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Experts answer: urban and rural cooperative medical insurance, was officially launched last year by the end of September. Longevity has been included in Chongqing Municipality 21 "urban and rural cooperative medical insurance, the pilot counties," one of the relevant documents under the Chongqing municipal government to revoke the original handling new-type rural cooperative medical institutions, re-established urban and rural residents in longevity district cooperative medical insurance management center, is business address is located in Simon Hall 3 Floor turntable administrative examination and approval. Of the original staff participating in the new rural cooperative medical insurance automatically integrated into the urban and rural residents file I enjoy the new rural cooperative medical compensation standard with the previous change. Changshou District of urban and rural residents in a cooperative medical insurance, insured notes, and which can participate in urban and rural cooperative medical insurance? 1. With a longevity district of urban and rural residents and rural residence does not belong to the coverage of medical insurance for urban workers, urban residents, including primary and secondary school students (including vocational high school, secondary school, technical school students), children and other non-practitioners of urban residents, can voluntarily apply for the residents in the seat of the relationship between health-care residence. 2. Holders of more than six months temporary residence permit (residence) of non-permanent residents in this area can be voluntarily insured, the premium paid in full by the insured persons themselves, the Government does not subsidize. Second, how to handle enrollment procedures? Willing participants in urban and rural residents can travel in the family residence booklet, resident identity card (second generation), unemployment card, student card; the difficulties of urban and rural residents need to hold a low guarantee, the five guarantees, the special care card, Disability card to the location of my residence (village) committees handle enrollment procedures. Access to family planning funding participants of the need to provide the appropriate documents. 3, payment time and the standard of the regulations? 1. To participate in urban and rural residents in 2008-2009 Medicare, an individual's contribution time for September 25, 2008 -10 30. 2. Urban and rural residents in urban and rural residents to participate in the annual 2009 health insurance payment standards: the insured files a standard pay 20 yuan per person per year, the insured second gear standard pay 120 yuan per person per year. 3. Urban residents to participate in the 2008 and 2009 annual urban and rural residents in health insurance payment criteria: pay the insured a file the standard 30 yuan, the insured pay the standard second gear 180. In which half of 2008 in accordance with the standard fee. 4. Insured Note: Due to the new rural cooperative medical care for residents in the rural areas of the accounts handled matters relating to the 2008 co-reference, so in 2008 Medicare will no longer apply for residents of rural residents insured; urban and rural residents in principle, the family as a unit insured, may voluntarily choose a file or two files standard insured, the family that meets the conditions of all members of the insured should choose the same level of insured tranche of funding, from 2009 onwards, select the grade, once established, shall not be changed within two years. Fourth, the treatment time to enjoy what regulations? To participate in the second half of 2008 residents in health insurance for urban residents, from July 1, 2008 start to enjoy medical insurance treatment of urban and rural residents. To participate in the year 2009 the residents of urban and rural residents in health insurance, since January 1, 2009 -2,009 year December 31 to enjoy medical insurance treatment of urban and rural residents. 5, insured residents of designated medical institutions in the region, the cost for reimbursement? Insured residents in the area designated medical institutions are required to produce "Longevity area of urban and rural residents in medical assurance", ID cards, medical treatment only after the end of pay personal conceited part, in line with the standard cost of medical insurance fund directly in the designated medical institutions in a timely reimbursement. 6, to participate in cooperative medical insurance, working out, visiting relatives, staff whether the reimbursement of medical expenses, how to be repaid? Outside the region to work, visiting relatives who have been hospitalized personnel, the cost paid by me first after discharge from hospital or visiting relatives who proved that the working units, "Longevity area of urban and rural residents in medical assurance ", hospital invoices, hospital charges, clearing the list, enter (a) hospital records (trauma patients will be asked to provide copies of patient medical records), identity card to the account location Jiezhen hospitals reimbursed for their medical expenses reimbursed by provincial and municipal level hospitals standard. (Note: the credentials of all medical treatment must be stamped with medical institutions of fresh chapter) 7, took part in the commercial insurance residents can participate in urban and rural cooperative medical insurance? Be able to participate. We encourage residents to participate in cooperative medical insurance, according to their participation in various commercial health insurance, better medical care. 8, cooperative medical insurance, medical expenses reimbursement standards of any regulations? 1. The general out-patient compensation. Implementation of outpatient co-ordination, limited compensation. Eligible for reimbursement for medical expenses out-patient range of 50% according to the proportion of compensation for the residents to participate in a stall standard cumulative maximum per person per year to compensate 30 yuan, to participate in second gear a standard cumulative maximum per year per resident in compensation for 50 yuan. Compensation limits for families All officers are not restricted reference materials transfers. 2. Compensation for special disease clinic. Special disease clinic scope of compensation for the following diseases: hypertension (with heart, brain, kidneys, device damage), chronic heart disease, chronic bronchitis (with emphysema), diabetes, cerebral vascular accident rehabilitation period, malignancy, systemic lupus erythematosus lupus, chronic aplastic anemia; tuberculosis. Among them, tuberculosis of compensation is limited to TB control zone in the longevity produced by treatment. 3. Cost of compensation for seriously ill patient: only applies to participate in the standard insured residents of second gear. Scope of compensation for the following diseases: renal failure in dialysis treatment; malignant tumor radiotherapy, chemotherapy, pain treatment; of the insured population under 18 years of age suffering from leukemia, aplastic anemia, cancer, severe multi-organ failure (heart, liver, brain, kidney), congenital heart disease outpatient treatment. Special disease and illness out-patient standard of compensation standards for project financing from pay-line compensation ratio (%), the maximum compensation limit per person per year (yuan) Jiezhen class medical institutions in the region (million) other designated district hospital (yuan) provincial and municipal hospitals ( yuan) Special sick patient a stall 100,100,100,050 500 II files 1,001,001,000,601,000 ill patient 2 files 1,001,001,000,703,000 unique, special provisions for compensation for seriously ill patient: tuberculosis, TB control zone in the longevity of the treatment standard of compensation for medical expenses : anti-tuberculosis treatment of tuberculosis drugs, chest radiography, sputum culture, which do not include compensation coverage to a file, two files are the implementation of the standard line from 100 yuan to pay, the compensation ratio of 50%, the maximum compensation limit of 1,000 yuan standards. 4. Inpatient hospital medical expenses at different levels of compensation, that is, according to different levels of fixed-point medical institutions apply different compensation ratio and from the hospital to pay line, starting line to pay for medical expenses borne by the patient, more than some of the following percentage of reimbursement. Calculated as follows: Reimbursement Amount = (single-hospital medical costs - their own costs - starting to pay line) X-patient ratio of compensation standard of compensation standards for project financing district-level medical institutions in the region Jiezhen other provincial and municipal hospitals designated hospitals for a cumulative maximum compensation limit ( million) a file from two files to pay line (yuan) a file 50250 (Chinese Medicine Hospital 150) 10003000050000 2 stall 1.003001 billion compensation ratio (%) a stall 654.53 thousand two files 7050355. Special provisions for hospitalization compensation (1) All insured hospital treatment eligible for reimbursement for the cost of traditional Chinese medicine increased by 10% the proportion of compensation. (2) to participate in the standard two year file of insured persons under the age of 18 years of age hospital charges the hospital at the same level of compensation based on the proportion of floating 5%. (3), migrant workers, visiting relatives, referral of the insured in-patient treatment outside the region, all medical expenses compensation standards in accordance with the implementation of provincial and municipal hospitals. No referral procedures, non-workers or relatives to prove that the insured be the implementation of provincial and municipal hospital standard of compensation reduced by 5% of the compensation ratio. (4) comply with the conditions of participation of Home medical assistance co-workers compensation methods shall be formulated by the Home department. (5) The insured maternal Compensation: Zhunsheng Zheng approved by holders of family planning departments, prenatal check cards, "longevity medicine residents in urban and rural areas", to ID cards insured pregnant women, in this district designated hospital enjoy the 100 yuan of free antenatal care benefits (sub-sub-, sub-standard). Hospital delivery in the designated medical institutions (including the level of production, cesarean section and pathological obstetrics) Fixed compensation for 400 yuan (enjoy the relief of poverty of maternal birth of their compensation from the hospital, "Reducing and Eliminating" project payments, not included in urban and rural residents hospitalized compensation range). 9, referral to a higher-level hospital, what are the requirements? Designated medical institutions in the area of disease diagnosis and treatment in principle can be transferred outside the clinic, if a serious condition, do need to switch to a higher level (provincial and municipal) hospitals for treatment, the right to have a referral by the designated medical institutions issued by the district referral, transfers procedures. With a qualified health care referral agencies: District People's Hospital, the district hospital of Chinese medicine, the district MCH hospital (limited to women and children's section), the District No. 3 People's Hospital (limited psychiatric), the District Chemical Industry Park Hospital. Referral in patients with medical expenses paid by me first after discharge from hospital referral who transferred proved that the "longevity medicine residents in urban and rural areas", to hospital invoices, hospital charges, clearing the list, entry (a) hospital records (trauma patients will be asked to provide copies of patient records ), identity card to the district center of urban and rural residents in Medicare reimbursement, their medical expenses reimbursed by provincial and municipal hospitals standard. (Note: the credentials of all medical treatment must be stamped with medical institutions of fresh chapter) 10, insured residents of health care, reimbursement should pay attention to what issues? 1. Doctor should take the initiative to produce a "Longevity area of urban and rural residents in medical guarantee" shall not Permit lend use by others. 2. Should not the use of false invoices, false evidence, false medical instruments, medical insurance fund taking the residents. 3. To be secretly altered the medical instruments. 4. To comply with Medicare residents in procedures, shall not be vexatious disputes or lead to medical institutions which can not work normally. 11 Which situation can not be reimbursed for medical expenses? 1. In non-designated medical institutions for medical treatment occurred in medical costs. 2. Interruption occurred during the pay medical expenses. 3. A result of traffic accidents, medical malpractice and other liability accident, medical expenses or judicial appraisal, appraisal of labor occurred in medical costs. 4. Because of my drug abuse, assault, crimes such as occurred in medical costs. 5. A result of suicide, self-mutilation, alcoholism, drug treatment, work injury, occupational diseases, unplanned births, non-hospital childbirth, infertility, miscarriage pregnancy, family planning, surgery, sexually transmitted diseases occurred in medical costs. 6. Because of beauty, fitness, myopia correction, Qigong therapy, music therapy, non-functional cosmetic, orthopedic surgery, health-preserving therapy, nutrition therapy, magnetic therapy, rehabilitation aids and other costs incurred. 7. Sentence took place during and outside the medical expenses for medical treatment. 8. State, District, Chongqing Municipality and longevity of other health insurance policy provisions are not paid for medical expenses. 12, special (heavy) disease outpatient reimbursement of the regulations? Special (heavy) The diagnosis of a certificate of need by the District People's Hospital, the district hospital of Chinese medicine, the district MCH hospital (limited to women and children's section), the District Chemical Industry Park Hospital, issued outside the three hospitals. And the special (heavy) disease outpatients required to hold a certificate of diagnosis to the district urban and rural residents in health-care centers to register for the record. Special (heavy) disease clinic is limited to Jiezhen level (including community) and above designated medical institutions for medical treatment took place in line for reimbursement of medical expenses. Medical care in the region immediately after the implementation of reimbursement for medical treatment. Outside the region for medical treatment, one must bear the costs, year-end urban and rural residents in the district health-care center a one-time checkout. Specific management practices in accordance with the implementation of special illness. 13, which is the urban and rural medical institutions, medical institutions designated health insurance? Designated medical institutions in the region were hung in the longevity area designated medical institutions in urban and rural residents in health insurance plaque. The designated medical institutions outside the region as long as the local residents recognized medical insurance designated medical institutions in our region have recognized that the implementation of full mutual recognition of designated medical institutions. In principle, people should choose the country for medical treatment in public hospitals for treatment. 14, the insured residents how to monitor reimbursement work? 1. Insured reimbursement, the hospital should pay reimbursement reimbursement clearing the list of signature recognition, reimbursement himself retained a copy if subsequently found to have errors, present their lists to find reimbursement settlement point of re-accounting. 2. The community neighborhood committee or village every month to the community (village) reimbursement of insured persons posting on the wall to the masses publicity. 3. The people found to have failure to cooperate in matters of health insurance regulations can be made to host Street (town) Medicare Office or the Regional Center for urban and rural residents in health-care complaints and reports. District Health Insurance Center urban and rural residents Address: Changshou District Administrative Examination and Approval Hall on the third floor (Simon Rotary Office). Report Tel: 40,669,302
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