城镇职工医疗保险

城镇职工医疗保险 城镇职工基本医疗保险政策 一、什么是医疗保险～为什么要建立医疗保险, 答:医疗保险是劳动者,或全体社会成员,因疾病需要治疗时～由国家或社会向其提供必需的医疗服务或经济补偿的一种社会保障制度。首先～建立医疗保险制度有利于劳动者的病伤得到及时、有效的医治～保证劳动者的身体健康～促进生产的发展。其次～建立医疗保障制度有利于消除或减轻劳动者极其家属由于病患或负伤而在经济和精神上产生的负担。 我国现行医疗保险制度改革是遵循“低水平、广覆盖”的原则开展的～其目的是最大限度地满足广大参保者的基本医疗需求～使之免除疾病、伤残时的经济负担和精神痛苦。只要用人单位及其职工按时足额缴纳基本医疗保险费～其参保人员的基本医疗就会得到切实保障。 二、 城镇职工基本医疗保险制度改革的任务和原则有哪些, 答:主要任务是:建立城镇职工基本医疗保险制度～既适应社会主义市场经济体制～根据财政、企业和个人的承受能力～建立保障职工基本医疗需求的社会医疗保险制度。 原则是:基本医疗保险的水平要与社会主义初级阶段生产力发展水平相适应,城镇所有用人单位及其职工都要参加基本医疗保险～实行属地管理,基本医疗保险费由用人单位和职工双方共同负担,基本医疗保险基金实行社会统筹和个人账户相结合。 三、 参加喀什地区城镇职工基本医疗保险的范围有哪些, 答:,一,企业～包括国有企业、城镇集体企业、股份制企业、股份合作制企业、外商投资,合资、合作,企业、港澳台胞投资企业和私营企业,,二,党政机关,,三,,,四,社会团体,,五,民办非企业单位,,六,城镇个体经济组织业主及从业人员。 四、 喀什地区城镇职工基本医疗保险费缴纳费率是多少, set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 答:城镇职工基本医疗保险费由参保单位和职工个人共同缴纳。喀什地区参保单位缴纳费率为职工工资总额,含退休人员养老金、退休人员生活费,的6.5%。职工个人缴纳费率为本人上年度平均工资收入的2%。 新建单位缴纳基本医疗保险费以上月工资收入缴费基数按期缴纳,没有上月工资收入的按年度社会月平均工资水平为基数缴纳,非公有制企业和个人经济组织业主极其从业人员缴费基数不低于喀什地区上年度社会平均工资。 五、什么是基本医疗保险个人账户, 答:基本医疗保险个人账户～是医疗保险经办机构为职工、退休人员建立的终身医疗专用账户～用于记载、储存个人缴纳的基本医疗保险费和从单位缴费中划入的医疗保险费。它是社会积累和个人积累两种模式有机结合的形式～既发挥社会统筹共济性强的长处～也发挥个人账户具有激励作用和制约作用的优点。其目的是通过个人自我积累机制～加强个人医疗保险费用意识和个人责任感～强化医疗消费行为的自我约束。个人账户的本金和利息归个人所有～可以结转和继承。 个人账户实行社会保障卡,IC卡,管理～由职工、退休人员支配使用。 六、喀什地区城镇职工基本医疗保险个人账户的计入是怎样规定的, 答:个人账户资金以职工、退休人员的年龄、在职和退休的不同情况作为划分标准～在一个统筹年度内按月计入。具体标准见下表: 35岁以36岁-45岁 46岁以上 企业正常病退年龄 段 下,含休人员 35岁, 项 目 set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 个人缴纳 2% 2% 2% 个人不缴费 基本医疗保险划入 1% 1.5% 2% 4(5% 合计个人账户费用 3% 3.5% 4% 4.5% 七、个人账户和统筹基金支付范围有哪些, 答:个人账户主要用于支付门诊医疗费用～个人账户余额可扩大用于支付已参加城镇居民基本医疗保险的家庭成员门诊费用～实现家庭互济～也可用个人账户结余额支付住院医疗费中应由个人负担的医疗费用～个人账户余额不足支付个人负担费用的～剩余部分由个人现金支付。 统筹基金主要用于支付住院的医疗费用和喀什地区特殊慢性病门诊的费用。 八、什么是住院起付标准和最高支付限额,是如何确定的, 答:住院起付标准又称起付线～是指统筹基金支付前按规定必须由个人负担的医疗费用额度～也就是通常所说的统筹基金支付的“门槛”,最高支付限额是指统筹基金支付的上限～即“封顶线”。 我区住院起付标准和最高支付限额几次政策调整～目前确定为:一级及以下医院为200元～二级400元～三级医院为600元～在一个自然年度内每次住院均需支付相应级别医院的起付费用。一个自然年度内～城镇职工基本医疗保险统筹基金最高支付限额为50000元。 城镇职工基本医疗保险在职职工住院报销比例调整表,2011年8月 调整, 医院等级 医疗费用,元, 原标准 新标准 set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 统等% 个人% 统等% 个人% 101---10000 85 15 90 10 一级 10001---25000 88 12 93 7 25001---50000 92 8 97 3 201---10000 80 20 85 15 县二级 10001---25000 85 15 90 10 25001---50000 90 10 95 5 401---10000 75 25 80 20 地区二级 10001---25000 80 20 85 15 25001---50000 85 15 90 10 601---10000 70 30 75 25 三级医院 10001---25000 75 25 80 20 25001---50000 80 20 85 15 九、为什么要制定基本医疗保险统筹基金的起付标准和最高支付限额, 答:制定基本医疗保险统筹基金的起付标准和最高支付限额～目的就是限定基本医疗保险统筹基金的支付范围～明确统筹基金的支付责任。统筹基金的支付范围明确以后～个人账户的支付范围也就相应明确～不在统筹基金支付范围的医疗费用～可以由个人账户支付。统筹基金起付标准～就是准予进入统筹基金支付的“门槛”定为400～那么～一个人发生400以内的费用～不在统筹基金支付范围内～只有发生400以上的费用～才能由统筹基金对超出400元以上部分医疗费用按比例支付。 十、参保职工就医～如何按规定享受基本医疗保险待遇, set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 答:,1,参保人员要在基本医疗保险定点医疗机构就医、购药～也可按处方到定点零售药店外购药品。在非定点医疗机构就医和非定点药店购药发生医疗费用～除符合急诊、转诊等规定条件外～基本医疗保险基金不予支付。 ,2,所发生医疗费用必须符合基本医疗保险药品目录～诊疗项目～医疗服务设施标准的范围和给付标准～才能由基本医疗保险基金按规定予以支付。超出部分～基本医疗保险基金将按规定不予支付。 ,3,对符合基本医疗保险基金支付范围的医疗费用～要区分是属于统筹基金支付范围还是属于个人账户支付范围。属于统筹基金支付范围的医疗费用～超过起付标准以上的由统筹基金按比例支付～最高支付到“封顶线”为止。个人也要负担部分医疗费用～“封顶线”以上费用则全部由个人支付或通过参加补充医疗保险～商业医疗保险等途径解决。起付标准以下医疗费用由个人帐户解决或由个人自付～个人帐户有结余的～也可以支付统筹基金支付范围内应由个人支付的部分医疗费用。 十一、为什么要制定《基本医疗保险药品目录》, 答:制定《基本医疗保险药品目录》的根本目的是为了保证城镇职工的基本医疗需求～保证基本医疗保险基金的收支平衡。 十二、什么是甲～乙类药品～自费药品主要有哪些, 答:纳入国家和自治区《药品目录》的药品～都是临床必须～安全有效～价格合理～使用方便～市场能够保证供应的药品。该目录分为甲类和乙类。 “甲类目录”的药品是临床治疗必需～使用广泛～疗效好～同类药品中价格低的药品。使用甲类目录的药品所发生的费用可直接进入统筹基金按规定支付。 “乙类目录”的药品是可供临床治疗选择使用～疗效好～同类药品中价比“甲类目录”的药品价格略高的药品。使用乙类目录的药品所发生的费用～目前喀什地区规定先由职工自付5%set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 比例后～95%的药品费进入统筹基金再按规定支付。 自费药品的主要种类有:,1,营养滋补～保健作用的单味中药～中药饮片及中成药～如十全大补膏等,,2,可以入药的动物脏器～干,水,果类如鹿茸～蝎子～胎盘等,,3,用中药材和中药饮片泡制的各类酒制剂～如杜仲酒等,,4,各类药品中的果味制剂～口服泡腾剂～如果味维生素C～阿斯匹林泡腾片等。 十三、为什么要制定城镇职工基本医疗保险诊疗项目目录, 答:在疾病治疗过程中～除使用药品外～还需要一系列的技术劳动服务～并利用各种仪器设备和医用材料进行诊断和治疗～这些诊断和治疗所消耗的成本～除一部分通过财政部拨款对医疗机构进行补偿外～大部分需要通过收费进行补偿。对参加基本医疗保险的参保人员来讲～参保人员享受诊疗服务所发生的费用～需要通过基本医疗保险基金予与支付。随着医学技术的不断发展～临床各种诊断～治疗手段日新月异～新的诊疗设备不断涌现。如在影像诊断学领域～计算机技术的应用～在八十年代出现了CT,MRI等新型的放射诊断技术,在临床治疗领域～器官移植技术的逐步成熟～基因工程技术的应用～许多疾病可以通过臵换器官～改变人体细胞的基因等技术得到有效的治疗。临床诊疗技术的发展～给人类战胜疾病～延长寿命带来了福音～但也使社会用于医疗服务的费用急剧增加。世界各国在八十年代出现的医疗费用迅速增长的现象～与这一客观因素有密切的关系。但是～无论是发达国家～还是发展中国家～医疗卫生资源总是有限的～特别是在我国目前生产力还不发达的历史时期下～按照财政和企业实际承受能力建立的基本医疗保险～所能筹集到的基本医疗保险基金更是非常有限～不可能将各种诊疗手段都纳入基金的支付范围～必须根据基本医疗保险基金的支付能力～确定一个可以支付费用的诊疗项目范围～项目确定的随意性较大～一些疗效不确切的项目也大量用于临床,由于部分医疗机构片面追求经济利益～存在乱检查～重复检查等不良行为。这些方面的缺陷和set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 不正当行为～造成了医疗费用的大量浪费。因此～有必要通过制定诊疗项目目录等办法～从基本医疗保险的角度加强对诊疗项目的管理。 十四、喀什地区参保人员如何就医购药, 答:基本医疗保险实行定点医疗机构～定点零售药店管理制度。参保人员可在获得定点资格并与社会保险经办机构签订服务协议的医疗机构和零售药店～自主选择定点医疗机构～定点零售药店就医～购药。 十五、基本医疗保险住院床位费支付标准是什么～它是如何确定的, 答:基本医疗保险住院床位费支付标准～由各统筹地区劳动保障行政部门按照本省物价部门规定的普通住院病房床位费标准确定。我区现行基本医疗保险住院病房床位费标准是:三级医院11元/人,二级医院9元/人,一级医院7元/人。之所以提出这一标准～主要是参考了公费、劳保医疗制度关于按多人间普通病房床位费标准报销的规定～这一方面与我国社会主义初级阶段的国情相适应～另一方面也与基本医疗保险保障基本医疗的原则相一致。 十六、基本医疗保险不支付生活服务项目和服务设施费用有哪些, 答:基本医疗保险基金不予支付的生活服务项目设施费用～主要包括五大类:一是就,转,诊交通费、急救车费,二是空调费、电视费、电话费、婴儿保温箱费、食品保温箱费、电炉费、电冰箱费及损坏公物赔偿费,三是陪护费、护工费、洗理费、问诊煎药费,四是膳食费,五是文娱活动费以及其他特需生活服务费用。之所以规定上述生活服务项目和服务设施费用不予支付～主要是考虑这些项目有的不是诊断、治疗和护理过程中必需的～如电视、电话、电冰箱等～有的虽必需～但属于个人或单位责任～如就诊交通费、急救车费、膳食费等。 十七、基本医疗保险医疗服务设施费用包括哪些费用, set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 答:基本医疗保险医疗服务设施费用主要包括住院床位费及门,急,诊留观床位费。根据各省,市、区,物价部门的规定～住院床位费和门,急,诊留观床位费主要包括三类费用:一是属病房基本配臵的日常生活用品如床、床垫、床头柜、椅、蚊帐、被套、床单、热水瓶、洗脸盆,桶,等的费用～二是院内运输用品如担架、推车等的费用～三是水、电等费用。对这些费用～基本医疗保险基金不另行支付～定点医疗机构也不得再向参保人员单独收费。 十八、喀什地区基本医疗保险统筹基金支付范围和报销比例是什么, 答:,1,支付范围:住院病人医疗费凡在《新疆维吾尔自治区城镇职工基本医疗保险药品目录、诊疗项目目录及服务设施项目》范围内～均属统筹支付范围。其中又分甲、乙类。 十九、为什么要建立大额医疗互助金, 答:建立大额医疗互助金主要是为了保证职工在享受基本医疗保险的基础上～职工在患大病期间获得一定的医疗补助～使职工得到更多的医疗保障。通过互助～增强职工抵御疾病风险的能力～防止和减少部分患大病职工看不起病导致因病致贫～充分体现党和政府对这部分人的关心。 二十、参加大病医疗互助的范围有哪些, 答:凡参加城镇职工基本医疗保险的单位和个人～必须同时参加城镇职工大病医疗互助。 二十一、大病医疗互助金如何缴纳费用, 答:喀什地区城镇职工大病医疗互助金由个人,含退休职工,按每人每月10元的标准由个人和单位共同缴纳～其中个人缴纳5元～全年60元。 二十二、大病医疗互助金如何报销的, 答:参保职工每人每年大额医疗保险最高支付限额为15万元。对进入大额医疗补助范围内的医疗费10万元以下,含10万set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 元,部分按90,予以支付～超过10万元以上部分按95,支付。 二十三、参保职工如何办理转诊转院手续, 答:经本区二级定点医疗机构多次会诊、检查仍未确定诊断的疑难病症～患者病情危重～二级定点医疗机构无条件,无设备或技术,进行检查治疗需转州境外诊疗的～经科主任提出～院长签署意见后转诊。境外转诊只能按病情选择一所医疗机构～如需转第二所医疗机构～必须有第一所医疗机构的转院证明。 参保人员外出看病就医必须办理转院手续～凡未经同意而自行转诊、自找医院、自购药品的费用～社会保险经办机构不予支付。 二十四、参保人员转诊出院后医疗费用应如何报销, 答:参保人转外治疗的～其费用先由个人全额垫付～治疗结束后持转诊证明、辅助检查单、加盖公章的住院完整病历的复印件、有效医疗费收据、结算明细清单和其它诊疗检查记录及单位证明～到参保地的社会保险经办机构办理报销手续。 二十五、参保人员因公出差、探亲、旅游等在外地突发急病住院后医疗费应如何报销, 答:公差、探亲、节假日在乡或街道以上国有公立医疗机构发生的急诊住院费用～凭急诊证明、加盖公章的住院完整病历的复印件、有效医疗费收据、结算明细清单、辅助检查单及其它诊疗检查记录到参保地的社会保险经办机构按规定报销。 二十六、参保职工医保卡丢失后如何办理挂失和补办手续, 答:参保职工医保卡丢失的～应及时办理书面挂失。凭本人身份证、户口簿到参保地的社会保险经办机构办理挂失手续。 二十七、异地安臵职工主要包括哪些人, 答:异地安臵的职工主要指:异地安臵的退休职工～包括集中安臵、投靠子女居住的退休职工,异地工作的职工～即长期派驻外地工作的职工。 二十八、异地安臵人员如何选择医院就医, set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 答:长期派驻外地及异地安臵、居住的参保人员～在居住地住院治疗的～要向参保地的社会保险经办机构办理申请手续。可在当地选择3家定点医疗医院～填写《城镇职工基本医疗保险异地人员登记表》～加盖现居住地市,县,以上医疗保险经办机构的公章～由所在单位盖章后～交统筹地同级社会保险经办机构审核确认～经确认方可按规定享受基本医疗保险待遇。如居住地及定点医疗机构发生变动～应在10日内与所在单位联系～由所在单位到参保地的社会保险经办机构办理变更手续。 二十九、基本医疗保险异地安臵人员住院医疗费用如何报销, 答:异地安臵的参保职工在异地住院治疗所发生的医疗费按统筹地区规定的报销比例核报。异地安臵的参保职工在居住地因病住院发生的医疗费用～先由本人垫付后～提交住院结算清单、出院小结、病历复印件、发票等材料到参保地的社会保险经办机构办理费用支付手续。 三十、什么是医疗保险最低缴费年限, 答:灵活就业人员医疗保险最低缴费年限是职工办理退休手续时～缴纳基本医疗保险费的最低年限～必须达到男满30年、女满25年。用人单位和职工自参加基本医疗保险之月起连续不间断缴费至国家法定退休年龄～缴费年限已达到最低缴费年限的～可按有关规定享受退休人员医疗保险待遇。 三十一、喀什地区城镇职工基本医疗保险十二种殊慢性病包括哪些,标准是多少, 喀什地区城镇职工基本医疗保险十二种门诊特殊慢性病及标准 序号 项目 标准 1 慢性阻塞性肺疾病 1000元 2 肺源性心脏病 2000元 3 高血压?期以上(含?期) 1800元 4 冠状动脉粥样硬化性心脏病 3000元 set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 5 脑血管意外后并发症、后遗症 2500元 6 糖尿病 2500元 7 各种恶性肿瘤 5000元 肾病综合症 3000元 慢性肾炎 1200元 8 慢性肾功能衰竭 药物治疗8000元 透析治疗及肾移植后抗排异用药的50000元 透析费用及药品费用 9 精神病 2500元 10 系统性红斑狼疮 3000元 11 肝硬化 2000元 12 白血病 5000元 三十二、参保人员怎样申请特殊慢性病, 答:参保人员因患有规定范围内的病种～病人可以申请慢性病病种鉴定～必须本人的所在单位申请～经劳动行政部门审查同意后～报劳动和社会保障局统一组织进行鉴定。 慢性病鉴定需上报的材料:,1,县市劳动行政部门或主管部门要求鉴定的申请报告,,2,本人近期病史～病历复印件、有关诊断证明材料,,3,填报《特殊慢性病人员名单表》及《医疗保险特殊慢性病种门诊治疗资格审批表》。 三十三、特殊慢性病门诊治疗带药规定是什么, 答:持《喀什地区特殊慢性病门诊治疗证》的患者在门诊就医时～若使用注射剂～门诊处方带药量不得超过一周,口服药品带药量一般不超过30天。 十三四、喀什地区异地安臵人员的特殊慢性病种门诊费如何报销, 答:持《基本医疗保险特殊慢性病异地人员门诊治疗证》的人员发生的医疗费用先自行垫付～凭用药及检查治疗有效处方、门诊有效票据由单位经办人到所属地的社会保险经办机构按规定报销。 set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 三十五、为什么国家要对公务员实行医疗补助, 答:保障国家公务员的医疗待遇～在参加城镇职工基本医疗保险的基础上～实行医疗补助的办法～是借鉴了国际上的通行做法～更重要的是考虑到我国国家公务员的工作性质和特点。国家公务员是保证国家公务正常运转～研究制定国家政策并监督国家政策贯彻实施的一支特殊队伍～必须保证队伍稳定～高效廉洁～他们的健康问题直接关系到国家机关的运行效率。同时～在我国现实国情下～国家公务员的收入水平还不能提高到应有的水平～对医疗费用的负担能力有限。因此～为了保证国家公务员的健康水平和国家机关的勤政廉政～保证国家公务员医疗待遇水平不下降～《决定》规定对公务员实行医疗补助。 三十六、对国家公务员实行医疗补助的总体思路是什么, 答:一是补助经费的拨付标准可按照改革前后公务员医疗费支出不减少的原则～考虑财政实际承受能力～按改革前公务员实际医疗费支出～减去基本医疗保险单位缴费水平后的实际余额合理核定。公务员医疗补助经费按现行财政管理体制列入当年财政预算, 二是补助经费的给付范围主要包括:基本医疗保险统筹基金最高支付限额以上的费用,在最高支付限额以下个人自付超过一定数额的医疗费用～和按政策规定享受医疗照顾的医疗费用, 三是补助经费由社会保险经办机构集中统一管理～单独建账～专款专用～统一结算。 三十七、公务员医疗补助范围有哪些, 答:,1,补助个人账户医疗费用,,2,补助年度内基本医疗保险基金最高支付限额以下个人支付超过一定比例的医疗费,,3,补助基本医疗保险基金最高支付限额以上～符合自治区“三个目录”范围按规定须由个人支付的医疗费。 三十八、公务员医疗补助办法是什么, 答:个人账户部分国家公务员均能享受以上年度月平均工资的1,标准划入个人账户,统筹基金基本医疗保险最高支付限set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet 额以下部分～个人自付超过本人年工资收入5,以上部分予以100,补助。超过个人工资收入1,以上部分予以补助90,。 三十九、为什么退休人员不缴纳医疗保险费, 答:规定退休人员不缴纳基本医疗保险费～一是社会医疗保险的性质决定的～社会医疗保险要体现互助共济～健康人帮助生病的人～退休职工一般患病较多～是需要社会照顾的脆弱人群,二是为了均衡企业负担～为企业提供公平竞争的机会～参与市场竞争,三是考虑到退休人员在以前的工作期间～已经为社会作出了贡献～退休后收入低～特别是现在已经退休的职工～没有足够的用于医疗支出的积累～医疗负担较重。因此～《决定》除规定退休职工个人不缴纳医疗保险费外～还规定了在单位缴费划入个人账户的金额和个人负担医疗费用的比例给予照顾。 set a data (intranet), and each ward set up a TV outlet. 2 doctor's Office: each doctor-station set up a net two-hole data socket + an audio socket. A TV Socket 3 nursing officer, Office of the Director: each station sets two-hole data socket (1 internal and 1 external) + a speech empty seats. Set up a TV outlet. 4 duty: each station sets a two-hole data socket (1 internal and 1 external) + a voice, setting up a TV outlet. 5 nursing station: every nurse station set up two double-hole data (intranet) + a voice double socket. 6 treatment and disposal areas: two data sets in each room (internal) + phonetic double-socket. 7 shows the classroom: each room set with two double-hole data (intranet and Internet + voice double socket and two television outlets. Outpatient area: 8 Office: each doctor workstation sets a two-hole data socket (internal) + a speech empty seats. 9 related equipment or its control room: sets a two-hole data socket (internal) + a speech empty seats. A television outlet. 10 hemodialysis: each bed set a double hole data socket (intranet). A television outlet. Surgery Center: 11 four two-hole data Sockets in each operating room. A television outlet. ICU area: 12 ICU beds set up an intranet data two-hole outlet. A room of a television outlet. Information points of distribution statistics following table: network, voice information points distribution statistics (medical floor, rehabilitation floor, 1th, floor, 2nd, floor) serial number F1 F2 F3 F4 F5 B1 B2 intranet outside network voice intranet outside network intranet outside network voice intranet outside network voice intranet outside network intranet outside network intranet