As we all know, in 2018, the payment of new rural medical care rose from 150 yuan in 2017 to 180 yuan, and this year to 220 yuan. Many farmers began to complain about the annual price increase of new rural cooperative medical care. So how much can the new rural cooperative medical system be reimbursed? What is the insurance ratio?
Reimbursement proportion of NCMS in 2019:
Outpatient compensation
The reimbursement of the village clinics and the village center clinics is 60%. The prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration of doctors in the health center is 50 yuan.
The town health center reimbursement 40%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 100 yuan.
The reimbursement of the second level hospital is 30%, and the limit of the examination fee and operation fee for each visit is 50 yuan, and the limit of the prescription drug fee is 200 yuan.
The reimbursement of the third level hospital is 20%, the limit of the examination fee and operation fee for each visit is 50 yuan, and the limit of the prescription drug fee is 200 yuan.
The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan per paste.
The annual compensation limit of Township cooperative medical clinic is 5000 yuan.
Hospitalization compensation
1. Reimbursement scope:
A. Medical expenses: auxiliary examination: the limit of examination expenses for ECG, X-ray fluoroscopy, film making, laboratory test, physical therapy, acupuncture, CT, MRI, etc. is 200 yuan; operation expenses (refer to the national standard, those exceeding 1000 yuan will be reimbursed according to 1000 yuan).
B. The elderly over 60 years old are hospitalized in the town health center, and the compensation for treatment and nursing expenses is 10 yuan per day, with a limit of 200 yuan.
2. Reimbursement ratio:
The reimbursement rate is 60% in township hospitals, 40% in secondary hospitals and 30% in tertiary hospitals.
Compensation for serious illness
Town risk fund compensation: for inpatients who participate in cooperative medical system, the one-time or annual accumulative medical expenses should be more than 5000 yuan, namely, the compensation of 5001-10000 yuan is 65%, 10001-18000 yuan is 70%, and the annual limit of compensation for inpatients and uremic outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy of town level cooperative medical system is 11000 yuan.
What are not covered by reimbursement
Self medical treatment (no designated hospital or referral form), self purchased drugs, drugs that cannot be reimbursed according to public medical regulations and medical expenses that do not conform to family planning;
Outpatient treatment expenses, visiting expenses, hospitalization expenses, food expenses, accompanying expenses, nutrition expenses, blood transfusion expenses (except those with family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating expenses, ambulance expenses, special care expenses and other expenses;
Medical expenses for traffic accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
Orthopedics, plastic surgery, dental implant, prosthesis, organ transplantation, name calling operation, consultation, etc;
Within the scope of reimbursement and beyond the limit.
Two accidents can't be predicted
If a person is seriously ill or disabled, there are three expenses that he must face: treatment fee, rehabilitation fee and income loss fee.
We have social security and medical insurance for treatment expenses, but what about rehabilitation expenses and income loss expenses? For example, you can earn 300000 yuan a year. Unfortunately, if you are sick or have an accident, you need to rest at home for five years. Have you calculated your income loss in these five years?
This is why we must buy commercial insurance, because commercial major illness insurance is to make up for the loss of income.
Because commercial critical illness insurance has the function of prepayment, with the diagnosis of the hospital and the submission of claim materials, the insurance company will pay hundreds of thousands or millions of claims in advance, which will help us spend 5 years or even 10 years safely.