Scope of reimbursement of rural medical insurance in Anhui Province
1, outpatient compensation:
(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.
(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.
(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.
(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.
(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.
2, hospitalization compensation
(1) Reimbursement scope:
A. Drug expenses: auxiliary examination: the examination expenses of electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Compensation for serious illness
(1) town risk fund compensation: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or throughout the year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan will be compensated by 65%,10001-.
(2) The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system inpatient and uremia clinic is1.65,438+0.000 yuan.
Questions and Answers on Rural Medical Insurance in Anhui Province
Q: My parents now live in rural Anhui and have joined the new rural insurance system. Is there an upper limit on the reimbursement amount of this insurance? What's the maximum you can quote? In addition, I want to buy them another critical illness medical insurance now. Will this insurance reimbursement conflict in the future?
Can the reimbursement rate reach 50% when you see a doctor in a hospital in this province? Besides, there is only one medical bill. If I have rural medical insurance, is there any way to apply for serious illness medical insurance from the insurance company?
A: The maximum annual cap of the new rural cooperative medical system is 40,000 yuan. Except the deductible, the reimbursement rate is 80% in township hospitals, followed by 60% in counties, and 45% at municipal and provincial levels, which does not conflict with other commercial insurance. Please keep copies of all materials, and ask the new rural cooperative medical office that received your materials to affix its official seal to reimburse commercial insurance.
Warm Tips for Rural Medical Insurance in Anhui Province
Compared with 2007 when the system was started, the new version of Anhui Province's Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance released on 20 10 contains 2,422 kinds of drugs of Class A and Class B, which is more than 300 kinds more than the previous version. At the same time, the scope of medical insurance fund payment has gradually expanded, and the scope of prescribed diseases for serious and chronic diseases in outpatient clinics has been increasing.
In addition, by doing a good job in the transfer and connection of medical insurance relations and medical settlement services in different places, our province focuses on solving the transfer and connection of rural medical insurance relations in Anhui Province, which flows between urban and rural areas, and realizes the smooth transfer and connection of medical insurance relations between different systems and different regions. Through the cooperation with the medical insurance management and handling services in the "Yangtze River Delta" region, we will constantly improve the settlement method of medical treatment in different places, so that the insured in our province can better enjoy the medical insurance treatment in different places.
2065438 In 2006, Hefei continued to implement the basic medical insurance system for urban residents, a livelihood project, and improved the medical insurance reimbursement treatment. In order to help insured residents further understand the residents' medical insurance policy, master the relevant procedures such as enrollment, medical treatment and reimbursement, and better enjoy the government's policy of benefiting the people, Hefei Human Resources and Social Security Bureau recently announced the 20 16-20 16 annual residents' medical insurance treatment and reimbursement policy.
Treatment of the insured
During this year 10 to September 30th of the following year, the insured can enjoy the following benefits with medical insurance card, social security card and ID card (the insured below 18 can use the household registration book, hereinafter referred to as "valid certificate"):
① hospitalization reimbursement treatment; ② Outpatient treatment of special diseases; ③ General outpatient treatment; (4) maternity allowance; ⑤ Subsidies for disabled people to assemble assistive devices.
● 1. hospitalization reimbursement treatment
Hospitalization in a first-class hospital:
The expenses within the scope of medical insurance exceed 90% of 200 yuan (Qifubiaozhun);
Hospitalization in secondary hospitals:
The expenses within the scope of medical insurance exceed 80% of 400 yuan (Qifubiaozhun);
Hospitalized in a tertiary hospital:
The expenses within the scope of medical insurance exceed 70% of 600 yuan (Qifubiaozhun);
Hospitalization in different places (transfer and emergency treatment in different places):
Within the scope of medical insurance, expenses exceeding 600 yuan (Qifubiaozhun) will be reimbursed by 50%.
The hospitalization Qifubiaozhun and fund payment ratio are shown in the following table:
The proportion of qifubiaozhun (qifubiaozhun fee) in medical institutions for ordinary residents is +08 (reimbursement ratio) from qifubiaozhun fund for students, children and residents under 65.
Tertiary hospital 60030070%
Secondary hospital 40020080%
Level I hospital 200 10090%
See a doctor in a different place 60030050%
1. In a settlement year, the maximum payment limit of the accumulated fund for hospitalization, outpatient special diseases and general outpatient service of insured residents is 1.6 million yuan.
2, the use of class B drugs and treatment projects, individuals need to pay a certain fee.
2. Outpatient treatment of special diseases
The insured suffers from coronary heart disease, hypertension III, diabetes, psychosis, liver cirrhosis, malignant tumor, renal dialysis, kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia, hemophilia, breast cancer (endocrine therapy), hepatolenticular degeneration, chronic heart failure, chronic renal insufficiency, hyperthyroidism, epilepsy, hepatitis C, prostate cancer (endocrine therapy), etc. Twenty-seven diseases, such as liver transplantation, hematopoietic stem cell transplantation, rehabilitation treatment, chronic hepatitis B (antiviral treatment) and cerebral palsy, can enjoy 60% to 80% reimbursement below the monthly limit after application confirmation.
●3. General outpatient treatment
Insured residents in the community health service center within the scope of the policy of outpatient medical expenses, the overall fund to pay 50% (in other residents designated hospitals do not enjoy this treatment). The maximum reimbursement limit for a single medical expense is 40 yuan. The maximum reimbursement limit within one year is 160 yuan, among which the maximum reimbursement limit for insured residents over 60 years old for males and over 55 years old for females is 240 yuan. There is no disease limitation for reimbursement of general outpatient service, and medical expenses are settled directly in community health service center.
●4. Maternity allowance
In line with the family planning policy, the insured residents give birth naturally (including midwifery) in 600 yuan, and the cesarean section allowance 1200 yuan.
●5. Provide subsidies for the insured disabled to assemble assistive devices.
For insured residents with disability certificates and hearing-impaired children under the age of 7, subsidies will be given to the assembly of lower limb prostheses and hearing AIDS in the designated institutions for the assembly of assistive devices for the disabled in our city. Ordinary thigh prosthesis is subsidized by 2000 yuan every five years, calf prosthesis 1 000 yuan, and hearing aid for children under 7 years old is subsidized by 2400 yuan. (Tel: 63536433)
Description of reimbursement processing
● 1. Local hospitalization
Insured persons should seek medical treatment in designated medical institutions, handle medical insurance hospitalization procedures in the hospital with valid certificates, and directly reimburse and settle medical expenses incurred when discharged. If you don't go to a designated hospital for medical treatment or go through medical insurance hospitalization procedures in the hospital, the medical expenses incurred will not be reimbursed.
2. Application form for outpatient treatment of special diseases.
The insured person shall fill in the Application Form for Special Disease Outpatient of Hefei Urban Residents' Basic Medical Insurance (which can be downloaded from the download center), and submit the recent relevant medical records and physical examination reports to the special disease appraisal office of Hefei Medical Insurance Center, which will organize medical insurance experts to conduct appraisal, issue qualified outpatient special disease treatment cards, and enjoy special disease outpatient treatment with the cards. Organize an appraisal every three months. (Application address: No.360 Jinzhai Road, Hefei, the third floor of the former Labor and Social Security Bureau, Tel: 626 13036)
●3. Go through the formalities of medical treatment in different places.
Insured persons suffering from diseases that are difficult to be diagnosed or have no treatment in tertiary hospitals (including specialized hospitals) in this Municipality may apply for hospitalization in different places. Transfer from different places must fill in the Application Form for Transfer from Different Places, which will be transferred to different places for treatment after being signed by the designated hospitals above Grade III in our city and reported to the municipal medical insurance agency for examination and filing.
The insured in different places sudden illness, hospitalization is really necessary, should be hospitalized in the local designated medical institutions, within 3 days after admission to the municipal medical insurance center for the record. (Record Tel: 63536433)
The medical expenses for transfer and emergency treatment in different places shall be paid by individuals in advance. Within one month after discharge, bring the transfer approval form, detailed list of hospitalization expenses, invoice documents, discharge summary and valid documents to the municipal medical insurance center for reimbursement and settlement. (Address: 3rd Floor, Hefei Social Security Service Center, No.88 Government Affairs Ring Road, Tel: 63536433)
●4. Maternity allowance.
Within one month after birth, report to the municipal medical insurance management center with valid documents, birth certificate, baby birth certificate, medical invoice, detailed list of expenses and discharge summary. (Address: 3rd Floor, Hefei Social Security Service Center, No.88 Government Affairs Ring Road, Tel: 635363 18)
5. Reimbursement of neonatal congenital diseases
If the newborn suffers from congenital diseases such as congenital heart disease and goes through the insurance procedures for the newborn within three months from the date of birth, it will enjoy the residents' medical insurance benefits from the date of birth. Hospitalization expenses due to congenital diseases should be reported to the municipal medical insurance management center with valid documents, hospitalization invoices, detailed list of expenses and discharge summary within 30 days after discharge. (Address: 3rd Floor, Hefei Social Security Service Center, No.88, Government Ring Road, Government District, Tel: 635363 18)
Medical insurance treatment for serious illness
For the medical expenses incurred by the insured due to illness, the insured can enjoy the treatment of critical illness insurance, and the part exceeding the deductible of 20,000 yuan within the scope of the policy will be reimbursed according to the proportion of 50%-80%. The specific division ratio is:
Within the scope of the policy, individuals pay more than 20,000 yuan for reimbursement by stages.
0 ~ 50,000 yuan (inclusive) 50%
50,000 yuan ~ 6,543.8+10,000 yuan (inclusive) 60%
65438+ 70% of RMB 10,000 ~ RMB 300,000 (inclusive)
More than 300,000 yuan (excluding) 80%
Specific reimbursement outlets, addresses and telephone numbers:
Yaohai District: Counter of Changjiang East Road, Hefei City, China Life Insurance, Address: Changjiang East Road 1005, Tel: 64695751;
Luyang District: Counter of Shouchun Road, Hefei City, China Life Insurance, Address: No.90 Shouchun Road, Tel: 62637378;
Shushan District: Counter of Jinzhai Road, Hefei City, China Life Insurance, Address: Financial Building, No.384 Jinzhai Road, Tel: 62646571;
Baohe District: China Life Insurance Hefei Xinduhui Counter, Address: 22nd Floor, Xinduhui,No. Maanshan Road 1000, Tel: 62687364.
The unified telephone number of the whole city is 12333.
Hefei Medical Insurance Center Resident Medical Insurance Office: 635363 1863536208
We will increase medical insurance subsidies for urban residents in Anhui Province. Anhui Province will invest 82.55 billion yuan to implement 33 livelihood projects this year, including 6 new ones.
This year, Anhui Province continued to implement 33 livelihood projects with a total investment of 82.55 billion yuan. According to the "Notice on Implementing 33 People's Livelihood Projects in 20 16" recently issued by the provincial government (hereinafter referred to as the "Notice"), six projects including the renovation of old urban communities will be added to the people's livelihood projects in Anhui Province this year.
Among them, Anhui Province will add six new projects, including rural road unblocked project, nursing subsidy for severely disabled people, legal aid for urban and rural vulnerable groups, improving rural grassroots party building and service funding guarantee, agricultural product food safety project, and renovation of old urban communities.
This year, Anhui Province will improve the implementation standards of six livelihood projects, 2 1 livelihood projects will continue to be implemented, and six projects that have completed their tasks or have been operating normally will be withdrawn from the category of livelihood projects.
The "Notice" requires that all levels and localities should adjust and optimize the structure of fiscal expenditures, vigorously reduce general expenditures, continuously strengthen the management of people's livelihood funds, and increase accurate assistance to specific people's special difficulties.
This year, the whole society will learn more about the implementation of people's livelihood projects through more channels. According to the notification requirements, Anhui Province will accelerate the overall application of basic information, big data, new media and Internet platforms in the field of people's livelihood, promote the openness, fairness and justice of people's livelihood work, and improve the scientific and informational level of people's livelihood projects.
In addition, explore the establishment of a long-term custody mechanism to support various market players to increase the supply of people's livelihood security services and products through purchasing services and equity cooperation.
List of livelihood engineering change projects
Six new livelihood projects were added.
Rural road unblocked project. We will implement the smooth road project in counties and townships, the road widening and reconstruction project in old villages, the road hardening project in merged villages and the road hardening project in poor villages to effectively improve rural traffic conditions.
Nursing allowance for severely disabled people. For severely disabled people who are rated as Grade I or Grade II and need long-term care, nursing subsidies are given to subsidize the extra long-term care expenses incurred by disabled people due to their disabilities.
Legal aid for urban and rural vulnerable groups. To provide legal aid to the poor urban and rural groups in the province who meet the conditions of legal aid, and promote the development of legal aid.
Improve rural grassroots party building and service funding guarantee. We will improve the stable funding guarantee system based on financial input, and constantly improve the ability of party building and service guarantee at the grassroots level in rural areas.
Agricultural products food safety project. Establish a rapid detection system for food safety of agricultural products in towns and communities, carry out quality and safety certification of agricultural products, and promote the solution of food safety problems of agricultural products.
Transformation of the old city. Strengthen and transform old buildings and dangerous houses in old urban communities, improve supporting facilities and environment, and effectively improve people's living and living environment.
Improve the standards of six livelihood projects
Improve the subsidy standard of policy agricultural insurance. The financial subsidy standards for rice, corn, wheat and cotton were raised from 20 15.84 yuan, 12 yuan, 9.72 yuan and 16.32 yuan to 19.49 yuan, 13.54 yuan and/kloc respectively.
Improve the subsidy standard for the new rural cooperative medical system. The financial subsidy standard of the new rural cooperative medical system was raised from 380 yuan per person in 20 16 years to 420 yuan.
Improve the basic medical insurance subsidy standard for urban residents. In 20 16, the financial subsidy standard for urban residents' medical insurance was raised from 380 yuan to 420 yuan.
Improve the financing standard of serious illness insurance for urban and rural residents. According to the Opinions of Anhui Province on Consolidating and Perfecting the Serious Illness Insurance System for Urban and Rural Residents, the per capita financing standard of the new rural cooperative medical system for serious illness insurance has been raised from 2065438+ 15 yuan in 2006 to 30 yuan, and the per capita financing standard of the serious illness insurance for urban residents is still 30 yuan.
Improve the subsidy standard for basic public health services. According to the pilot program of deepening the comprehensive reform of medical and health system in Anhui Province, the subsidy standard for basic public health services in 20 16 years was raised from 40 yuan to 45 yuan.
Raise the subsidy standard for compulsory education funds. We will promote the overall planning of urban and rural areas, and raise the standard of school tuition and fees and subsidies for public funds in urban compulsory education from 264 yuan per pupil and 375 yuan per junior high school student in 2006 to 625 yuan and 825 yuan respectively (including 25 yuan for heating). In the compulsory education stage, the subsidy standard of public funds per student in special education schools has been raised from 5,000 yuan per student in 20 16 years to 6,000 yuan.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.