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How to reimburse the marginal hospitalization of rural subsistence allowances in Wujiang City? How is it calculated? How is the time defined (for example, if the patient is going to leave the hospital
How to reimburse the marginal hospitalization of rural subsistence allowances in Wujiang City? How is it calculated? How is the time defined (for example, if the patient is going to leave the hospital, it will be done) I. Targets and methods of assistance

(1) relief object

People who enjoy the minimum living guarantee in rural areas in our city.

(2) Relief measures

Medical assistance for rural low-income families is implemented once a year. For rural residents who have participated in cooperative medical care, if the expenses incurred in hospitalization due to major diseases in that year meet the scope of reimbursement for cooperative medical care, and the basic family life is still affected after reimbursement for cooperative medical care, medical assistance for serious illness in rural areas, charity assistance, insurance compensation, etc., medical assistance shall be given according to the standards. Appropriately improve the standard of medical assistance for five-guarantee households, disabled people above the second level and only-child households in rural subsistence allowances.

Second, the types and scope of relief.

(a) medical assistance for rural low-income families mainly helps the following major diseases:

1, uremia;

2. Malignant tumor;

3. Leukemia;

4. Chronic severe hepatitis and its complications;

5. Cardiovascular and cerebrovascular diseases;

6. Mental illness;

7, according to the city's economic and social development to determine other major diseases.

Five-guarantee households in rural subsistence allowances are not restricted by the above-mentioned relief diseases, and all diseases requiring hospitalization are included in the scope of relief.

(ii) Scope of assistance

The hospitalization expenses related to the rescue of major diseases specified in these rules occurred in the designated medical institutions of cooperative medical care in this Municipality.

(three) the following circumstances do not belong to the scope of assistance:

1, unable to provide valid receipt or valid original voucher;

2, due to fighting, traffic accidents, drug abuse, suicide, self-mutilation, alcoholism and other injuries, as well as orthopedics, medical care, rehabilitation, organ transplantation and other medical expenses;

3. Cumulative medical expenses across years;

4. Medical expenses beyond the scope of drug list, medical service facilities and diagnosis and treatment projects stipulated in the implementation plan of cooperative medical care;

5. Designated medical expenses incurred in non-cooperative medical institutions;

6, did not enjoy the rural subsistence allowances and medical expenses incurred before the establishment of this system.

Third, the standard of assistance.

Medical assistance for rural residents shall be provided in a lump sum within the year. After deducting the reimbursement of the new rural cooperative medical system, medical assistance for serious illness in rural areas, charitable assistance, insurance compensation and social mutual assistance, if the hospitalization expenses incurred during the year still affect the basic life of the family, they can apply for medical assistance for low-income families in rural areas. Medical assistance for low-income families in rural areas is capped. After deducting the above reimbursement and assistance, the maximum amount of assistance is 6,000 yuan according to the principle of dividing the medical expenses borne by individuals and calculating them in proportion.

Personal burden of medical expenses in 5000 yuan (including 5000 yuan), according to the proportion of 40% to give assistance;

Personal burden of medical expenses between 500 1 yuan-1 ten thousand yuan, according to the proportion of 50% to give assistance;

The portion of medical expenses borne by individuals between 100 1 yuan-12500 yuan shall be given assistance according to the proportion of 60%;

When the individual's self-funded drug expenses reach 1.25 million yuan, the amount of assistance will reach the top line, so the part above 1.25 million yuan will no longer be assisted in proportion.

The standard of medical assistance for the disabled and the one-child households in rural subsistence allowances is increased by a certain proportion, and the standard of medical assistance for the five-guarantee households in rural subsistence allowances is calculated by 60%, but the amount of assistance shall not exceed the maximum limit line.

The proportion of medical assistance for rural low-income families will be adjusted according to the social and economic development of this city.

After the five-guarantee households in the rural subsistence allowances are rescued in proportion, the medical expenses that have not been rescued shall be borne by the town (street office) and the village respectively.

Four, rescue declaration, review and disbursement

(a) rural residents to apply for medical assistance, by the head of the household to the village (neighborhood) committee to apply, fill in the "Jiaonan rural residents medical assistance application form", provide the necessary materials, after the village (neighborhood) people's representative meeting investigation and verification, publicity without objection, submitted to the town people's government (street offices) audit, and fill in the "Jiaonan rural residents medical assistance expenses audit form", submitted to the town people's government (street offices).

(two) the Civil Affairs Bureau will send the materials to the cooperative medical institutions at the same level for review.

(III) The Civil Affairs Bureau shall, according to the audit of cooperative medical service agencies, determine the examination and approval opinions, summarize and fill in the Audit Summary of Medical Assistance Funds for Rural Low-income Families in Jiaonan City, and report to the Municipal Finance Bureau for fund disbursement procedures.

(four) the implementation of social relief funds.

V. Identification of relevant materials

(1) Relevant materials for applying for medical assistance for rural low-income families:

The medical expenses of rural residents that meet the requirements in a cooperative medical system operation year shall be reimbursed by cooperative medical system and medical assistance for serious illness in rural areas, and the accumulated part shall be borne by itself.

(2) The certification materials include the following parts:

1, copy of cooperative medical certificate, discharge record and receipt of medical expenses;

2, Jiaonan new rural cooperative medical system hospitalization expense reimbursement statement (second hospitalization), Jiaonan new rural cooperative medical system serious illness overall reimbursement statement copy, Jiaonan rural serious illness medical assistance approval form and towns (street offices) cooperative medical reimbursement, charity assistance, insurance compensation and other related documents;

3. Proof of social mutual assistance.

(three) medical assistance for rural low-income families does not include the following expenses:

1, general outpatient expenses;

2. Reimbursement of expenses for cooperative medical care;

3. Other expenses without assistance;

(four) social organizations and social assistance and other forms of relief funds should be given appropriate preferential treatment in medical assistance for rural low-income families.

Fund raising and management of intransitive verbs

(1) The medical assistance fund for rural low-income families (hereinafter referred to as the rural medical assistance fund) has been established in our city. The sources of funds mainly include: financial allocation from Jiaonan City, financial subsidies from Qingdao City, voluntary donations from all walks of life, fund interest income, etc.

(2) According to the development of local rural low-income families' medical assistance, the Municipal Finance Bureau reasonably arranged the rural low-income families' medical assistance funds in the budget at the beginning of the year. Set up a "special account for rural medical assistance funds" in the special account of social security finance, handle the raising, disbursement and payment of funds, formulate the procedures and ledger system for fund management, review and disbursement, and improve the efficiency of the use of rural medical assistance funds. Timely transfer financial subsidies and social donations at all levels to the "special account for rural medical assistance funds" to ensure that the funds are earmarked.

(three) the Civil Affairs Bureau to establish a "special account for rural medical assistance fund", and timely submit a report on the use of funds and the use of funds to the Finance Bureau.

(four) at the end of the year, the Civil Affairs Bureau and the Finance Bureau submitted a written report on the use and distribution of rural medical assistance funds this year to the higher authorities.

Seven. medical service

(a) medical assistance services for low-income families in rural areas are provided by designated medical institutions of cooperative medical care.

(II) Designated medical institutions of cooperative medical care shall provide high-quality medical services for rural low-income families in accordance with the basic drug list, diagnosis and treatment list and medical service facilities list of Qingdao New Rural Cooperative Medical Care within the prescribed scope, so as to ensure that the medical services are reasonable, accurate, open, fair and transparent.

(three) in line with the "Qingdao new rural cooperative medical system referral management regulations" of rural low-income families medical assistance object, according to the provisions of the referral procedures.

(4) Designated medical institutions of cooperative medical care should improve and implement various diagnosis and treatment norms and management systems, ensure service quality, improve service efficiency, and provide medical assistance services to the maximum extent on the basis of controlling medical expenses.

Eight, organize the implementation

Medical assistance for rural low-income families is organized and implemented under the leadership of Jiaonan Municipal People's Government, and all relevant departments should actively cooperate with each other, perform their respective duties and jointly implement it.

(a) the Civil Affairs Bureau should grasp the situation through careful investigation and study, establish rules and regulations, improve procedures, and do a good job in comprehensive coordination.

(two) the municipal health department should strengthen the supervision and management of designated medical institutions, standardize medical service behavior, and improve service quality and efficiency.

(three) the municipal finance department should strengthen the collection and management of relief funds.

(4) civil affairs, finance and auditing departments at all levels should strengthen the supervision and inspection of rural medical assistance funds, find problems and correct them in time to ensure that the funds are earmarked. Found false impersonator, misappropriation, corruption and waste and other violations, severely punished in accordance with relevant laws and regulations.

(five) the relevant units, organizations and individuals shall truthfully provide the necessary information and cooperate with the medical assistance investigation.

Nine, the "Rules" shall come into force as of June 2005 1 day.

Timetable:

1, Application Form for Medical Assistance for Rural Low-income Families in Jiaonan City

2, "Jiaonan rural low-income families medical assistance expenses audit table"

3, "Jiaonan rural minimum living security medical assistance roster"

4, "Jiaonan rural low-income families medical assistance funds audit summary"

Schedule 1:

Jiaonan rural low-income families medical assistance application approval form

Jiaonan town (street) village (neighborhood) Committee No.

Household name low-income insurance

Passbook account patient

draw

(1 inch)

Patient's name, sex and age

Patient ID number related to the householder.

Five types of protection for patients (); Disability above level 2 (); One-child family ().

Home address and telephone number

Disease uremia () Malignant tumor () Leukemia ()

Chronic severe hepatitis and its complications ()

Cardiovascular and cerebrovascular diseases () Psychosis () Others ()

apply for aid

Rio

Signature of the applicant:

date month year

Opinions of the village (neighborhood) committee

(official seal)

Signature of person in charge: year month day.

Town (street office) opinion

(official seal)

Signature of person in charge: year month day.

Ministry of Civil Affairs

Total hospitalization medical expenses:

Expenses to be deducted:

① Expenses to be deducted from the audit of the Municipal Cooperative Medical Management Center: RMB;

Charity to help 2 yuan; ③ Insurance compensation yuan;

④ Other expenses to be deducted: RMB.

Scope of assistance: RMB.

After research, it was approved to grant medical assistance of RMB yuan.

(official seal)

Signature of person in charge: year month day.

Remarks: 1. The applicant is the head of the household (must be the same as the name on the low-income passbook). 2. The photo is a recent one-inch bareheaded photo of the patient. 3, to apply for medical assistance for low-income families to take the initiative to accept the village (neighborhood), town (street offices), the Civil Affairs Bureau review, audit. 4 this form is in duplicate, one for the Civil Affairs Bureau and one for the town (street office).

Schedule 2:

Audit form of medical assistance expenses for rural low-income families in Jiaonan City

Jiaonan Civil Affairs Bureau (Seal)No.:

Surname, first name, gender, age contact

telephone

Town (street) cooperative medical certificate number copy receipt.

a sum of money

Types of diseases

Hospitalization number of famous treatment hospital

The starting and ending time of medical expenses is from MM DD YY to MM DD YY.

Opinions of town (street) cooperative medical management office

Special administrator of cooperative medical system:

Person in charge (signature) Town (street) Cooperative Medical Management Office (seal)

date month year

Review opinions of town civil affairs office

(Seal)

Civil Affairs Officer (Signature): Year Month Day.

Total hospitalization expenses of rural cooperative medical management center: RMB.

Deduction: RMB. These include:

Basic cooperative medical reimbursement yuan; ② overall serious illness; ③ serious illness relief fund; (4) Beyond the reimbursement scope of cooperative medical care.

Examiner: Municipal Rural Cooperative Medical Management Center (seal)

date month year

Note: 1. The applicant shall truthfully provide proof of reimbursement, assistance and other expenses. If it is not provided truthfully, citizens will

The political situation has the right to cancel the rescue.

2. Please paste all kinds of medical treatment and reimbursement documents that meet the medical assistance for major diseases on the back of this form.

Paste location of medical and reimbursement documents

Paste in sequence

And be serious, neat and beautiful.

Paste content:

1, copy of cooperative medical care certificate, discharge record, receipt of medical expenses and detailed list of hospitalization;

2, the township one-child family planning certificate, a copy of the patient's secondary disability certificate.

3, Jiaonan new rural cooperative medical system hospitalization expense reimbursement form (second hospitalization), Jiaonan new rural cooperative medical system serious illness overall reimbursement form, Jiaonan rural serious illness medical assistance approval form and towns (street offices) cooperative medical reimbursement, charity assistance, insurance compensation and other related documents.