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郑州市医保中心生育险报销流程

2017-09-02 11页 doc 38KB 185阅读

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郑州市医保中心生育险报销流程郑州市医保中心生育险报销流程 报销流程: 女职工生育报销(一) 流程 1、女职工在怀孕5个月内,首先在市医疗保险中心办理《生育保险登记卡》; 2、在定点医疗机构进行围产期保健; 3、到定点医疗机构生产; 4、生育后在规定时间内申报有相关材料; 5、医疗保险中心进行生育费用审核; 6、生育后4个月内报销生育费用。 女职工生育报销(二) 办理《生育保险登记卡》 ※ 办理《生育保险登记卡》所需资料: 1、准生证原件(及复印件,A4纸); 2、本人身份证原件(及复印件,A4纸); 3、市医疗保险卡原件; 4、...
郑州市医保中心生育险报销流程
郑州市医保中心生育险报销流程 报销流程: 女职工生育报销(一) 流程 1、女职工在怀孕5个月内,首先在市医疗保险中心办理《生育保险登记卡》; 2、在定点医疗机构进行围产期保健; 3、到定点医疗机构生产; 4、生育后在时间内申报有相关材料; 5、医疗保险中心进行生育费用审核; 6、生育后4个月内报销生育费用。 女职工生育报销(二) 办理《生育保险登记卡》 ※ 办理《生育保险登记卡》所需资料: 1、准生证原件(及复印件,A4纸); 2、本人身份证原件(及复印件,A4纸); 3、市医疗保险卡原件; 4、1张1寸近期免冠彩色照片; 5、结婚证原件; 6、办理时间:每月20至30日期间的工作日到市医疗保险中心3楼生育科办理。 7、生育科咨询电话:68698155 备注:由他人代办时,请提交代办人身份证原件及复印件。 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 女职工生育报销(三) 生育报销时所需材料 ※ 女职工在郑州市医疗保险中心进行生育保险报销应携带的材料: 1、病历复印件(包括:首页、医嘱、手术记录、出院小结+医院章); 2、婴儿的出生医学证明及复印件、围产期保健票据; 3、住院期间每日费用、结帐凭据、出院证; 4、郑州市社会医疗保险卡(简称:医保卡)、郑州市城镇职工生育保险登记卡、(如有外地就医情况,请携带外地非定点需要急诊的证明); 5、报销人身份证原件及复印件(新版身份证需要复印正反两面); 6、生育费用报销地点及时间: 地点:郑州市医疗保险中心3楼生育科 时间:每季度最后1个月的25-30日报送以上材料; 次月18-22日携带本人身份证、医保卡原件领取现金支票。 咨询电话:68698155 7、注意事项: ? 生育时所有能报销的费用必须以现金结算,如用医保卡结算的则不予报销此部分费用; ? 生产后4个月内按时报销; ? 提供的复印件均为A4纸。 友情提示:因生育报销时人员较为集中,排队等候时间较长。建议提早到市医疗保险中心等候。 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 生育险报销 (1)缴费政策 单位不缴生育险 每天加收千分之二滞纳金 办法规定,郑州市行政区域内的各类企业和国家机关、事业单位、社会团体、民办非企业单位、有雇工的个体工商户都应参加生育保险,为其职工缴纳生育保险费。 缴费时,用人单位应以本单位上年度职工月平均工资总额的1%按月缴纳保险费。国家机关和财政全供事业单位按本单位上年度职工月平均工资总额的0.5%按月缴纳。 如果哪个单位一再拖延,不愿缴生育保险,将按日加收千分之二的滞纳金。 保险待遇 (2)生育报销 以前剖腹产报销3000元,现在最少4300元 据郑州市医保中心某位负责人示,新办法最大的特点就是提高了生育医疗费用的支付标准。 从2011年1月1日起,将按以下标准支付(实际费用低于标准的据实支付,高于标准的,按限额标准支付): 产前检查:800元/例; 正常分娩:三类定点医疗机构2200元/例;二类及以下定点医疗机构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 2000元/例; 异常分娩(难产):三类定点医疗机构2800元/例;二类及以下定点医疗机构2600元/例; 剖宫产:三类定点医疗机构4500元/例;二类及以下定点医疗机构4300元/例; 剖宫产的同时做其他相关妇产科手术5000元/例。 相关解读 从2003年实施至今的《郑州市城镇职工生育保险暂行办法》规定,围产期保健费用生育保险基金最高支付标准仅为500元;剖宫产生育保险基金支付标准仅为3000元,如此看来,此次的支付标准有了明显提高。 生育津贴 月津贴大致为产妇上班时一月的工资 低的部分单位补齐 生过孩子之后,按照规定还要给女职工一定的生育津贴。办法规定,按1%的缴费比例缴纳生育保险费的单位,妊娠满28周以上生产或者引产的,享受90天的生育津贴;难产的增加15天的生育津贴;多胞胎生育的,每多生育1个婴儿增加15天的生育津贴;晚育的增加90天的生育津贴。 妊娠满12周不满28周流产、引产的,享受42天的生育津贴。 妊娠满8周不满12周流产的,享受30天的生育津贴。 妊娠不满8周流产的,享受15天的生育津贴。 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 相关解读 与以往不同的是,此次规定生育津贴全部按日计发。日标准按照女职工所在用人单位申报的本人月缴费工资除以30计算,大致为单位之前申报的你上班时一个月的工资。生育津贴低于女职工生育或者实施计划生育手术前工资水平的,差额部分由用人单位补足。 此外,老办法中未对进行计划生育手术的支付标准做出规定。此次特别指出,输精管结扎术(含检验费):三类定点医疗机构1200元/例,二类及以下定点医疗机构1000元/例;输卵管结扎术(含检验费):三类定点医疗机构2600元/例,二类及以下定点医疗机构2400元/例。 (3)惠民亮点 1.没工作的女性,只要老公单位缴了生育险, 可补助一半生育费用 该办法的另一大变化就是扩大了生育保险的享受人群。 办法规定,如果女性符合计划生育政策生育,但没有工作,只要其配偶单位足额缴纳了生育保险,可领取正常生育医疗费用支付标准50%的补助金。 2.单位只要缴一年以上生育险, 女职工下岗两年内生育仍能报销医疗费 办法还规定:用人单位如果足额缴纳生育保险费1年以上不满3年,就算与用人单位终止劳动关系,24个月内没有工作面临生育或实施计划生育手术的职工,产生的医疗费用可按正常标准报销。 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 用人单位如果足额缴纳生育保险费3年以上,后与用人单位终止劳动关系未就业的职工,面临生育或实施计划生育手术产生的医疗费用也可按正常标准报销。 咋领津贴 参保次月即可享受 由用人单位申领 生育津贴,是不是生了孩子就能领取,办法规定,生育津贴原则上由用人单位向医疗保险经办机构申领,一次性生育补助金由本人或其委托人向医疗保险经办机构申领。职工自用人单位缴纳生育保险费次月起,就能享受办法中的相关待遇。 申领生育津贴或一次性生育补助金应提交生育证明等材料,其中,男职工的配偶无工作单位的,应提交男职工所在单位及其配偶所在的村(居)民委员会出具的无工作单位证明。 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
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