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Medical insurance in different places in Sun Yat-sen University Cancer Hospital
Scope and standard of compensation. Outpatient compensation: (1) village clinics and village center clinics will be reimbursed by 0%, and the limit of prescription drug expenses for each visit is 0 yuan, and the limit of prescription drug expenses for temporary rehydration of doctors in health centers is 50 yuan. (two) the town health center reimbursement of 40%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 100 yuan. (3) The reimbursement for medical treatment in secondary hospitals is 30%, and the examination fee and operation fee for each visit are limited to 50 yuan, and the prescription drug fee is limited to 200 yuan. (4) 20% reimbursement for medical treatment in tertiary hospitals, with the examination fee and operation fee for each visit limited to 50 yuan and prescription drug fee limited to 200 yuan. (5) The prescription attached to the invoice of traditional Chinese medicine is limited to one yuan each. (Lu) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan. II. Hospitalization compensation (1) Reimbursement scope: A. Drug expenses: auxiliary examinations: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and MRI are limited to 200 yuan; Surgery expenses (refer to national standards, those exceeding 1000 yuan will be reimbursed as 1000 yuan). B, the elderly over 0 years old are hospitalized in Xingta Town Health Center, and the daily compensation for treatment and nursing expenses is 1 0 yuan, with the limit of 200 yuan. (2) Reimbursement ratio: 0% for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%. Three. Compensation for Serious Illness (1) Town Risk Fund Compensation: All inpatients who participate in the cooperative medical care and declare that the medical expenses exceed 5,000 yuan at one time or throughout the year will be compensated by stages, that is, 500- 10000 yuan 5%, 1000- 1000 yuan 0%. The annual compensation limit for hemodialysis and radiotherapy and chemotherapy in the town-level cooperative medical system hospitalization and uremia outpatient service is 1. 1 ten thousand yuan. Not within the scope of reimbursement. 1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care, and medical expenses that do not conform to family planning; Second, outpatient treatment fee, house call fee, hospitalization fee, meal fee, escort fee, nutrition fee, blood transfusion fee (except for family blood storage, reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc. Three, car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; Four, orthopedics, cosmetic surgery, dentures, organ transplantation, roll call surgery fees, consulting fees, etc. ; 5, within the scope of reimbursement, beyond the limit. Scope of compensation: (1) Pay the hospitalization expenses of patients due to illness. It mainly includes: medical expenses, operation expenses, materials expenses, hospitalization expenses, treatment expenses, laboratory expenses, inspection expenses, etc. (two) payment of outpatient chronic disease treatment costs. Chronic diseases mainly refer to hypertension (phase II), heart disease complicated with cardiac insufficiency, cerebral hemorrhage and cerebral infarction recovery, rheumatoid arthritis, chronic active hepatitis, chronic obstructive emphysema and cor pulmonale, epilepsy, hepatolenticular degeneration, decompensated cirrhosis, diabetes mellitus with ineffective diet control, chronic nephritis, Parkinson's disease, systemic lupus erythematosus, disc herniation, chronic pelvic inflammatory disease and adnexitis, and others audited by the Expert Committee on Chronic Diseases of the New Rural Cooperative Medical System and the District Management Center. Extra-large outpatient expenses such as radiotherapy and chemotherapy for malignant tumor, dialysis treatment for chronic renal insufficiency, aplastic anemia, leukemia, hemophilia, schizophrenia, organ transplantation and anti-rejection treatment are included in hospitalization compensation. Participating farmers suffering from the above-mentioned chronic diseases shall apply by themselves, based on the diagnostic proof materials of the second-class first-class hospitals, identified by the expert committee of chronic diseases of the new rural cooperative medical system in the district, submitted to the district joint management center for examination and approval, and receive a chronic disease outpatient certificate, which shall be audited by the district joint management center at the beginning of each year. (three) to pay the special inspection fee when the patient is hospitalized due to illness. Mainly refers to CT, cardiac and angiographic X-ray machine, electronic gastroscope, color Doppler instrument, hyperbaric oxygen chamber, extracorporeal shock wave lithotripsy, hemodialysis, organ transplantation and other high-cost medical projects. Patients who need to check the above items shall apply to the designated hospitals and report to the district management center for examination and approval. (four) in line with the conditions of childbirth to two hospitals, designated medical institutions, designated delivery points. (5) there is no other responsible party for the accidental injury (excluding unpaid items) that farmers have in the process of production, life and study; If there is any responsibility of the other party, it shall be borne by the other party. Accidental injury compensation can only be paid if it is publicized within a certain range for more than one month, without objection or report, or after investigation and confirmation. (Lu) The participating farmers were hospitalized immediately after the outpatient examination, and the outpatient examination expenses closely related to hospitalization were included in the hospitalization medical expenses. During hospitalization, the application is made by the hospital under the jurisdiction due to illness, and after the examination and approval by the district joint management center, the examination expenses are calculated according to the compensation ratio corresponding to the examination hospital level and included in the compensation scope. (Lacquer) Hospitalization expenses incurred by newborns who were not born at the time of fund-raising and did not attend hospitalization with their parents due to maternal complications, complications and other reasons. Within a few days after birth (perinatal period). It is recommended that pregnant women who are about to give birth or are expected to give birth in the coming year pay the alloy for their unborn children in advance.

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