Our country has always been people-oriented, paying special attention to the people's pension and medical care.
In terms of medical care, our country has an excellent medical insurance systemIn addition, the New Rural Cooperative Medical Insurance has been launched for rural areas to solve the problem of difficult and expensive medical treatment for those who are farmers.
As long as they participate in the NCMS medical insurance, those who work in agriculture do not have to worry about their future medical expenses, and the NCMS can reimburse most of the expenses.
Recently, however, there was an elderly person who participated in the NCMS insuranceHe underwent an operation that cost more than 30,000 yuan, but he didn't expect that in the end, NCMS Insurance reimbursed 972 yuan.
This made the old man wonder, so what the hell is going on?
First of all, let's get to know the NCMS medical insurance policy.
In order to better solve the problem of difficult and expensive medical treatment for those farmersIn 2003, our country officially launched a new type of rural cooperative medical insurance system.
This is a system of mutual medical assistance and mutual aid for farmers financed by individual collectives and multi-party financing, and based on the overall planning of serious diseases.
This system was introduced specifically to ensure basic health services for farmers and alleviate the poverty caused by illness or return to poverty due to illness.
After all, for those farmers, their medical problems are certainly more prominent than those of office workers in the cities.
Those who work in the city are mainly covered by social health insurance.
Because according to the relevant regulations of our country, social medical insurance is mandatory through legislation.
The company or business that employs them must pay a percentage of the employee's health insurance premiums.
But for those farmers who do not have formal jobs, they may have to pay a higher percentage of insurance premiums if they want to participate in social health insurance.
Many farmers can't afford to pay so much money a year.
NCMS is differentThe payment standard is relatively low, and the annual payment standard for individual farmers is only not less than 10 yuan.
This is due to the fact that ** or qualified township collective economic organizations will give appropriate support to the local new rural cooperative medical insurance, so the payment standard is so low.
It can be seen that the excellence of China's NCMS medical insurance, so what is the reimbursement scope and reimbursement ratio of NCMS medical insurance?
According to the corresponding systemThe reimbursement scope of NCMS mainly includes outpatient compensation, hospitalization compensation and serious illness compensation.
These three parts, such as some medical expenses, laboratory fees, and surgical care fees, can be reimbursed.
The reimbursement rate is also very high, but there will be some differences depending on the level of the medical treatment unit.
For example, the reimbursement ratio in ** hospitals can reach 20%, while the reimbursement ratio in secondary hospitals is as high as 30 percentage points.
If you go to a village clinic or health center, 60 percent of the medical expenses will be reimbursed.
This means that if you suffer from some minor illnesses such as cold and fever and go to the clinic for medical treatment, and it costs a total of 100 yuan, then you can reimburse 60 yuan through NCMS.
If you suffer from some serious diseases that require surgery, and go to a hospital in the city for medical treatment, the total medical expenses can reach tens of thousands of yuanThere is also at least 2,000 yuan of medical expenses to be reimbursed.
Judging from the above content, our country's NCMS medical insurance system is still very good, the reimbursement ratio is not low, and the coverage is relatively broad.
Those who participate in the NCMS medical insurance are widely recognized by this systemBut why is there an old man who has been bothered by this in recent times?
The beginning and end of the incident are as follows, there is an uncle Wang in Dingzhou, Hebei Province, China, who made a living from farming when he was youngHe was not involved in any social work, so he did not have health insurance. But in order to consider his future medical problems, Uncle Wang participated in the New Rural Cooperative Medical Insurance at the suggestion of his children.
But all events are such coincidencesAfter participating in the New Rural Cooperative Medical Insurance, one day Uncle Wang suddenly felt a slight discomfort in his waist.
Uncle Wang didn't pay too much attention to this, he still simply thought that it might just be a problem of overwork, as long as he took a break, he would be fine.
However, after a few daysUncle Wang found that the discomfort in his waist was getting stronger and stronger, and he even had paroxysmal pain.
Uncle Wang is already old, and his children also attach great importance to his health problems, so they discourage Uncle Wang from going to the hospital for medical treatment.
After some examination, Uncle Wang was diagnosed with lumbar spine inflammation.
This disease is mainly divided into two main types: infectious inflammation and non-infectious inflammation, of which infectious inflammation is mainly caused by purulent infection.
People who suffer from this disease will feel local redness and swelling in the lower back at first, and as time goes on, the pain in the lower back will become more severe.
If the inflammation begins to spread in the later stage, then systemic symptoms will appear, such as high fever and weight loss.
As for non-infectious inflammation, it is the stiffness and toughness pain of the lower back first, followed by a similar sensation in the lumbar and cervical spineAnd Uncle Wang is suffering from infectious lumbar inflammation.
Fortunately, Uncle Wang found it relatively early and came to the hospital in time, at this time the inflammation has not spread all over the body, and it is relatively easy to want **, only a small minimally invasive surgery is required.
Although it is said to be a minimally invasive surgery, the cost required is not lowCombined, the cost of surgery, examination and hospitalization costs cost as much as 30,000 yuan
For Uncle Wang, who doesn't have much savings at home, it is still difficult to come up with the 30,000 yuan.
Fortunately, Uncle Wang has participated in China's New Rural Cooperative Medical Insurance beforeAt this time, Uncle Wang couldn't help but feel how wise his previous decision was.
If you are reimbursed through medical insurance, you will not have to pay so much.
Nowadays, not only can the disease be cured, but it does not cost so much money, which is indeed very good.
So Uncle Wang and his son came to the payment window to go through the reimbursement proceduresHowever, the reimbursement ratio of NCMS medical insurance made Uncle Wang jaw-dropping.
Because according to the regulations, the total cost of Uncle Wang's minimally invasive surgery for lumbar spine inflammation can reach more than 30,000 yuan.
However, NCMS can only reimburse 972 yuan, and the remaining more than 20,000 yuan needs to be borne by Uncle Wang himself.
A minor operation that costs as much as 30,000 yuan, Uncle Wang, who is insured, still needs to bear 97 percent of the main cost.
If so, then what is the use of participating in NCMS medical insurance? This inevitably made Uncle Wang feel a great headache.
Uncle Wang had surgery, and the total reimbursement rate of medical expenses was low, in fact, there was a reason.
The total cost of more than 30,000 yuan for Uncle Wang's surgery can be divided into examination costs, hospitalization costs and diagnosis and treatment costs.
Compared with the NCMS medical insurance system, there are indeed many reimbursement restrictions.
For hospitalization expenses, the reimbursement standard of NCMS medical insurance will be divided into three categories according to the different subsequent use of drugs.
Among them, 50% of the expenses of Category A can be reimbursed, while 95% of the expenses of Category B are reimbursed by the hospital, and the remaining 5% is borne by themselves.
The final Category C expenses all need to be taken care of by the patient, and Uncle Wang is precisely within the category of Category CSo don't think about reimbursing the 17,000 yuan Uncle Wang.
Let's talk about the fundamental cost of surgeryIn fact, the cost of this minimally invasive surgery is not high, and it is only more than 5,000 yuan.
According to the reimbursement ratio of NCMS medical insurance, the reimbursement ratio of surgical expenses ranges from 50% to 70%.
Some people will think that this can reimburse Uncle Wang at least 2,500 yuan.
But we have to note thatThere is a condition for the surgical reimbursement of the NCMS medical insurance, that is, it must reach the minimum payment line of 3,500 yuan.
Only when the minimum payment line of 3,500 yuan is reached, can the reimbursement be made according to the subsequent reimbursement ratio.
Uncle Wang has obviously reached this threshold line, but the reimbursement ratio must be calculated according to the cost of the operation after deducting the threshold line.
This means that Uncle Wang's total of 5,000 yuan of surgical expenses needs to be deducted 3,500 yuan first, and the remaining 1,500 yuan can be reimbursed according to the reimbursement ratio range of 50 70
The amount of reimbursement given by the hospital can reach 972 yuan, which is indeed within this reimbursement ratio.
As for Uncle Wang's inspection costs, they cannot be reimbursed.
The total cost can reach 8,000 yuan, and the 8,000 yuan is not borne by the NCMS medical insurance system.
In other words, the 8,000 yuan cannot be reimbursed, and Uncle Wang needs to pay for it himself.
On the whole, Uncle Wang spent a total of more than 30,000 yuan in medical expenses this timeIn fact, only the cost of surgery can be partially reimbursed in accordance with the corresponding regulationsOther expenses are not reimbursable.
Of course, this is also in full accordance with the provisions of our country's NCMS medical insurance system, and there is nothing unreasonable.
The total reimbursement fee is low, but it is better than nothing.
Looking back on Uncle Wang's experience this time, we can find that there are indeed many restrictions in the reimbursement of the NCMS medical insurance system.
For example, the reimbursement rate for some minor illnesses and pains may be higherHowever, if it is a serious illness, then it must be determined according to the type of disease and the distribution of the total medical expenses.
Of course, the reason why NCMS has these reimbursement restrictions is also reasonable, after all, the proportion of insured people is low, and the system itself also needs to coordinate many factors.
However, on the whole, NCMS medical insurance is still a very good medical insurance system.
In the future development, it is presumable that our country will continue to improve it and effectively solve the problem of difficult and expensive medical treatment for peasant groups.