The standard of hospitalization reimbursement is related to the hospital level where the insured person lives.

outside the province: minimum payment standard: 1511 yuan, reimbursement ratio: 51% for 1511-7111 yuan, and 68% for more than 7111 yuan.

township level: township hospitals (community medical institutions): minimum payment standard: 211 yuan, reimbursement ratio: 211-71% in 811 yuan; 91% above 811 yuan.

county level: level ii or a hospital below a certain scale (including level ii): qifubiaozhun: 411 yuan, reimbursement ratio: 63% for 411-1,511 yuan, and 83% for more than 1,511 yuan.

municipal level: level ii or hospitals below a certain scale (including level ii): minimum payment standard: 511 yuan, and reimbursement ratio: 511-3,111 yuan, 55%, and over 3,111 yuan, 75%.

tertiary hospital: qifubiaozhun: 911 yuan; Reimbursement ratio: 53% for 911-4,111 yuan, and 72% for more than 4,111 yuan.

Provincial level: level II or hospitals below a certain scale (including level II): Qifubiaozhun: 611 yuan, reimbursement ratio: 53% for 611-4,111 yuan, and 72% for more than 4,111 yuan.

provincial level: tertiary hospital: minimum threshold: 1511 yuan, reimbursement ratio: 51% for 1511-7111 yuan, and 68% for more than 7111 yuan.

reimbursement of rural cooperative medical insurance can be made with reference to the following procedures. The details are as follows:

1. The insured patients of the new rural cooperative medical system can submit their reimbursement directly by swiping their ID cards and medical insurance cards at the designated medical institutions of township-level general outpatient clinics in the region, staying in the designated medical institutions in the region and outside the region, and directly swiping their reimbursement at the time of discharge and checkout.

2. Insured patients who are hospitalized in public medical institutions outside the city at or above the second level should, three months after discharge, directly submit the original medical invoice, detailed list of hospitalization medical expenses, discharge summary, medical card, household registration book, outpatient medical records and ID card of the agent to the new rural cooperative medical system window for reimbursement of medical expenses.

3. Outpatient reimbursement for special diseases. Insured patients can apply to the New Rural Cooperative Medical Management Center with medical records and related inspection reports issued by designated medical institutions at or above the second level and the Approval Form for Outpatient Treatment for Special Diseases of New Rural Cooperative Medical System. After examination and approval, their outpatient medical expenses can be included in the reimbursement scope of the New Rural Cooperative Medical System.

4. If you are hospitalized due to accidental injury, you can only submit the proof of the cause of accidental injury and the medical record of the hospital after discharge. Those who cannot provide valid proof and record will not be accepted. After the information of the insured patients is adjusted, it will be completed within 31 working days after the acceptance of the new rural cooperative medical system window. However, it needs to be investigated and audited by the inspectors of the new rural cooperative medical system management center before it can be reimbursed.

Extended information:

Out-patient compensation

The village clinics and village center clinics are reimbursed 61%, and the prescription drug fee for each visit is limited to RMB 11. The prescription drug fee for temporary rehydration of doctors in health centers is limited to 51 yuan.

41% reimbursement for medical treatment in the town health center. The examination fee and operation fee for each visit are limited to 51 yuan, and the prescription fee is limited to RMB 111.

31% reimbursement will be made for medical treatment in secondary hospitals. The limit of examination fees and operation fees for each visit is 51 yuan, and the limit of prescription drug fees is 211 yuan.

tertiary hospitals will be reimbursed 21%, and the examination fees and operation fees for each visit will be limited to 51 yuan, and the prescription drug fees will be limited to 211 yuan.

The invoice of traditional Chinese medicine is attached with a prescription with a limit of 1 yuan per paste.

the annual compensation limit of town-level cooperative medical outpatient service is 5,111 yuan.

Hospitalization compensation

Reimbursement scope:

a. Medicine expenses: auxiliary examination expenses: ECG, X-ray fluoroscopy, filming, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic resonance, etc., limited to 211 yuan; Surgical expenses (refer to national standards, those exceeding RMB 1,111 will be reimbursed according to RMB 1,111).

B, the elderly over 61 years old are hospitalized in the town health center, and the treatment and nursing expenses are compensated by 11 yuan per day, with the limit of 211 yuan.

reimbursement ratio: 61% for town hospitals; 41% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 31%.

compensation for serious illness

compensation from the town's risk fund: all inpatients who participate in the cooperative medical system should report medical expenses of more than 5,111 yuan at one time or for the whole year, which means 65% compensation for 5,111-11,111 yuan and 71% compensation for 11,111-18,111 yuan.

The annual compensation limit for hospitalization and uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy in town-level cooperative medical system is RMB 1.1111.

The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis of severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental decline; Systemic lupus erythematosus (one of complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery. The rest of the special diseases that can be reimbursed shall be subject to local specific policies.

Specific outpatient treatment for special diseases includes necessary supportive therapy and symptomatic treatment of systemic and local reactions during treatment, while general adjuvant therapy is not included in the reimbursement scope.

Reference: Baidu Encyclopedia-Proportion of medical reimbursement