50 yuan, and the limit of prescription drug fees is 100 yuan.

30% reimbursement for visits to secondary hospitals, 50 yuan for examination and surgery fees for each visit, and 200 yuan for prescription drugs.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2 The family of the brothers shall establish a social insurance system of basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, etc., to protect citizens' right to receive material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so on.

Article 23 Workers and workers shall participate in the basic medical insurance for employees, and the employer and the workers shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Legal analysis: bring the original ID card or social security card, the original certificate of disease diagnosis issued by the specialist doctor of the designated medical institution, the original medical information such as outpatient medical records, examinations, test results reports, etc., the original receipt of outpatient charges of the unified financial and taxation medical institutions, the detailed list of outpatient expenses printed by the hospital computer or the original payer prescribed by the doctor, the designated pharmacy: the original uniform invoice for the sale of tax commodities and the original computer-printed list, and the original ID card of the agent if it is handled on behalf of the agent.

Bring all the above information to the relevant departments of the local social security center to apply for processing, and after review, the information is complete and meets the conditions of trouser rolling, you can handle it immediately.

Legal basis: Social Insurance Law of the People's Republic of China

Article 27 Individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, the cumulative contributions reach the number of years prescribed by the State, and the basic medical insurance premiums shall not be paid after retirement, and the basic medical insurance benefits shall be enjoyed in accordance with the provisions of the State, and the total number of years of rent shall be paid for the specified number of years.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

How should rural cooperative health care be reimbursed. The reimbursement process of rural cooperative medical care is as follows: 1. The insured person can go to the designated medical institution to go through the reimbursement procedures; 2. After confirming the identity, you can directly swipe the card for reimbursement.

China's social insurance laws and regulations: in line with the basic Zenqiao jujube medical insurance drug catalog, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance **. The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

Legal basis, Article 28 of the Full Text of the Social Insurance Law of the People's Republic of China in accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service and sail facility standards, as well as emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance **. Article 29 of the full text of the Social Insurance Law of the People's Republic of China shall be paid by the basic medical insurance for the medical expenses of the insured persons, which shall be directly settled by the social insurance agency and the medical institutions and drug business units. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

1. Insured patients of the new rural cooperative medical care must present their medical card and valid ID card (household registration booklet if there is no ID card), and after confirming their identity, they can directly swipe the card for reimbursement in the designated medical institutions at the township level in the district, and be hospitalized in the designated medical institutions in the district and outside the district, and directly swipe the card for reimbursement when they are discharged from the hospital.

2. Insured patients who are hospitalized in the second and above public medical institutions outside the city** shall, within three months after discharge, be reimbursed by the insured or their family members at the New Rural Cooperative Medical Cooperative Window on the first floor of the District Administrative Service Center with the original invoice of medical expenses (the copy is invalid), the summary and detailed list of inpatient medical expenses, the discharge summary and outpatient medical records, the patient's ID card, medical card, household registration booklet, and the ID card of the handler.