Sihai network

Is the reimbursement rate of NCMS high? Details of reimbursement proportion of new rural cooperative

In order to solve the problems of expensive and difficult to see a doctor in rural areas, the state has implemented the new rural cooperative medical system throughout the country. In the past two years, the payment fee of new rural cooperative medical system is also growing, which has risen to 220 yuan a year in 2018. In 2019, the payment of new rural cooperative medical system has also increased, so what is the reimbursement proportion of new rural cooperative medical system? Let's get to know!

1、 What is the reimbursement ratio standard of NCMS in 2019?

The reimbursement proportion standard of NCMS varies from region to region. The reimbursement proportion standard is as follows:

1. Outpatient reimbursement ratio standard

(1) The reimbursement rate of village clinics is 60%, and the drug fee limit for each visit is 10 yuan, while the drug fee limit for doctors' temporary rehydration prescription is 50 yuan.

(2) The reimbursement rate of the town health center is 40%. The limit of the examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 100 yuan.

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

(4) The reimbursement rate of tertiary hospitals is 20%. The limit of each examination and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

2. Hospitalization reimbursement ratio standard

(1) Hospitalization reimbursement scope

The first is the reimbursement limit of auxiliary examination including cardio cerebral electrogram, X-ray fluoroscopy, film making, laboratory test, physical therapy, acupuncture, CT, nuclear magnetic resonance and other examination expenses of 200 yuan; the second is the operation expenses (according to the national standard, if more than 1000 yuan, it will be reimbursed according to 1000 yuan). Third, the town health center for the elderly over 60 years old was hospitalized. The daily compensation for treatment and nursing expenses was 10 yuan, and the reimbursement limit was 200 yuan.

(2) Proportion of hospitalization reimbursement

The proportion of reimbursement in township hospitals is 60%, in secondary hospitals is 40%, and in tertiary hospitals is 30%.

3. Reimbursement ratio standard for serious illness

(1) For the inpatients who participate in the rural cooperative medical insurance, if the one-time or annual accumulative medical expenses exceed 5000 yuan, they will be compensated by stages. If the hospitalization expenses are 5001-10000 yuan, 65% of them will be compensated, and if the hospitalization expenses are 10001-18000 yuan, 70% of them will be compensated.

(2) The annual compensation limit for hospitalization and uremia outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy of town level cooperative medical system is 11000 yuan, which means that the maximum reimbursement limit of new rural cooperative medical system is 11000 yuan, and the higher expenses can only be borne by oneself.

The above reimbursement ratio standard is for reference only, and the detailed standard is based on the latest policy issued by the local government.

2、 The new rural cooperative medical system will not be reimbursed in these four cases!

1. Those who do not seek medical treatment in designated medical institutions of NCMS will not be reimbursed!

Nowadays, there are more and more medical institutions, and more and more choices to see a doctor. Farmers can only choose to see a doctor in the designated medical institutions of the new rural cooperative medical system. If they do not belong to the designated medical institutions of the new rural cooperative medical system, they can not claim reimbursement!

2. No reimbursement will be given if the patient is transferred to another hospital without approval!

When a farmer friend sees a doctor in a designated hospital, he or she may need to go to a hospital with better medical conditions for treatment, but he or she must go to the hospital first to go through the transfer procedures, because only with the approval of the current hospital transfer can he or she meet the reimbursement requirements of the new rural cooperative medical system, otherwise he or she will not be able to get reimbursement at that time!

3. If the reimbursement exceeds the time limit, it will not be reimbursed!

Farmers may think that as long as they see a doctor in the hospital, they can make reimbursement at any time. Because of busy farming, they don't have the first time to make reimbursement for medical expenses. When they think about it, they find that they have exceeded the time limit for reimbursement, which will lead to non reimbursement.

4. Special medical expenses will not be reimbursed

Special medical expenses refer to the expenses for orthopedics, plastic surgery, dental implant, prosthesis, organ transplantation, consultation and so on.

3、 What is the reimbursement scope of NCMS in 2019?

In 2019, the medical expenses, examination expenses, laboratory test expenses, operation expenses, treatment expenses, nursing expenses, etc. of the new rural cooperative medical system personnel who are hospitalized in the designated hospital due to illness during the overall planning period are in line with the reimbursement scope of medical insurance for urban employees (i.e. effective medical expenses).