医疗保险:致全县医保参保人员的一封公开信
<p class="MsoNormal" align="center" style="text-align:center"><span style="font-size:22.0pt;font-family:方正小标宋_GBK">致全县医疗保险参保人员的一封公开信<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK"> </span></p><p class="MsoNormal"><span style="font-size:16.0pt;font-family:方正仿宋_GBK">全县医疗保险参保人员:<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:31.5pt"><span style="font-size:16.0pt;font-family:方正仿宋_GBK">大家好!<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:31.5pt"><span style="font-size:16.0pt;font-family:方正仿宋_GBK">近段时间,有部分网友在梁平论坛等网络媒体上咨询医保参保、特殊疾病就医、社保卡发放等相关政策与工作,为了各位网友能正确了解医保政策,提高对医保政策的知晓度。借此网络平台首先感谢大家对医保工作的关心,同时也将县医保局的工作职责及主要医保政策予以公开。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="margin-left:31.5pt"><span style="font-size:16.0pt;font-family:方正黑体_GBK">一、县医保局的基本情况及主要工作职责<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:仿宋_GB2312">县医保局内设六科一室:办公室、参保管理科、医疗管理科、审计稽核科、基金财务科、信息管理科和公费医疗管理科。目前在职在编<span lang="EN-US">22</span>人。办公地址:梁山路<span lang="EN-US">359</span>号。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:仿宋_GB2312">县医保局工作范围:一是经办城镇职工医疗保险(参保人员包括城镇职工、关破企业退休人员、城镇灵活就业人员、农民工,参保人数<span lang="EN-US">4.3</span>万人,已于<span lang="EN-US">2012</span>年<span lang="EN-US">1</span>月<span lang="EN-US">1</span>日纳入市级统筹),二是经办城乡居民合作医疗保险(参保人数<span lang="EN-US">82.59</span>万人,已于<span lang="EN-US">2012</span>年<span lang="EN-US">12</span>月<span lang="EN-US">1</span>日纳入市级统筹),三是特殊人群(离休干部<span lang="EN-US">62</span>人、伤残军人<span lang="EN-US">118</span>人、退休返籍军官<span lang="EN-US">28</span>人、武警消防官兵约<span lang="EN-US">80</span>人)医疗费统筹管理。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:仿宋_GB2312">主要工作职责:<span lang="EN-US">1</span>、县内各类人员医疗保险数据收集、费用测算、编制政策初稿;<span lang="EN-US">2</span>、各类人员医疗保险参保登记及信息变更;<span lang="EN-US">3</span>、编制各类人员医疗保险费征收计划;<span lang="EN-US">4</span>、各类人员医疗保险费的征收;<span lang="EN-US">5</span>、用人单位缴费基数人数稽核;<span lang="EN-US">6</span>、医疗保险待遇审核;<span lang="EN-US">7</span>、两定机构监督管理;<span lang="EN-US">8</span>、医疗保险待遇拨付;<span lang="EN-US">9</span>、信息系统建设维护及操作培训;<span lang="EN-US">10</span>、社保卡制作、发放及补换。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="margin-left:31.5pt;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正黑体_GBK">二、咨询较多的医保问题<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;color:red">1</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;color:red">、为什么我还没有拿到社保卡?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;mso-pagination:widow-orphan"><span style="font-size:16.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt">梁平县居民医保参保人员<span lang="EN-US">82.4</span>万人,截止<span lang="EN-US">2013</span>年<span lang="EN-US">10</span>月底,已回社保卡<span lang="EN-US">813826</span>张,约<span lang="EN-US">1</span>万人参保居民的社保卡因参保登记信息与户籍信息比对数据不一致、身份证信息不匹配、<span lang="EN-US">16</span>岁以上公民无照片、人员跨区县重复参保等因素尚未制作到位。</span><span lang="EN-US" style="font-size:13.5pt;font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt"><o:p></o:p></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;mso-pagination:widow-orphan"><span style="font-size:16.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt">全市制作发放带有金融功能的社保卡的具体流程为:参保登记信息与公民身份信息数据比对成功后,由重庆市卡中心将制卡数据发至相应的合作银行,合作银行将制卡信息发送至江苏、深圳、上海等地的制卡商制卡,制作出来之后的社保卡返回至各合作银行重庆市分行导入金融数据,市分行分类整理后再通知各区县支行领卡,然后各区县支行按照乡镇、村组分好卡后通知各乡镇(街道)社保所领回,最后发到参保人员手中。制卡发卡环节繁多,程序复杂,工作量大。社保卡是否制作出来可与当地乡镇社保所联系查询,如果已经到位,请及时领取,如果尚未制作出来,请耐心等待,据了解,全市只要制卡材料正确的社保卡均能在年底前到位,如果接到通知制卡材料不符合要求,请及时将规定格式的身份证(或户口薄本人页)复印件、照片、制卡工本费交社保所及时申办。</span><span lang="EN-US" style="font-size:13.5pt;font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt"><o:p></o:p></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;mso-pagination:widow-orphan"><span style="font-size:16.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt">另外,根据重庆市人社局相关规定,在申办社保卡过程中,未领卡人员可凭身份证或户口簿在定点医疗机构正常就医报账,参保人员医保待遇不受影响。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;color:red;mso-font-kerning:0pt">2</span><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;color:red;mso-font-kerning:0pt">、</span><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">单位职工医保的缴费标准是多少?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">医疗保险费包括职工基本医保费和大额医疗互助金两部分。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(一)职工基本医保费:<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">1.</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">单位按职工缴费基数的<span lang="EN-US">8</span>%缴纳;<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">2.</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">在职职工按本人缴费基数的<span lang="EN-US">2</span>%缴纳。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(二)大额医疗互助金:<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">1</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">.在职职工由用人单位按其本人基本医保缴费基数的<span lang="EN-US">1%</span>缴纳;退休人员由用人单位按本单位在职职工基本医保平均缴费基数的<span lang="EN-US">1%</span>缴纳。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">2</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">.退休人员和在职职工每人每月缴纳<span lang="EN-US">2</span>元。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">3</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、单位职工医保个人账户可划入多少钱?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">个人账户划入标准:职工个人缴纳的基本医疗保险费全额划入本人个人账户(即社保卡上);用人单位缴纳的基本医疗保险费按以下比例划入职工和退休人员个人账户:<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(<span lang="EN-US">1</span>)<span lang="EN-US">35</span>岁以下的职工,按本人基本医疗保险缴费基数的<span lang="EN-US">1.3</span>%划入;<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(<span lang="EN-US">2</span>)<span lang="EN-US">35</span>岁至<span lang="EN-US">44</span>岁的职工,按本人基本医疗保险缴费基数的<span lang="EN-US">1.5</span>%划入;<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(<span lang="EN-US">3</span>)<span lang="EN-US">45</span>岁以上的职工,按本人基本医疗保险缴费基数的<span lang="EN-US">1.7</span>%划入;<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(<span lang="EN-US">4</span>)退休人员按本单位在职职工人均缴费基数的<span lang="EN-US">4</span>%划入。从<st1:chsdate isrocdate="False" islunardate="False" day="1" month="1" year="2014" w:st="on"><span lang="EN-US">2014</span>年<span lang="EN-US">1</span>月<span lang="EN-US">1</span>日起</st1:chsdate>,对用人单位只有退休人员,没有在职职工的,其退休人员个人账户按上年度我市社平工资的<span lang="EN-US">60%</span>的<span lang="EN-US">4</span>%划入。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(<span lang="EN-US">5</span>)一次性趸缴余命医疗费的国有关闭破产企业退休人员及国有企业大龄下岗职工,其个人账户按上年度我市社平工资的<span lang="EN-US">60%</span>的<span lang="EN-US">4</span>%划入,个人应承担的每人每月<span lang="EN-US">2</span>元的大额医保费从个人账户中代扣。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">4</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、职工医保有多少类特殊疾病?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">目前职工医保共有<span lang="EN-US">21</span>类医保特殊疾病:恶性肿瘤放疗、化疗、镇痛治疗;肾功能衰竭病人的透析治疗;肾脏、心脏瓣膜、造血干细胞移植术后的抗排异治疗;糖尿病<span lang="EN-US">1</span>型、<span lang="EN-US">2</span>型;系统性红斑狼疮;高血压病(<span lang="EN-US">1</span>级高血压中高危和很高危、<span lang="EN-US">2</span>级高血压、<span lang="EN-US">3</span>级高血压);冠心病;风湿性心瓣膜病;脑血管意外后遗症(脑梗死、脑出血、蛛网膜下腔出血后遗症);支气管哮喘、慢性支气管炎伴阻塞性肺气肿、慢性肺源性心脏病;肝硬化(失代偿期);再生障碍性贫血;精神分裂症、心境障碍(抑郁躁狂症)、偏执性精神障碍;结核病;血友病;重度前列腺增生;类风湿关节炎;帕金森病;肌萎缩侧索硬化症;骨髓增殖性疾病;丙型肝炎。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">但以个人身份参加职工医保一档的参保人员目前只能享受到<span lang="EN-US">4</span>类特殊疾病的医保报销:恶性肿瘤放疗、化疗、镇痛治疗;肾功能衰竭病人的透析治疗;肾移植后抗排异治疗;血友病。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">5</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、个人身份参加职工医保每年的缴费标准是多少?如何办理?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">医疗保险缴费标准分为两档,由个人自愿选择档次参保。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">一档年缴费:按我市上年度城镇非私营单位在岗职工平均工资(以下简称社平工资)的<span lang="EN-US">5%</span>缴纳(<span lang="EN-US">1%</span>用于建立大额医疗费互助保险);<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">二档年缴费:按我市上年度社平工资的<span lang="EN-US">11%</span>缴纳(<span lang="EN-US">1%</span>用于建立大额医疗费互助保险)。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">具体标准每年度由市人力社保局和市财政局公布。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" align="left" style="text-indent: 32pt;"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">持本人身份证、户口簿、失业证或解除劳动合同书(或退休证)、社会保障卡于每月<span lang="EN-US">10-20</span>日到户籍所在地医疗保险经办机构办理医疗保险登记、变更登记或者注销登记手续。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">6</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、职工医保参保人员如何选择医院就医?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(一)参保人员可自由选择在全市所有定点医院普通门诊,在全市所有定点零售药店刷卡购药,即时结算。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(二)参保人员在本区县内各级定点医疗机构和市内二级及以下定点医疗机构住院,可自由选择。在市内非参保所在区县(自治县)三级定点医疗机构住院,应报经参保所在区县(自治县)医疗保险经办机构备案;未备案的,住院起付线提高<span lang="EN-US">5%</span>,同时报销比例下降<span lang="EN-US">5</span>个百分点。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(三)参保人员在市外突发疾病临时异地就诊的,应在当地医疗保险定点医疗机构治疗(门〔急〕诊危重病抢救除外)。参保职工应在入院后<span lang="EN-US">3</span>个工作日内向所在单位报告,有关单位在职工住院之日起<span lang="EN-US">5</span>个工作日内向参保地区县医疗保险经办机构办理外诊登记手续;个人身份参加职工医保的人员则在其住院之日起<span lang="EN-US">5</span>个工作日内,由参保人或委托人向参保地区县医疗保险经办机构或区县指定的机构办理登记手续。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(四)参加职工医保的退休人员市外异地安置或单位长期派驻市外工作的职工,应由本人申请,经参保所在区县医疗保险经办机构同意后,在当地确定<span lang="EN-US">3</span>所定点医疗机构就诊,其中一、二、三级医疗机构各<span lang="EN-US">1</span>所。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" align="left" style="text-indent: 32pt; line-height: 28pt;"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(五)对在市内非参保地居住或单位长期派驻市内非参保地工作的,应由本人申请,经参保所在区县医疗保险经办机构或区县指定机构同意后,可在居住地或工作地选择<span lang="EN-US">1</span>所三级医疗机构就诊,其发生的医保费用由就医地的医疗保险机构按规定与定点医疗机构实时结算。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">7</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、居民医保参保人员发生的普通门诊费用如何报销?普通门诊定额当年未使用完的怎么办?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">从<span lang="EN-US">2013</span>年起,普通门诊实行定额报销。每年按照一档个人缴纳的居民医疗保险费标准确定。<span lang="EN-US">2013</span>年、<span lang="EN-US">2014</span>年为<span lang="EN-US">60</span>元<span lang="EN-US">/</span>人·年。普通门诊在定额报销额度内使用不设封顶线和报销比例。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员的普通门诊定额当年未使用完的余额可跨年度结转使用。对未连续参保缴费的居民,从未连续缴费的当年起,将其定额报销未使用的金额调整为统筹基金,不再结转使用。定额报销资金为居民医保基金的组成部分,不属于个人所有。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:31.5pt;mso-char-indent-count:1.96;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">8</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、居民医保参保人员住院医疗费用报销标准?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:40.0pt;mso-char-indent-count:2.5;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员住院发生的符合医保报销范围的医疗费用按以下标准报销:</span><span lang="EN-US" style="mso-bidi-font-size:16.0pt;font-family:仿宋_GB2312;mso-fareast-font-family:宋体"><o:p></o:p></span></p><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.4pt;border-collapse:collapse;mso-table-layout-alt:fixed; mso-padding-alt:0cm 0cm 0cm 0cm"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:12.75pt"><td width="240" colspan="2" style="width:180.0pt;border:solid black 1.0pt;mso-border-top-alt:.5pt;mso-border-left-alt:.5pt;mso-border-bottom-alt:.6pt;mso-border-right-alt:.6pt;mso-border-color-alt:black;mso-border-style-alt:solid;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.75pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">筹资标准</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="168" style="width:126.0pt;border:solid black 1.0pt;border-left:none;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-top-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.75pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">一档</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="180" style="width:135.0pt;border:solid black 1.0pt;border-left:none;mso-border-left-alt:solid black .6pt;mso-border-top-alt:.5pt;mso-border-left-alt:.6pt;mso-border-bottom-alt:.6pt;mso-border-right-alt:.5pt;mso-border-color-alt:black;mso-border-style-alt:solid;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.75pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">二档</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:1;height:12.9pt"><td width="84" rowspan="3" style="width:63.0pt;border:solid black 1.0pt;border-top:none;mso-border-top-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-left-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.9pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">门槛费</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.9pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">一级及以下定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="348" colspan="2" style="width:261.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.9pt"><p class="MsoNormal"><span lang="EN-US">100</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">元</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:2;height:11.65pt"><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.65pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">二级定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="348" colspan="2" style="width:261.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.65pt"><p class="MsoNormal"><span lang="EN-US">300</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">元</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:3;height:11.8pt"><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.8pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">三级定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="348" colspan="2" style="width:261.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.8pt"><p class="MsoNormal"><span lang="EN-US">800</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">元</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:4;height:15.15pt"><td width="84" rowspan="3" style="width:63.0pt;border:solid black 1.0pt;border-top:none;mso-border-top-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-left-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:15.15pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">报销比例</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:15.15pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">一级及以下定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="168" style="width:126.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:15.15pt"><p class="MsoNormal"><span lang="EN-US">80%<o:p></o:p></span></p></td><td width="180" style="width:135.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-right-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:15.15pt"><p class="MsoNormal"><span lang="EN-US">85%<o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:5;height:11.8pt"><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.8pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">二级定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="168" style="width:126.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.8pt"><p class="MsoNormal"><span lang="EN-US">60%<o:p></o:p></span></p></td><td width="180" style="width:135.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-right-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:11.8pt"><p class="MsoNormal"><span lang="EN-US">65%<o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:6;height:12.1pt"><td width="156" style="width:117.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.1pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">三级定点医疗机构</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="168" style="width:126.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.1pt"><p class="MsoNormal"><span lang="EN-US">40%<o:p></o:p></span></p></td><td width="180" style="width:135.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-right-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.1pt"><p class="MsoNormal"><span lang="EN-US">45%<o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:7;height:12.2pt"><td width="240" colspan="2" style="width:180.0pt;border:solid black 1.0pt;border-top:none;mso-border-top-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-left-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.2pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">全年报销封顶线(元)</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="168" style="width:126.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.2pt"><p class="MsoNormal"><span lang="EN-US">80000</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">元</span><span lang="EN-US"><o:p></o:p></span></p></td><td width="180" style="width:135.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .6pt;mso-border-left-alt:solid black .6pt;mso-border-alt:solid black .6pt;mso-border-right-alt:solid black .5pt;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:12.2pt"><p class="MsoNormal"><span lang="EN-US">120000</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">元</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr> <tr style="mso-yfti-irow:8;mso-yfti-lastrow:yes;height:26.25pt"><td width="588" colspan="4" style="width:441.0pt;border:solid black 1.0pt;border-top:none;mso-border-top-alt:solid black .6pt;mso-border-top-alt:.6pt;mso-border-left-alt:.5pt;mso-border-bottom-alt:.5pt;mso-border-right-alt:.6pt;mso-border-color-alt:black;mso-border-style-alt:solid;padding:1.4pt 1.4pt 1.4pt 1.4pt;height:26.25pt"><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">计算办法:报销金额</span><span lang="EN-US">=</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">(符合医保报销范围的医疗费用-起付线)×报销比例</span><span lang="EN-US"><o:p></o:p></span></p><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">另:特殊疾病中的重大疾病门诊费和住院费合并计算封顶线;未成年人住院报销比例在同档参保成年人的基础上提高</span><span lang="EN-US">5</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">个百分点。</span><span lang="EN-US"><o:p></o:p></span></p><p class="MsoNormal"><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">参保人员在我市三级和二级中医医疗机构住院、特殊疾病门诊治疗起付标准降低一个档次。在中医医疗机构住院、特殊疾病门诊使用医疗保险范围内的中药饮片、中成药以及医院自制中药制剂的医疗费用,政策报销比例提高</span><span lang="EN-US">10</span><span style="mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman"">个百分点。</span><span lang="EN-US"><o:p></o:p></span></p></td> </tr></tbody></table><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">9</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、居民医保参保人员如何选择医院看病就医?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">1.</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员在本区县和市内二级及以下医保定点医疗机构住院,可自由选择。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">2.</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员在市内非参保所在区县医保三级定点医疗机构住院,需在其住院之日起<span lang="EN-US">5</span>个工作日内,由参保人或委托人向参保地区县医保中心或医保局或区县指定的机构办理登记手续。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">3.</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">在市外长期居住的,可在居住地医保定点医疗机构就医住院。住院者应在住院之日起<span lang="EN-US">5</span>个工作日内,由本人或委托人向参保地所在地医保中心或医保局办理外诊登记手续。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">注意:对未办理登记手续的,其住院起付线提高<span lang="EN-US">5%</span>,同时报销比例下降<span lang="EN-US">5</span>个百分点。<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">10</span></b><b><span style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;color:red">、居民医保参保人员看病就医后怎样报销医疗费用?<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">市内看病就医:</span></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员发生的医保政策范围内的医疗费用,凭社会保障卡或身份证(或临时就医证)在定点服务机构实时结算。参保人员只需交纳个人自己负担的医疗费用,其余按规定由医保基金报销。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">市外看病就医:</span></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保人员在市外发生医保政策范围内的医疗费用,由参保人员到户籍所在区县医保中心(医保局)或区县规定的机构审核报销。对当年发生的医保费用,报销时间不得晚于次年<span lang="EN-US">3</span>月底。<b><u>报账所需的资料:</u></b>就医地财政或地税部门监制的原件的发票(收据)和出院证,加盖鲜章的住院病历复印件、费用明细清单和医院级别证明,社会保障卡,居民身份证件等。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正黑体_GBK;mso-hansi-font-family:宋体">三、特别提示<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(一)职工医保和居民医保分别于<span lang="EN-US">2012</span>年<span lang="EN-US">1</span>月<span lang="EN-US">1</span>日与<span lang="EN-US">2012</span>年<span lang="EN-US">12</span>月<span lang="EN-US">1</span>日纳入市级统筹,执行全市统一的参保项目、缴费办法、待遇标准、信息管理、就医管理、基金管理政策。<u>市级统筹后,各区县无制定及修改任何政策的权利。<span lang="EN-US"><o:p></o:p></span></u></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">(二)近两年来,县医保局印制了大量的医保政策宣传资料通过各乡镇(街道)社保所、各用人单位发到参保人员手中,请各参保人员仔细研读宣传资料,若还未领到宣传资料的人员请到各乡镇(街道)社保所或本人所在单位索取,也可在本论坛下载宣传资料电子版(链接附后)。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正黑体_GBK;mso-hansi-font-family:宋体">(三)县医保局部分业务科室工作主要职责及咨询电话<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><u><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">参保管理科:</span></u></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">主要负责城镇职工、居民、个人身份人员参加职工医保登记、变更、医保关系转接等。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">咨询电话:<span lang="EN-US">53226225<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><u><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">医疗管理科:</span></u></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">负责审核职工医保参保人员医疗保险待遇享受;特殊疾病(重大疾病)门诊就医证的认定和颁发;负责对职工医保参保人员住院、转诊转院、特检特治、特种用药的审查审批。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">咨询电话:<span lang="EN-US">53226059<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><u><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">审计稽核科:</span></u></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">负责审核居民医保参保人员医疗保险待遇享受;负责对居民医保参保人员住院、转诊转院、特检特治、特种用药的审查审批;负责对两定机构及参保患者的监管。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">咨询电话:<span lang="EN-US">53225028<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0"><b><u><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">公费医疗管理科:</span></u></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">负责离休干部、一至六级伤残退伍军人的医疗管理服务工作;负责离休干部、一至六级伤残退伍军人门诊及住院费用报销;负责提供公费医疗相关业务咨询。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">咨询电话:<span lang="EN-US">53366805<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><u><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">基金财务科:</span></u></b><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">负责各类参保人员医疗保险费的征收,县内定点医疗机构、定点零售药店、定点村卫生室及市外住院参保人员医疗保险待遇资金划拨。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">职工医保待遇拨付咨询电话:<span lang="EN-US">53366330<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">居民医保待遇拨付咨询电话:<span lang="EN-US">53226005<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">为了你和家人的医疗保险待遇享受不受影响,请你通过电视、报纸、网络和宣传资料进一步熟悉医疗保险各项政策。<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">祝你:身体健康,生活愉快!<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体"> </span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体"> </span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;mso-pagination:widow-orphan"><span lang="EN-US" style="font-size:16.0pt;font-family:方正楷体_GBK;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;color:red;mso-font-kerning:0pt"> </span></p><p class="MsoNormal" style="text-indent:240.0pt;mso-char-indent-count:15.0;mso-pagination:widow-orphan"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt">梁平县医疗保险局<span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:240.0pt;mso-char-indent-count:15.0;mso-pagination:widow-orphan"><st1:chsdate year="2013" month="10" day="30" islunardate="False" isrocdate="False" w:st="on"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体; mso-bidi-font-family:宋体;mso-font-kerning:0pt">2013</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体; mso-bidi-font-family:宋体;mso-font-kerning:0pt">年<span lang="EN-US">10</span>月<span lang="EN-US">30</span>日</span></st1:chsdate><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体;mso-bidi-font-family:宋体;mso-font-kerning:0pt"><o:p></o:p></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体"> </span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体"> </span></p><p class="MsoNormal" style="text-indent:44.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span style="font-size:22.0pt;font-family:方正小标宋_GBK;mso-hansi-font-family:宋体">更多医保政策请参阅:<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">社会保障卡使用政策解读<span lang="EN-US">http://www.lp023.com/bbs/ShowPost.asp?ThreadID=142861<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">重庆市城镇职工医疗保险政策解读<span lang="EN-US">http://www.lp023.com/bbs/ShowPost.asp?ThreadID=142862<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">重庆市城乡居民医保政策解读<span lang="EN-US">http://www.lp023.com/bbs/ShowPost.asp?ThreadID=142863<o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span lang="EN-US" style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体"> </span></p><p class="MsoNormal" style="text-indent:44.15pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><b><span style="font-size:22.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">医疗保险在线视频宣传:<span lang="EN-US"><o:p></o:p></span></span></b></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">第一期:怎么参加医疗保险 <span lang="EN-US"><a href="http://t.cn/zRSjqjH">http://t.cn/zRSjqjH</a><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">第二期: 医保病人怎样办理住院出院 <span lang="EN-US"><a href="http://t.cn/zRSjJBS">http://t.cn/zRSjJBS</a><o:p></o:p></span></span></p><p class="MsoNormal" style="text-indent:31.5pt"><span style="font-size:16.0pt;font-family:方正仿宋_GBK">第三期:</span><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">医保能报多少</span><span lang="EN-US"><a href="http://t.cn/zRoHKBa" action-data="title=%E7%AC%AC%E4%B8%89%E6%9C%9F%20%E5%8C%BB%E4%BF%9D%E8%83%BD%E6%8A%A5%E5%A4%9A%E5%B0%91&short_url=http://t.cn/zRoHKBa&full_url=http%3A%2F%2Fv.ku6.com%2Fshow%2FjQuRxdakLZI49ApSSXMLvw...html%3Ffrom%3Dmy&type=1&" action-type="feed_list_media_video" style="orphans: 2; widows: 2;">http://t.cn/zRoHKBa</a> 密码:53226509<o:p></o:p></span></p><p class="MsoNormal" style="text-indent:31.5pt"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">第四期:如何进行特殊疾病门诊就医和结算</span><span lang="EN-US"><a href="http://t.cn/zRoHKBS" action-data="title=%E7%AC%AC%E5%9B%9B%E6%9C%9F%20%20%E5%A6%82%E4%BD%95%E8%BF%9B%E8%A1%8C%E7%89%B9%E6%AE%8A%E7%96%BE%E7%97%85%E9%97%A8%E8%AF%8A%E5%B0%B1%E5%8C%BB%E5%92%8C%E7%BB%93%E7%AE%97%20%E6%88%90%E7%89%87&short_url=http://t.cn/zRoHKBS&full_url=http%3A%2F%2Fv.ku6.com%2Fshow%2Fp16ZKyXzF54lsU7JyV5L3Q...html%3Ffrom%3Dmy&type=1&" action-type="feed_list_media_video" style="orphans: 2; widows: 2;">http://t.cn/zRoHKBS</a> <o:p></o:p></span>密码:53226509</p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"></p><p class="MsoNormal" style="text-indent:31.5pt"><span style="font-size:16.0pt;font-family:方正仿宋_GBK;mso-hansi-font-family:宋体">第五期:异地就医医保怎么报销</span><span lang="EN-US"><a href="http://t.cn/zRoHrhe" action-data="title=%E7%AC%AC%E4%BA%94%E6%9C%9F%20%E5%BC%82%E5%9C%B0%E5%B0%B1%E5%8C%BB%E5%8C%BB%E4%BF%9D%E6%80%8E%E4%B9%88%E6%8A%A5%E9%94%80%20%E6%88%90%E7%89%87&short_url=http://t.cn/zRoHrhe&full_url=http%3A%2F%2Fv.ku6.com%2Fshow%2F-FSKZ3XlMBJan4Vs_rWZYw...html%3Ffrom%3Dmy&type=1&" action-type="feed_list_media_video" style="orphans: 2; widows: 2;">http://t.cn/zRoHrhe</a> <o:p></o:p></span>密码:53226509</p><p class="MsoNormal" style="text-indent:31.5pt">第三、四、五期等电视台播放后全面公开,不再设置密码。</p><p class="MsoNormal" style="text-indent:32.0pt;mso-char-indent-count:2.0;line-height:28.0pt;mso-line-height-rule:exactly"><br></p><p>[此帖子已被 梁平县医疗保险局 在 2013-10-30 17:10:06 编辑过]Re:医疗保险:致全县医保参保人员的一封公开信
<P>我也很不幸,在一万里头了,</P>Re:医疗保险:致全县医保参保人员的一封公开信
赞。Re:医疗保险:致全县医保参保人员的一封公开信
<IMG src="data/attachment/bbsxp/Emotions/2.gif">Re:医疗保险:致全县医保参保人员的一封公开信
在册企业职工医保是不是你们管哟Re:医疗保险:致全县医保参保人员的一封公开信
<FONT size=6>医保卡上的钱在异地都不能使用,郁闷<IMG src="data/attachment/bbsxp/Emotions/21.gif"></FONT>Re:医疗保险:致全县医保参保人员的一封公开信
<STRONG><FONT color=#ff0000 size=5>希望我县特殊疾病与市上接轨,得了特殊疾病在我县不一定有门诊费报销,要看严重不严重,难道你们希望得病就要严重,不希望早发现,早诊断,早治疗,早康复嘛,我认为,只要达标医院诊断确定为特殊疾病,就应该享受有关医疗费用,请你们将21种特殊疾病好好对照检查下,在梁平认真落实党和政府有关医保政策!!!</FONT></STRONG>Re:医疗保险:致全县医保参保人员的一封公开信
早都该站出来说一下了,赞成其他部门也站出来说一下,免得办事人员像无头苍蝇一样,乱串Re:医疗保险:致全县医保参保人员的一封公开信
慢慢看Re:医疗保险:致全县医保参保人员的一封公开信
不错 顶一个 现在清楚多了
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