Yunnan medical insurance trans-provincial designated hospital

The scope and proportion of rural medical insurance reimbursement in Yunnan 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 expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, 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%.

Proportion of medical insurance reimbursement in Yunnan Province from 2065438 to 2007

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 Yunnan 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 cap of the new rural cooperative medical system is 40,000 yuan per year, and the reimbursement rate is 80% in township hospitals, 60% at county level and 45% at provincial level except the deductible line, 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.

Tips on rural medical insurance in Yunnan 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, Yunnan 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 in the "Yangtze River Delta" region and the docking of handling services, we will constantly improve the settlement method for medical treatment in different places, so that the insured in our province can better enjoy the medical insurance treatment in different places.

20 15 Yunnan province continued to implement the basic medical insurance system for urban residents, a livelihood project, and increased the proportion of medical insurance reimbursement. 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, Yunnan Provincial Human Resources and Social Security Bureau recently announced the 20 15-20 16 annual residents' medical insurance treatment and reimbursement policy.

Treatment of Insured Persons in Yunnan Province

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 in Yunnan province

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 in Yunnan

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 in Yunnan Province

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. Subsidies for childbirth expenses in Yunnan Province.

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. Subsidies for the assembly of assistive devices for the insured disabled in Yunnan Province

Subsidies will be given to insured residents with disability certificates and hearing-impaired children under the age of 7 to assemble lower limb prostheses and hearing AIDS in designated institutions for the disabled. 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.

Instructions for reimbursement of medical insurance in Yunnan Province

● 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 fills in the Application Form for Special Disease Outpatient of Basic Medical Insurance for Urban Residents in Yunnan Province, and submits the recent relevant medical records and physical examination reports to the special disease appraisal office of Yunnan Medical Insurance Center, which will organize medical insurance experts to carry out appraisal, issue qualified outpatient special disease treatment cards, and enjoy special disease outpatient treatment with the cards. Organize an appraisal every three months.

●3. Go through the formalities of medical treatment in different places.

Insured persons suffering from diseases in tertiary hospitals (including specialized hospitals) that are difficult to diagnose or have no treatment can apply for hospitalization in different places. Transfer from different places must fill in the Application Form for Transfer from Different Places, and after the opinions are signed by the designated hospitals above Grade III in Yunnan Province, they will be transferred to different places for treatment after being reported to the medical insurance agency in Yunnan Province for examination and filing.

Insured persons who have sudden diseases in different places and really need hospitalization should be hospitalized in local designated medical institutions and call the medical insurance center for the record within 3 days after admission.

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 medical insurance center for reimbursement and settlement.

●4. Maternity allowance.

Within one month after delivery, report to the medical insurance management center with valid documents, birth certificate, baby birth certificate, medical invoice, detailed list of expenses and discharge summary.

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 medical expenses due to congenital diseases should be reported to the medical insurance management center with valid documents, hospitalization invoices, detailed list of expenses and discharge summary within 30 days after discharge.

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 at a rate 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%

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.