What is the reimbursement ratio of NCMS for serious illnesses?

Reimbursement for serious illnesses: Compensation for town risk**: For inpatients who participate in cooperative medical care, the one-time or annual cumulative reportable medical expenses exceed 5,000 yuan, that is, 65% of 5,001-10,000 yuan and 70% of 10,001-18,000 yuan.

The annual compensation limit of town-level cooperative medical inpatient and uremia outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy is 10,000 yuan.

[Extended content].The reimbursement scope of the new rural cooperative medical care is: the part of the reimbursement scope (i.e., effective medical expenses) incurred by the participants in the designated hospital for diagnosis and treatment due to illness during the overall planning period, such as drug expenses, examination fees, laboratory fees, surgery fees, ** fees, nursing fees, etc., which meet the reimbursement scope of urban employees' medical insurance.

The new type of rural cooperative medical care** payment establishes a minimum payment standard and a maximum payment limit. Hospitalization expenses below the hospital's annual payment standard shall be paid by the individual.

If the minimum payment standard is reached during the same pooling period, the hospitalization expenses incurred by two or more hospitalizations can be reimbursed cumulatively. Hospitalization expenses exceeding the minimum payment standard shall be calculated in stages and reimbursed cumulatively, with a maximum limit for cumulative reimbursement per person per year.

Legal analysis: The minimum payment standard of NCMS critical illness insurance is 11,301 yuan, and the amount of eligible medical expenses exceeding 11,301 yuan is 0 yuan and 5,000 yuan, and the reimbursement ratio is 50%; 5,000 20,000 yuan, the reimbursement ratio is 60%; 20,000 50,000 yuan, the reimbursement ratio is 76%; For the part above 50,000 yuan, the reimbursement ratio is 91%.

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

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with law have the right to inquire about payment records and records of individual rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions for them.

Article 5: The people at or above the county level shall include social insurance undertakings in their national economic and social development plans.

The state raises social insurance funds through multiple channels. The people at or above the county level shall give necessary financial support to the social insurance undertakings.

The state supports social insurance through preferential tax policies.

What is the reimbursement rate for NCMS critical diseases?

Reimbursement ratio. If the medical expenses are less than 0-40,000 yuan, 85% will be reimbursed;

If the medical expenses are less than 4-80,000 yuan, 90% will be reimbursed;

If the cost of medical treatment is more than 8 yuan, 95% can be reimbursed.

The reimbursement ratio of NCMS for critical diseases will vary according to the level of the hospital. The reimbursement method is for medical expenses that exceed the maximum payment limit for basic medical care, and the reimbursement ratio will vary depending on the scope of medical expenses.

Reimbursement ratios for different medical institutions.

The proportion of outpatient co-ordinated township and village subsidies was increased to %;

The hospitalization fee of a first-level medical institution is less than 400 yuan, and there is no threshold standard;

NCMS is divided into four types: general outpatient reimbursement, serious illness hospitalization reimbursement, serious illness assistance reimbursement and chronic disease outpatient reimbursement.

The reimbursement ratio of hospitalization for serious illnesses is divided into the level of designated medical institutions, and the higher the level, the lower the reimbursement ratio. Generally, it is divided into four levels: township level, county level, city, provincial level and outside the province, the general township level starting line is 100 200 yuan, the reimbursement ratio is 80 90%, the county starting line is 300 700 yuan, the reimbursement ratio is 70 80%, the municipal starting line is 500 2000 yuan, the reimbursement ratio is 60 70%, the provincial and provincial starting line is 800 3000 yuan, the reimbursement ratio is 50 60%, the ceiling line is about 150,000, and the total medical expenses are more than 60,000 or 80,000 yuan in some areas, and the reimbursement ratio is increased accordingly.

The reimbursement model for serious illness assistance is based on some clear diagnosis and treatment paths, unified surgical models, high medical costs, high morbidity, and diseases with a large burden on the family as a reimbursement model for serious illness assistance, and the reimbursement model for serious illness assistance has limited price requirements for hospitals, which are not generally limited by the starting line, reimbursement ratio and ceiling line, and are directly reimbursed according to the percentage of total medical expenses, such as children under 14 years old suffering from congenital heart disease and leukemia, 90% of the total direct medical expenses will be reimbursed, of which 20% will be borne by the civil affairs department.

The reimbursement ratio for serious illness assistance is as follows:

1. The urban and rural subsistence allowance recipients, the injured people who are injured in the righteous cherry orange bravery, are hospitalized due to illness (injury), and after being reimbursed by the New Rural Cooperative Medical System, resident medical insurance and serious illness insurance, they will be given assistance in accordance with the proportion of 60%, and the maximum ceiling line for a rescue is 20,000 yuan;

2. The key preferential care objects (excluding 1 6 level disabled soldiers, 7 10 grade old injured ** disabled soldiers) who are hospitalized due to illness will be given a maximum of 20,000 yuan per person per year after being reimbursed by the special assistance of the New Rural Cooperative Medical System, resident medical insurance, serious illness insurance and Youyun filial piety care department;

3. Hospitalization of low-income families and families with serious illnesses who are hospitalized due to illness will be given assistance in accordance with the proportion of 20% after being reimbursed by the New Rural Cooperative Medical System, resident medical insurance and serious illness insurance, and the maximum ceiling line for one-time assistance is 10,000 yuan.

4. After the amount of hospitalization assistance for urban and rural subsistence allowance recipients reaches the upper limit, the out-of-pocket expenses shall start at 10,000 yuan, and the part above 10,000 yuan shall be provided with secondary assistance according to the proportion of 30%, and each person shall not exceed 40,000 yuan per year; After the amount of hospitalization assistance for other aid recipients reaches the upper limit, the out-of-pocket expenses shall start at 10,000 yuan, and the part above 10,000 yuan shall be assisted for the second time according to the proportion of 20%, and each person shall not exceed 20,000 yuan per year.