为了正常的体验网站,请在浏览器设置里面开启Javascript功能!

新生儿医保政策

2017-10-12 50页 doc 150KB 32阅读

用户头像

is_633423

暂无简介

举报
新生儿医保政策新生儿医保政策 早产儿宝宝的家长们注意了: 如果您的宝宝符合国家计划生育政策,而且您又是城镇居民户口的话,那您一定要注意了:宝宝的医院费用是可以报销的,具体步骤: 1、宝宝出生后在出生医院办理医学出生证明。注意:宝宝并不一定要出院才能办,只要宝宝母亲出院就可以办理,如宝宝父亲办理,需要宝宝妈妈填写授权证明(授权证明在妈妈出院前向所在医院产科索取) 2、带齐医学出生证明、结婚证、户口本、计划生育登记证(准生证)、身份证(父母双方)到户籍所在地派出所给宝宝登记上户口。(以上证件派出所都要留复印件,需要提前准备,另外宝宝名字...
新生儿医保政策
新生儿医保政策 早产儿宝宝的家长们注意了: 如果您的宝宝符合国家生育政策,而且您又是城镇居民户口的话,那您一定要注意了:宝宝的医院费用是可以报销的,具体步骤: 1、宝宝出生后在出生医院办理医学出生证明。注意:宝宝并不一定要出院才能办,只要宝宝母亲出院就可以办理,如宝宝父亲办理,需要宝宝妈妈填写授权证明(授权证明在妈妈出院前向所在医院产科索取) 2、带齐医学出生证明、结婚证、户口本、计划生育登记证(准生证)、身份证(父母双方)到户籍所在地派出所给宝宝登记上户口。(以上证件派出所都要留复印件,需要提前准备,另外宝宝名字要想好,一旦登记再要改名有点麻烦) 3、带齐医学出生证明、结婚证、宝宝户口本、计划生育登记证(准生证)到所在街道(乡镇)社会保障服务中心交30元给宝宝办理新生儿城镇居民基本医疗保险。(注:在当地社保中心只能拿到医保本,不能拿到医保卡,不能直接用来报销) 4、带齐医学出生证明、宝宝户口本、计划生育登记证(准生证)、新生儿城镇居民医疗保险本到当地市级医保中心联系办理城镇居民医疗保险卡,拿到卡后就能报销,而且可以直接在医保定点医院刷卡治疗。(注:办卡一般需要3个月,of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 若办理时宝宝还在住院,可以到医院开个住院证明,然后申请一张15天的特急卡) 注意:城镇居民医保条例规定新生儿6个月以内办理城镇医保的从出生之日起享受医保待遇,如6个月以后办理,需要在办卡的第二年才能享受,请广大宝宝家长注意了。另外宝宝每年保费才30元(个别地区40元),可以报销的部分达80%,我家宝宝住院42天,总共医院花了3W8,一共报销到2W4,差不多65%. 八成武汉人今年进"医保" 新生儿上户口就参保 汉网2008 -03-03 稿件来 武汉晚报 www.cnhan.com 08:19:49 源: ?低保人员、重度残疾人100%参保 ?九成以上少年儿童和中小学生参保 ?五类居民可自愿参保 ?新生儿上户口就可参保 ?学生参保一年只交20元 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 市民得到满意答案,与咨询人员握手致谢。 专咨询吸引了不少市民。 我市是全国城镇居民医疗保险的首批试点城市。去年, of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 我市已有55万居民办理了参保登记。今年市政府为民办理的十件实事中,承诺全市居民参保率将达到80%,并尽量提高低收入家庭老人和劳动年龄内非从业人员的参保率。副市长孙亚表示,今年,我市将确保低保人员、重度残疾人100%参保,少年儿童和中小学生参保率超过90%,争取八成城镇居民进医保。 连日来,不少读者致电本报《百姓问政》咨询:哪些人办城镇居民医保,有哪些程序,就此,记者昨日采访了市劳动和社会保障局医保处处长李文韬。 【参保范围】 五类城镇居民可自愿参保 根据我市城镇居民医保试点政策,具有我市城镇户籍,且不属于职工医保覆盖范围的5类城市居民,可参加居民医保: 一、各类中小学阶段的在校学生(包括职业高中、中专和技校学生)、少年儿童及其他18周岁以下的居民; 二、享受低保的对象; 三、丧失劳动能力的重度残疾人; of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 四、未按月享受养老金或退休金待遇且无固定收入的60周岁以上的老人; 五、18周岁及以上,60周岁以下的其他非从业城镇居民。 参保均以自愿为原则,每年缴费一次,缴费额由政府补助和个人缴费共同构成。从缴费次年的1月1日起,参保人员即可享受居民医保待遇,报销一定比例的普通门诊、门诊重症和住院的医疗费用。 据悉,江岸、江汉等7个中心城区的城镇居民医保实行市级统筹,受惠人群达121万余人。蔡甸、江夏、东西湖、汉南、黄陂和新洲等6个远城区,根据新政策制定该区实施意见,暂实行区级统筹。 【享受待遇】 ?一年最多报销3万元 在一个保险年度内,医保基金累计支付的参保居民符合条件的医疗费用,最高限额为3万元。居民连续参保缴费满3年及以上的,医保基金支付的最高限额会更高。居民中断缴费后再次参保的,视同首次参保。 ?门诊费一年最多报30元 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 参保缴费的居民,从缴费次年的1月1日起,即可享受居民医保待遇。新生儿从参保缴费的次月起,享受基本医疗保险待遇。未按时足额缴费的,不能享受居民医保待遇。 居民医保参保者可享受门诊报销待遇。在一个保险年度内,参保居民在定点医疗机构发生的普通门诊费,在100元及以下的,医保基金支付30%;100元以上的费用个人自理。 参保居民还可在门诊进行恶性肿瘤放化疗、慢性肾功能不全透析和肾移植术后抗排异等3种重症疾病治疗,医疗费用由医保基金按一定比例给予补助。 ?“小医院”报销比例大 参保居民生病住院,将按其所住的医院等级,设不同的起付线。起付线以下,由个人支付,起付线以上的,由医保基金和参保居民按比例分担。具体比例为: 在社区卫生服务中心、一级医疗机构和惠民医院住院的,医保基金支付60%;在二级医疗机构住院的,医保基金支付50%;在三级医疗机构住院的,医保基金支付40%。 参保居民因危、急、重症等情况在门诊实施紧急抢救of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 后需住院的,其紧急抢救费用并入住院医疗费用;经抢救后不需要住院的,其紧急抢救医疗费用并入普通门诊医疗费用。 ?用乙类药个人先付10% 参保居民在门诊治疗重症疾病和住院,属于城镇职工基本医疗保险统筹基金支付部分费用的诊疗项目和药品范围内乙类药品的医疗费用,由个人先付10%,余额再按其就医医院的等级,按上述比例报销。 定点社区卫生服务中心,原则上使用城镇职工基本医疗保险药品目录的甲类药品,诊疗必需的,可按国家和省规定使用部分乙类药品。超出目录范围内的医疗费用,医保基金将不予报销。 参保居民按规定使用体内置放材料、置换人工器官和血液制品的医疗费用,医保基金将按一定比例支付。 ?赴外地就医个人先付10% 参保居民经批准转往外地医疗机构就医,所发生的住院医疗费用,先由个人自付10%,余额再按其所就医的医院,按规定的比例报销。 ?治疗结束后30天内报销 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 参保居民可在定点医疗机构中,自主选择就医。目前我市所有的城镇职工医保定点医疗机构,均为居民医保定点医疗机构。 居民因病情需要转往城镇职工转院定点医疗机构或外地医疗机构治疗的,须由本市定点三级医疗机构按规定办理转诊手续,并报社保经办机构核准。除紧急抢救外,未按规定办理转诊手续发生的医疗费用,医保基金不予支付。 参保居民在定点医疗机构发生的医疗费用,个人应负担的部分,由个人支付;医保基金应支付的部分,由定点医疗机构记账。因转诊或紧急抢救发生的医疗费用,先由个人垫付,在治疗结束后的30日内,持有关单据到社保经办机构审核报销。 ?五类情形不报销 根据规定,有以下情形之一的,医保基金将不予支付: 1、在国外或港、澳、台地区治疗的; 2、自杀、自残的(精神病除外); 3、斗殴、酗酒、吸毒及其他违法犯罪行为所致伤病的; 4、交通事故、意外伤害、医疗事故等由他方承担医疗of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 费赔偿部分的。 5、按规定不予支付的其他费用。 【参保手续】 新生儿上了户口就可参保 符合条件的居民,可携带户口簿、身份证及其复印件、照片,低保对象和重度残疾人还需分别提供低保证和残疾证,到户籍所在地或居住地社区居委会办理参保登记。 参保后居民每年缴费一次,缴费期限为每年的11月1日至12月30日。 新生儿可在完成户籍登记后,即可办理参保登记手续,并缴纳当年的基本医疗保险费。 【缴费方式】 学生参保一年只交20元 居民医保每年缴费一次,缴费额由个人缴费和政府补助构成。具体标准为: 1、各类中小学阶段的在校生、少年儿童及其他18周岁以下的居民,政府每人每年补助80元,家庭(个人)每of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 人每年缴纳20元; 2、低保对象、丧失劳动能力的重度残疾人,由政府全额补助,家庭(个人)不缴费; 3、未按月享受养老金或退休金待遇且无固定收入的60周岁及以上老人,政府每人每年补助370元,家庭(个人)每人每年缴纳50元。 4、18周岁及以上,60周岁以下的其他非从业城镇居民,政府每人每年补助80元,家庭(个人)每人每年缴纳340元。 同时具备上述两项及以上补助条件的参保居民,按政府补助额"就高不就低",不重复补助。 武汉市城镇居民基本医疗保险试行办法(武政[2007]84号)中规定:(1)新生儿可在完成户籍登记后办理参保登记手续,并缴纳当年的基本医疗保险费。(2)新生儿从参保缴费的次月起开始享受居民医保待遇。 各位要是还没给自己的宝宝办理的话可以携带户口簿、身份证及其复印件、照片到户籍所在地或居住地社区居委会办理参保登记。 武汉市城镇居民基本医疗保险试行办法(武政[2007]84号) 第一章 总 则 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 第一条 为进一步建立健全多层次医疗保障体系,保障城镇居民的基本医疗需求,根据《国务院关于开展城镇居民基本医疗保险试点的指导意见》(国发[2007]20号)精神,结合本市实际,制定本办法。 第二条 本市行政区域内城镇居民基本医疗保险(以下简称居民医保)适用本办法。蔡甸、江夏、东西湖、汉南、黄陂和新洲区可依据本办法,并结合各区实际制定实施意见,暂实行区级统筹。 第三条 建立居民医保制度应当遵循以下原则: (一)坚持低水平起步,筹资水平和保障标准与我市经济社会发展水平以及各方面的承受能力相适应的原则; (二)坚持自愿参保,权利与义务对等的原则; (三)坚持家庭(个人)缴费为主,政府给予适当补助的原则; (四)坚持以收定支,收支平衡,略有结余的原则; (五)坚持与城镇职工基本医疗保险、新型农村合作医疗和社会医疗救助统筹兼顾、协调发展的原则。 第四条 劳动保障部门是本市居民医保工作的主管部门,负责居民医保的组织实施和管理。各级社会保险经办机构(以下简称社保经办机构)负责经办居民医保日常业务工作,街道办事处(乡镇人民政府,下同)和社区居委会配合经办有of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 关业务工作。各级社保经办机构、街道和社区的编制、人员和工作经费要与居民医保的实际工作量相适应。 各区人民政府及发展改革、财政、民政、卫生、地税、编制、教育、公安、食品药品监督、统计、残联等有关单位和部门应当在各自职责范围内,共同做好居民医保的相关工作。 第二章 参保登记缴费 第五条 居民医保参保范围是具有武汉市城镇户籍、不属于城镇职工基本医疗保险制度覆盖范围的城镇居民。具体对象包括: (一)各类中小学阶段的在校学生(包括职业高中、中专和技校学生,下同)、少年儿童及其他18周岁以下的居民; (二)18周岁及以上的非从业居民; (三)未按月享受养老金或退休金待遇的60周岁及以上老人。 第六条 参保登记业务工作实行社保经办机构负责,街道办事处、社区居委会配合经办。各类在校中小学学生参保工作,由学校统一组织登记。 第七条 居民须携带户口簿、身份证及其复印件、照片,享受城市最低生活保障的对象(以下简称低保对象)和丧失劳of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 动能力的重度残疾人(以下简称重度残疾人)还需分别提供低保证和残疾证,到户籍所在地或居住地社区居委会办理参保登记。 第八条 居民医保费实行地税征收。参保居民每年缴费一次,缴费期限为每年的11月1日至12月20日。新生儿可在完成户籍登记后办理参保登记手续,并缴纳当年的基本医疗保险费。 第九条 参保登记的信息上报、审核与确认等业务实行网上办理,劳动保障部门及其经办机构应与公安、民政、卫生和残联等单位和部门实现计算机网络联通,并延伸到街道和社区。 第三章 基金筹集 第十条 城镇居民基本医疗保险基金(以下简称医保基金)主要由家庭(个人)缴费、政府补助资金和基金利息构成。政府补助资金列入财政预算。地方政府补助资金由市、区财政各承担50%。 第十一条 各类中小学阶段的在校学生、少年儿童及其他18周岁以下的居民筹资水平为每人每年100元,18周岁及以上居民筹资水平为每人每年420元。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 第十二条 政府补助和家庭(个人)缴费按下列标准确定: (一)各类中小学阶段的在校学生、少年儿童及其他18周岁以下的居民,政府每人每年补助80元,家庭(个人)每人每年缴纳20元。 (二)18周岁及以上的非从业居民,政府每人每年补助80元,家庭(个人)每人每年缴纳340元。 (三)未按月享受养老金或退休金待遇的60周岁及以上老人,政府每人每年补助370元,家庭(个人)每人每年缴纳50元。其他60周岁及以上老人,政府每人每年补助80元,家庭(个人)每人每年缴纳340元。 上述参保居民中的低保对象、重度残疾人,由政府全额补助,家庭(个人)不缴费。 第十三条 鼓励有条件的用人单位对职工家属参保给予补贴,并按国家规定享受有关税费优惠政策。 第四章 居民医保待遇 第十四条 医保基金用于支付参保居民符合规定的门诊和住院医疗费用。 第十五条 居民医保的保险年度按自然年度计算。按规定参保缴费的居民,从缴费次年的1月1日起享受居民医保待遇;新生儿从参保缴费的次月起开始享受居民医保待遇。未按时足额缴费的,不能享受居民医保待遇。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 第十六条 居民医保的门诊包括普通门诊和在门诊治疗重症疾病。 一个保险年度内,参保居民在定点医疗机构发生的普通门诊医疗费,在100元及以下的,医保基金支付30%;100元以上的费用,由个人自理。 参保居民在门诊进行恶性肿瘤放化疗、慢性肾功能不全(失代偿期)透析和肾移植术后抗排异等3种重症疾病治疗,医疗费用由医保基金按50%给予补助。 第十七条 参保居民的住院医疗费用,起付标准以下的由个人支付;起付标准以上的,由医保基金和参保居民按比例分担。 (一)住院起付标准确定为:社区卫生服务中心和一级医疗机构200元,二级医疗机构400元,三级医疗机构800元。 低保对象在惠民医院住院起付标准为100元。 无劳动能力、无固定收入、无法定赡养人或抚养人的居民在惠民医院住院,不设起付标准。 一个保险年度内,参保居民两次及以上住院的,起付标准减半。 (二)在起付标准以上的住院医疗费用,医保基金的支付比例分别为:在社区卫生服务中心、一级医疗机构和惠of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 民医院住院的,医保基金支付60%;在二级医疗机构住院的,医保基金支付50%;在三级医疗机构住院的,医保基金支付40%。 第十八条 参保居民因危、急、重症等情况在门诊实施紧急抢救后住院的,其紧急抢救费用并入住院医疗费用。 第十九条 居民医保的药品目录、诊疗项目目录、医疗服务设施范围和支付标准参照城镇职工基本医疗保险的有关规定执行,并按国家和省规定适当增加适宜少年儿童诊疗的药品、诊疗项目和服务设施范围。 定点社区卫生服务中心原则上使用城镇职工基本医疗保险药品目录的甲类药品,诊疗必需的,可以按国家和省规定使用部分乙类药品。 超出目录范围的医疗费用,医保基金不予支付。 第二十条 参保居民在门诊治疗重症疾病和住院,属于城镇职工基本医疗保险统筹基金支付部分费用的诊疗项目和药品目录范围内乙类药品的医疗费用,先由个人自付10%,余额再按本办法第十六条和第十七条的规定办理。参保居民按规定使用体内置放材料、置换人工器官和血液制品的医疗费用,医保基金支付35%。 第二十一条 参保居民经批准转往外地医疗机构就医发生的住院医疗费用,先由个人自付10%,余额再按本办法第十of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 七条和第二十条规定办理。 第二十二条 在一个保险年度内,医保基金累计支付参保居民符合规定的医疗费用的最高限额为3万元。居民连续参保缴费满3年及以上的,医保基金最高支付限额提高到4万元。中断缴费后再次参保的,视同首次参保。 第二十三条 参保居民在定点社区卫生服务中心就诊,仍然执行《市人民政府关于加强城市卫生服务工作保障社区居民基本医疗卫生服务的意见》(武政,2005,10号)规定的“五免”政策,减免费用由政府补助。 第二十四条 有下列情形之一的医疗费用,医保基金不予支付: (一)在国外或港、澳、台地区治疗的; (二)自杀、自残的(精神病除外); (三)因违法犯罪行为所致伤病的; (四)交通事故、意外伤害、医疗事故等由他方承担医疗费赔偿责任部分的; (五)按有关规定不予支付的其他费用。 第五章 医疗服务管理和费用结算 第二十五条 参保居民就医实行定点医疗机构管理。城镇职工医保定点医疗机构即为居民医保定点医疗机构,参保居民可在其中自主选择就医。劳动保障部门根据需要,适当增加of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 妇幼专科医疗机构作为居民医保定点医疗机构。社保经办机构应与各定点医疗机构签订居民医保医疗服务协议。 第二十六条 参保居民因病情需要转往城镇职工转院定点医疗机构或外地医疗机构治疗的,须由本市定点三级医疗机构按规定办理转诊手续,并报社保经办机构核准。除紧急抢救外,未按规定办理转诊手续发生的医疗费用,医保基金不予支付。 第二十七条 参保居民在定点医疗机构发生的医疗费用,个人应负担的部分,由个人支付;医保基金应支付的部分,由定点医疗机构记账。因转诊或紧急抢救发生的医疗费用,先由本人垫付,在治疗结束后的30日内,持有关单据到社保经办机构审核报销。 第二十八条 居民医保医疗费用结算采取总额控制、定额结算、项目审核、年度清算。 第六章 基金管理 第二十九条 医保基金纳入财政专户管理,单独建账,专款专用,不得挤占挪用。 第三十条 医保基金的银行计息执行国家社会保险基金计息的有关规定。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 第三十一条 社保经办机构应按规定建立医保基金的财务会计和内部审计制度,编制医保基金的预、决算报告。 第三十二条 财政和劳动保障部门要加强对医保基金的监督管理;审计部门应定期对医保基金的收支和管理情况进行审计;卫生部门应指导和督促医疗机构通过规范管理,优化服务,提高医疗质量,保证医保基金合理支出。 第三十三条 建立由政府有关部门、居民代表、定点医疗机构和有关专家组成的医保基金监督组织,加强对医保基金的社会监督。 第三十四条 根据经济社会发展水平和居民医疗消费需求,劳动保障部门可会同财政部门对居民医保的筹资标准、财政补助标准、医保基金起付标准、最高支付限额和支付比例等提出调整意见,并按规定程序报批后执行。 第七章 相关责任 第三十五条 有关职能部门按照各自职责对定点医疗机构进行监督检查,定点医疗机构应当予以配合。 第三十六条 定点医疗机构应按照“合理施治、合理检查、合理用药”的原则为参保居民提供医疗服务,不得随意降低参保of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 居民的医疗待遇水平。 第三十七条 定点医疗机构违反居民医保有关管理规定和医疗服务协议,造成基金不合理支出和增加居民负担的,相应扣减其结算费用;情节严重的,取消定点资格。 第三十八条 对弄虚作假,采取隐瞒、欺诈等手段骗取医保基金的参保居民,视情节依法给予相应处罚。 第三十九条 劳动保障部门、社保经办机构及其工作人员滥用职权、玩忽职守,损害参保居民合法权益,或者造成医保基金流失的,依法给予行政处分;构成犯罪的,依法追究刑事责任。 第八章 附 则 第四十条 卫生部门应加大惠民医院的建设力度,并指导和督促惠民医院积极推行医药分家,降低医疗成本,按规定为参加居民医保的低保对象提供优惠服务。 第四十一条 劳动保障部门会同相关部门制定本办法的具体配套办法。 第四十二条 本办法由劳动保障部门负责解释。 第四十三条 本办法自发布之日起施行。 市人民政府关于调整武汉市城镇居民基本医疗保险有关政策的通知 武政规[2009]2号 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 各区人民政府,市人民政府各部门: 为了逐步提高城镇居民基本医疗待遇水平,根据《人力资源和社会保障部财政部关于做好2008年城镇居民基本医疗保险试点工作的通知》(人社部发[2008]39号)和《省人民政府关于武汉市调整城镇居民基本医疗保险政策的批复》(鄂政函[2009]25号)精神,结合我市居民医保运行实际,经研究,现就调整我市城镇居民基本医疗保险有关政策通知如下: 一、低保对象和重度残疾人个人不缴纳居民基本医疗保险费,其他个人缴纳的居民基本医疗保险费标准不变,政府提高补助标准,即:各类中小学阶段的在校学生、少年儿童及其他18周岁以下的居民筹资水平由每人每年100元提高到120元;18周岁及以上居民筹资水平由每人每年420元提高到440元,其中政府补助标准在原基础上提高20元。 二、居民医保在门诊治疗重症和慢性疾病的病种从3种扩大到10种,即:参保居民在门诊进行慢性肾功能不全(失代偿期)透析、肾移植术后抗排异、恶性肿瘤放化疗、高血压?期(有心、脑、肾并发症之一的)、糖尿病(合并感染或有心、肾、眼、神经并发症之一的)、重症精神病(精神分裂症、情感性精神病、脑器质性精神病)、慢性重症肝炎及肝硬变、帕金森氏病及帕金森氏综合症、系统性红斑狼疮、慢性再生障碍性贫血等疾病治疗,医疗费用由医保基金按50,给予补of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 助(详见后附医保基金年度支付限额情况表)。同时患有上述两种及以上疾病的医保基金支付比例不变,每增加一种疾病,年度支付限额在所患疾病最高支付限额基础上增加800元,但多种疾病年度支付限额累计不超过30000元。 三、提高医保基金支付居民住院的比例。医保基金对参保居民在起付标准以上的住院医疗费的支付比例分别为:在社区卫生服务中心、一级医疗机构和惠民医院住院由60,提高到80,,在二级医疗机构住院由50,提高到65,,在三级医疗机构住院由40,提高到50,。 四、本通知自2009年2月1日起施行。 二〇〇九年三月三日 武汉市城镇居民基本医疗保险门诊重症(慢性病) 各病种医保基金年度支付限额情况表 医保基金 医保基金 序号 病 种 年度支付 支付比例 限额(元) 慢性肾功能不全(失代 1 50% 30000 偿期)透析 2 肾移植术后抗排异 50% 30000 3 恶性肿瘤放化疗 50% 30000 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 高血压?期(有心、脑、 4 50% 4000 肾并发症之一的) 糖尿病(合并感染或有 5 心、肾、眼、神经并发50% 4000 症之一的) 重症精神病(精神分裂 6 症、情感性精神病、脑50% 1600 器质性精神病) 7 慢性重症肝炎、肝硬变 50% 4000 帕金森氏病及帕金森氏 8 50% 1200 综合症 9 系统性红斑狼疮 50% 2800 10 慢性再生障碍性贫血 50% 8000 关于印发《武汉市城镇居民基本医疗保险儿童医疗服务项目》的通知 武劳社[2007]171号 各区劳动保障局,各社会保险经办机构,各定点医疗机构: 根据《武汉市城镇居民基本医疗保险试行办法》(武政[2007]84号)和《武汉市城镇职工基本医疗保险诊疗项目管理办法》(武劳社[2001]117号)有关规定,为保证参保儿童的医疗需求,现将《武汉市城镇居民基本医疗保险儿童医疗服务项目》印发给你们,望认真贯彻执行。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 医疗保险中心有关业务办理程序 一、医疗保险费用结算(两定机构月度结算) 1.办事依据:《武汉市城镇职工基本医疗保险医疗费用结算办法》(武劳社[2001]125号) 2.办事程序: (1) 定点医疗机构和定点零售药店个人帐户费用报销程序: 1)每月10日前,各定点医疗机构和定点零售药店向所在辖区社保处医保科申报上月费用,提供《医疗保险个人帐户定点医疗机构门诊费用申报表》或《医疗保险个人帐户定点零售药店费用申报表》。保存门诊处方、购药明细及结算发票备查。并于10日前在华南结算系统中进行费用交接汇总,将系统数据提交至医保中心数据库。 2)社保处医保科对两定机构申报的费用进行审核,产生审核汇总表,20日前报医保中心审核科。 3)审核科对两定机构申报的费用进行复核,产生费用应付帐,次月10日前交付财务科。 (2)定点医疗机构住院费用申报程序: 1)每月10日前,各定点医疗机构向所在辖区社保处医保科申报上月住院费用,提供《住院医疗费用结算申报审核表》、《医疗保险住院医疗费用申报明细表》。保存结算发票、医疗保险定点医疗机构医疗费用结算清单、住院明of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 细费用清单备查。并在5日前将上月住院费用结算数据上传至医保中心数据库。 2)社保处医保科对定点医疗机构申报的住院费用进行审核,产生审核汇总表,20日前报医保中心审核科。 3)审核科对定点医疗机构申报的住院费用进行复核,产生费用应付帐,次月10日前交付财务科。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:1个月 二、医疗保险费用结算(定点零星报销,含大额段费用): 1.办事依据:《武汉市城镇职工在外地基本医疗保险管理办法》(武劳社[2001]123号) 2. 办事程序:定点零星报销包括长驻外地、易地安置人员和市内无卡费用报销。 (1)长驻外地、易地安置人员在外地发生的医疗费用,其出院后一个月内,由所在单位向辖区社保处申报结算; (2)无卡人员费用是指:参保人原卡损坏、丢失,新进已享受医保待遇的参保人员卡未做出来,长驻外地、异地安置人员回汉在定点住院住院(门诊治疗重症慢性疾病)发生的医疗费用。先由参保人垫付,出院后10日内由其单位向所在辖区社保处医保科申报结算。 3.需提交的材料:《医疗费用申报审核表》、发票、费用of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 清单、住院病历(出院等)、门诊重症慢性疾病需原始处方,无卡人员费用报销需无卡原因说明(单位盖章)。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:2个月 三、医疗保险费用结算(非定点零星报销,含大额段费用): 1.办事依据:《武汉市城镇职工基本医疗保险转院管理规定》(武劳社[2001]122号) 2.办事程序: (1)申报:在医院治疗后5个工作日内,由单位或个人将就医情况写成书面申请报告,单位盖章(灵活就业人员由辖区社保处盖章),附相关资料到市医保中心紧急抢救窗口申报。 (2)报销:审批通过的参保人员在出院后一个月之内,认真阅读填表说明,填写《医疗费用申报审核表》相应栏目并加盖公章,携申报审核表“第2条”规定的相关资料到医保中心申报窗口办理。 3.须提交的材料: (1)申报:申请报告、门诊急救病历、相关检查报告(主要的能说明病情严重程度的检查)、120急救发票等资料。 (2)报销:《医疗费用审核申报表》、发票原件、住院费用清单、医保卡和身份证复印件、出院小结、临时医嘱、of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 长期医嘱、病案首页、手术记录、麻醉记录、置换材料发票复印件。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限: (1)申报:收到参保人资料后7个工作日完成审批,并以电话形式通知经办人; (2)报销:每月15前上报的费用,次月拨付;每月15日后申报的费用,隔月拨付。 五、门诊重症(慢性)疾病办理: 1.办事依据:《武汉市城镇职工基本医疗保险门诊治疗部分重症疾病规定》(武劳社[2001]12号)、《武汉市城镇职工基本医疗保险若干政策补充规定》(武劳社[2002]46号)、《门诊治疗重症精神病患者门诊医疗费用部分纳入统筹基金支付范围的暂行规定》(武劳社[2003]16号)、《武汉市城镇职工基本医疗保险门诊治疗部分重症疾病补充规定》(武劳社[2003]154号)和《武汉市城镇职工基本医疗保险门诊治疗部分慢性疾病暂行规定》(武劳社[2003]155号)。 2.办事程序: 1)患者向所在单位提出申请(个人窗口办理的患者直接向所在辖区社保处申报),所在单位统一登记,连同重症of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 人员名单及其提供的相关资料,报辖区社保处申报办理。 2)辖区社保处受理初审合格的,发给《武汉市医疗保险中心门诊治疗部分重症疾病审批登记表》,参保人员按规定填写相应栏目。 3)初审合格的参保人员持《审批登记表》,到辖区社保处指定的医院作相关检查,鉴定确诊病情,提出治疗建议。参保人员将《审批登记表》报社保处,经核准,发放重症病历,即可到选定治疗医院就医。 3.需提交的资料:申请、近一到两年连续治疗病历、相关检查报告单、出院小结等原始资料(易地安置参保人员需提交当地医院出具的病情证明材料), 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:14个工作日。。 六、医疗保险市内转院、市内紧急抢救审批: 1.办事依据:《武汉市城镇职工基本医疗保险转院管理规定》(武劳社[2001]122号)。 2.办事程序: (1)市内转院:参保人员在定点医疗机构住院期间,因定点医疗机构限于技术和设备条件所限不能诊治的危重疑难病症,由三级或专科医院诊治科室提出转院申请,转往市内转院定点医疗机构;科室主任同意后,报医院医保办of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 及分管院长审批签章。参保人员持《转院审批表》一式三份到市医保中心申报窗口办理,符合条件者即时审批并签章,将一份《审批表》存档备查,另两份交参保人员,一份作报销凭证,一份交定点医院存档。 (2)市内紧急抢救:参保人员因紧急抢救在市内非定点医院治疗,治疗后5个工作日内,由单位或个人将就医情况写成书面申请报告,单位盖章(灵活就业人员由辖区社保处盖章),附相关资料到市医保中心紧急抢救窗口申报。 3.需提交的材料: (1)市内转院:《转院审批表》; (2)市内紧急抢救:书面申请报告、门诊急救病历、相关检查报告(主要的能说明病情严重程度的检查)、120急救发票等资料。 4.收费标准:无收费 5.收费依据:无收费 5.办事时限: (1)市内转院:即时审批 (2)市内紧急抢救:收到申报资料7个工作日内完成审批,并以电话形式通知经办人。 六、医疗保险大额医疗费用结算(两定机构月度结算) 1.办事依据:《武汉市基本医疗保险三大目录》、《关于大额医疗保险规范用药的通知》(武劳社医[2007]12号) of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 2.办事程序:每月10日前(逢节假日延至15日)将上月大额申报资料送至大额办。 3.须提交的材料:凡申报大额保险费用须统一使用“武汉市城镇职工大额医疗保险理赔资料袋”,同时上报“定点医院大额医疗费用申报明细表”(电子版及手工版各一份)。资料袋封面各栏目一律用钢笔填写,字迹要清晰端正;申报明细表须加盖公章。住院资料袋内应提供:身份证(复印件)、IC卡(复印件)、住院病历首页(复印件)、医保结算清单(表38)、首次病程记录(复印件)、出院记录(复印件)、长期医嘱(复印件)、临时医嘱单(复印件)、住院医疗收费收据(原件)、门诊资料袋内应提供:身份证(复印件)、IC卡(复印件)、医保结算清单(表38)及收据原件. 注意事项:?住院费用须提供汇总清单、?门诊费用也须提供医保结算清单(表38)及收据原件、?门诊用药应标明每种药品的单价及规格、?凡进行放射治疗均须提供放疗治疗单。重症病人需要提供重症病历首页。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:1个月 七、医疗保险转外地治疗: 1.办事依据:《武汉市城镇职工基本医疗保险转院管理规of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 定》武劳社[2001]122号 2.办事程序: (1)申报:由三级综合医疗服务定点医疗机构和专科服务定点医疗机构开出《转院审批表》或由参保单位提出申请。 (2)报销:出院后一个月内到武汉市医疗保险中心3、4号窗口办理。 3.须提交的材料: (1)申报:书面申请报告(《转院审批表》)、相关检查报告、门诊病历、出院小结等。 (2)报销:《医疗费用申报审核表》、发票原件、住院费用清单、医保卡和身份证复印件、出院小结、临时医嘱、长期医嘱、病案首页、手术记录、麻醉记录、置换材料发票复印件。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限: (1)申报: 7个工作日。 (2)报销:每月15前上报的费用,报销周期1个月;每月15日后申报的费用,报销周期2个月。 八、生育保险费用支付(两定机构月度结算) 1.办事依据:《武汉市职工生育保险医疗管理办法》(武of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 劳社[2006]100号);《武汉市职工生育保险待遇结算管理办法》(武劳社[2007]27号); 2.办事程序: 定点医疗机构住院费用申报程序: (1)每月5日前,各定点医疗机构向所在辖区社保处生育科申报上月住院费用,提供《住院医疗费用结算申报审核表》、《医疗保险住院医疗费用申报明细表》。保存结算发票、定点医疗机构生育医疗费用结算清单、住院明细费用清单备查。并在5日前将上月住院费用结算数据上传至医保中心数据库。 (2)社保处生育保险审核科对定点医疗机构申报的住院费用进行审核,产生审核汇总表,20日前报工伤生育中心审核科。 (3)中心审核科对定点医疗机构申报的生育医疗费用进行复核,产生应付帐,次月10日前交付财务科。 (4)医疗机构提供单位账户、账号、收据领取款项。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日 九、生育保险费用结算(定点零星报销): 1.办事依据:《武汉市职工生育保险待遇结算管理办法》(武劳社[2007]27号) of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 2. 办事程序:定点零星报销包括长驻外地、易地安置人员、市内无卡及特殊情况的费用报销。 (1)长驻外地、易地安置人员在外地发生的医疗费用,其出院后一个月内,由所在单位向辖区社保处申报结算; (2)无卡人员费用是指:参保人原卡损坏、丢失,新进已享受生育保险待遇的参保人员卡未制作; (3)长驻外地、异地安置、无卡人员等在定点医院住院生育发生的医疗费用,先由个人垫付,出院后10日内由单位或个人向所在辖区社保处生育保险审核(医保)科申报审核。 (4)社保处生育保险审核科对申报的生育医疗费用进行审核,产生审核汇总表,20日前报工伤生育中心审核科。 (5)中心审核科进行复核,产生费用应付帐,次月10日前交付财务科。 3.需提交的材料:申报费用时需提交发票、清单、出院小结(病历)、医嘱、身份证和社保卡复印件、《生育保险就医登记表》、《现金报销申报审核表》;领取费用时凭个人社会保障卡及身份证到汉口银行柜台领取或选择其他方式领取; 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 十、生育保险费用结算(非定点零星报销): 1.办事依据:《武汉市职工生育保险待遇结算管理办法》(武劳社[2007]27号); 2.办事程序: (1)申报:在医院治疗后5个工作日内,由单位或个人将就医经过写成书面情况说明,附相关资料到市医保中心工伤生育窗口申报。 (2)报销:审批通过的参保人员在出院后一个月之内,填写《生育保险现金报销申报审核表》,携相关资料到医保中心申报窗口办理。 3.须提交的材料: (1)申报:情况说明、门诊急救病历、相关检查报告(主要的能说明病情严重程度的检查)、120急救发票等资料。 (2)报销:《生育就医登记表》、《现金报销审核申报表》、发票、清单、出院小结(病历)、医嘱、身份证和社保卡复印件。 (3)领取费用:凭个人社会保障卡、身份证到汉口银行柜台领取或选择其他方式领取; 4.收费标准:无收费 5.收费依据:无收费 6.办事时限: (1)申报:收到参保人资料后7个工作日完成审批,并电of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 话通知经办人; (2)报销:每月15前上报的费用,次月拨付;每月15日后申报的费用,隔月拨付。 十一、生育保险固定待遇费用支付: 1.办事依据:《武汉市职工生育保险待遇结算管理办法》(武劳社[2007]27号)。 2.办事程序: (1)分娩或流引产完成后两个月内由单位或个人提交相关材料,报辖区社保处申报办理。 (2)辖区社保处受理并初审后产生待遇审核汇总表,20日前报工伤生育中心审核科。 (3)中心审核科对申报的津贴进行复核,产生费用应付帐,次月10日前交付财务科。 3.需提交的资料: (1)申报生育津贴提供生育登记表、出院小结、出生证;申报护理假津贴时提供出生证、生育登记表复印件; (2)生育津贴和护理假津贴费用由单位领取,需提供正式收据(盖单位财务章)和账号,每月11-24日到市工伤生育保险中心办理领款手续。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 十二、工伤保险费用支付(两定机构月度结算): 1.办事依据:《武汉市工伤职工医疗管理办法》(武劳社[2005]87号)。 2.办事程序: (1)每月5日前,各定点医疗机构向所在辖区社保处工伤科申报上月住院费用,提供《住院医疗费用结算申报审核表》。保存结算发票、定点医疗机构工伤费用结算清单、住院汇总明细清单。并在5日前将上月住院费用结算数据上传至医保中心数据库。 (2)社保处工伤科对定点医疗机构申报的住院费用进行审核,产生审核汇总表,20日前报工伤生育中心审核科。 (3)中心审核科对定点医疗机构申报的住院费用进行复核,产生应付帐,次月10日前交付财务科。 (4)医疗机构提供单位账户、账号、收据领取款项。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日 十三、工伤保险费用支付(定点零星报销、非定点零星报销) 1.办事依据:《武汉市工伤职工医疗管理办法》(武劳社[2005]87号) 2.办事程序: of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. (1)在工伤认定前发生的医疗费用以及因长驻外地、异地安置、无卡人员等在定点及非定点医院住院发生的工伤医疗费用,先由参保人垫付,出院后10日内由单位或个人向所在辖区社保处工伤科申报审核。 (2)社保处工伤科对申报的工伤医疗费用进行审核,产生审核汇总表,20日前报工伤生育中心审核科。 (3)中心审核科进行复核,产生费用应付帐,次月10日前交付财务科。 3.须提交的材料:申报费用时需提交工伤认定书、非定点就医提供情况说明、发票、清单、出院小结(病历)、医嘱、身份证和社保卡复印件、现金报销申报审核表;工伤医疗费用由单位领取,需提供正式收据(盖单位财务章)和账号,每月11-24日到市工伤生育保险中心办理领款手续。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日 十四、工伤辅助器具配置费用支付 1、办事依据:武汉市工伤保险实施办法(武汉市政府令第161号) 2、办事程序: (1)需配置辅助器具的,由个人或单位提交病历资料及of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. 申请,经市劳动能力鉴定中心审批后,到市工伤中心根据配置标准选择一家定点配置机构进行辅助器具配置; (2)单位或个人持《辅助器具配置申请表》到配置机构配置辅助器具,费用由辅助器具配置机构垫付,每月5日前,各定点配置机构向所在辖区社保处工伤科申报上月辅助器具配置费用,提供《配置辅助器具费用申报表》、《辅助器具配置申请表》、产品说明书复印件等; (3)社保处工伤科对申报的配置费用进行审核,产生审核汇总表,20日前报工伤生育中心审核科。 (4)中心审核科进行复核,产生费用应付帐,次月10日前交付财务科。 (5)辅助器具配置机构凭正式收据(盖单位财务章)和账号,每月11-24日到市工伤生育保险中心办理领款手续。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日 十五、工伤(亡)职工一次性待遇支付、工伤长期待遇支付 1.办事依据:武汉市工伤保险实施办法(武汉市政府令第161号)。 2.办事程序: of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. (1)工亡人员在取得工伤认定书后,工伤人员在取得劳动能力鉴定书后由单位或个人提交相关材料,报辖区社保处申报办理。 (2)辖区社保处受理并初审后产生待遇审核汇总表,20日前报工伤生育中心审核科。 (3)中心审核科对定点医疗机构申报的住院费用进行复核,产生费用应付帐,次月10日前交付财务科。 3.需提交的资料: (1)申报伤残等级待遇的提供工伤认定书、劳动能力鉴定书、历史缴费记录、《伤残(工亡)待遇申报审核表》、有伤残津贴的每年应提供生存证明; (2)申报工亡待遇的提供工伤认定书、有抚恤金的提供户口复印件、身份证复印件、无收入来源证明、供养关系证明、《伤残(工亡)待遇申报审核表》、每年提供生存证明; (3)伤残等级(工亡)费用由单位领取,需提供正式收据(盖单位财务章)和账号,每月11-24日到市工伤生育保险中心办理领款手续;伤残津贴、生活护理费和供养亲属抚恤金也可选择其他方式领取。 4.收费标准:无收费 5.收费依据:无收费 6.办事时限:30个工作日。 of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood. of work enthusiasm and forward-looking. The difficulties and problems of individual cadres indifferent masses as the buck passing, long, make some simple complex problems. Some cadres general talk about pay, do not take the initiative to undertake for the bitter and tired of the work, the lack of courage to play a positive attitude." corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, effectively solve the enterprise less, help is not enough. In order to "turn style, solve problems, and do practical things, heart to heart" as the core, in accordance with the provisions of division of Labor Bureau, by the Bureau of Party members and cadres room composition the working group , to help enterprises solve problems, promote the construction of major projects; close ties with the masses, to ask for the people, ask for people to know the people, public opinion, the people, improve people's livelihood.
/
本文档为【新生儿医保政策】,请使用软件OFFICE或WPS软件打开。作品中的文字与图均可以修改和编辑, 图片更改请在作品中右键图片并更换,文字修改请直接点击文字进行修改,也可以新增和删除文档中的内容。
[版权声明] 本站所有资料为用户分享产生,若发现您的权利被侵害,请联系客服邮件isharekefu@iask.cn,我们尽快处理。 本作品所展示的图片、画像、字体、音乐的版权可能需版权方额外授权,请谨慎使用。 网站提供的党政主题相关内容(国旗、国徽、党徽..)目的在于配合国家政策宣传,仅限个人学习分享使用,禁止用于任何广告和商用目的。

历史搜索

    清空历史搜索