What is covered by rural cooperative medical insurance reimbursement?

The new rural cooperative medical insurance is a farmer medical mutual aid system organized, guided and supported by the government, with voluntary participation by farmers and multi-party funding from individuals, collectives and the government, focusing on major illness pooling. Its reimbursement scope roughly includes three parts: outpatient compensation, inpatient compensation and major illness compensation. Now let us take a look at exactly what the rural cooperative medical insurance reimbursement scope covers!

Rural cooperative medical insurance outpatient reimbursement

1. Visits to village clinics and village central clinics are reimbursed at 60%, with a limit of 10 yuan per visit for prescription drug costs, and a limit of 50 yuan for prescription drug costs for temporary fluid replacement by health center doctors.

2. Visits to township health centers are reimbursed at 40%, with a limit of 50 yuan per visit for various examination fees and surgery fees, and a limit of 100 yuan for prescription drug costs.

3. Visits to secondary hospitals are reimbursed at 30%, with a limit of 50 yuan per visit for various examination fees and surgery fees, and a limit of 200 yuan for prescription drug costs.

4. Visits to tertiary hospitals are reimbursed at 20%, with a limit of 50 yuan per visit for various examination fees and surgery fees, and a limit of 200 yuan for prescription drug costs.

Note: For traditional Chinese medicine invoices with prescriptions attached, the limit is 1 yuan per packet, and the annual limit for township-level cooperative medical outpatient compensation is 5,000 yuan.

Rural cooperative medical insurance inpatient reimbursement

1. Reimbursement scope

① Drug costs: auxiliary examinations: examination fees for electrocardiogram and electroencephalogram, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT, MRI and other items, with a limit of 200 yuan.

② Surgery fees (refer to national standards; amounts over 1,000 yuan are reimbursed at 1,000 yuan).

③ For elderly people aged 60 and above hospitalized in township health centers, treatment fees and nursing fees are compensated at 10 yuan per day, with a limit of 200 yuan.

2. Reimbursement ratio: township health centers reimburse 60%, secondary hospitals reimburse 40%, tertiary hospitals reimburse 30%.

Rural cooperative medical insurance major illness reimbursement

1. For hospitalized patients participating in cooperative medical insurance, if the reimbursable medical costs in a single instance or cumulative over the year exceed 5,000 yuan, compensation is provided in tiers, namely 65% compensation for 5,001 to 10,000 yuan and 70% compensation for 10,001 to 18,000 yuan.

2. The annual limit for township-level cooperative medical inpatient reimbursement as well as outpatient hemodialysis for uremia and outpatient radiotherapy and chemotherapy for tumors is 11,000 yuan.

3. Special diseases reimbursed and paid by the new rural cooperative medical fund include chemotherapy and radiotherapy for malignant tumors, hemodialysis and peritoneal dialysis for severe uremia, anti-rejection treatment after tissue or organ transplantation, schizophrenia with mental deterioration, systemic lupus erythematosus (with one of the complications involving the heart, lungs, kidneys, liver or nervous system), aplastic anemia, and anticoagulation therapy after heart surgery. Other reimbursable special diseases shall be subject to the specific local policies.

4. Specific outpatient treatment for special diseases includes necessary supportive therapy during treatment and symptomatic management of systemic and local reactions; general auxiliary treatment is generally not included in the reimbursement scope.