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%.

3. Compensation for serious illness

List of compensation standards:

(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.

New reimbursement policy of outpatient medical insurance in Anhui province;

(1) On-the-job employees: cancel the enterprise-to-enterprise ratio, and only keep individual contributions.

(2) Retirees: fixed accounts, with the standard of 150 yuan/month in 2022. That is to say, after the adjustment, the amount of money transferred to personal accounts by employees and retirees of enterprises has decreased every month.

New scope of use: on the basis of the original, three groups of people have been added: spouses, parents and children. In other words, after adjustment, the personal medical insurance account can be used to pay the medical expenses incurred by oneself, spouse, parents and children in designated medical institutions.

The reimbursement rate of outpatient service has changed, and the reimbursement rate of on-the-job outpatient service: 50%. Proportion of reimbursement for retirees' outpatient service: increase by 5%.

It should be noted that in order to link up with personal accounts, a deductible line and a capping line are also set up for outpatient reimbursement. The threshold for outpatient reimbursement is about 3% of the per capita disposable income of urban and rural residents in the previous year. Outpatient reimbursement ceiling standard: set at about 5% of the per capita disposable income of urban and rural residents in the previous year. Specifically, in a natural year (65438+1October-65438+February), if the expenses incurred in the general outpatient service of designated hospitals or the expenses incurred in purchasing medicines according to outpatient prescriptions in designated retail pharmacies exceed about 3% of the per capita disposable income of urban and rural residents in the previous year, the medical insurance pooling fund will pay a part according to the prescribed proportion, and individuals will pay a part. However, there is an upper limit for overall payment, which cannot exceed about 5% of the per capita disposable income of local urban and rural residents in a natural year.

Legal basis:

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 2 The following units and their employees in towns of this province must participate in the basic medical insurance in accordance with these regulations:

(1) Enterprise and its employees

(2) Organs, institutions, intermediaries, social organizations, private non-enterprise units and their employees;

(3) Employers of troops without military status and their employees. These Regulations shall apply to the retirees of the above-mentioned units.