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医保政策问答 | 医保待遇及报销(一)

发布:太仓人才网   发布日期:2020-03-26  阅读次数:  

1、canjiayibaohou,canbaorennenggouxiangshouzenyangdebaoxiaodaiyu?

da:congquanguozongtiqingkuangkan,zhuyuanbaozhangfangmian,zhigongyibaohejuminyibaozhengcefanweineizhuyuanfeiyongbaoxiaobilifenbiedadao 80% zuoyouhe 70% zuoyou,tongchoujijinnianzuigaozhifuxianefenbiedadaodangdizhigongnianpingjungongzihuojuminnianrenjunkezhipeishourude 6 beizuoyou。menzhenbaozhangfangmian,zhigongyibaohejuminyibaopubiankaizhanlemenzhenmanxingbing(teshujibing)baozhang,juminyibaohaipubiankaizhanlemenzhenfeiyongtongchou。


2、医保可以报销哪些医疗费用?

da:yibanqingkuangxia,yibaofeiyongdebaoxiaozunxunzheijitiaoguize,zhiyaozaizheixieguizedefanweineideyiliaofeiyongdoushikeyibaoxiaode:

zhengchangxiangshoudaiyuqinei(yibaomeiduanjiao);

zaidingdianyiliaojigoujiuyi;

fuhe“sangemulu”fanwei;

zaiqifuxianyishanghefengdingxianzhinei;

erxiangduide,zaiguizewaidefeiyongjiubukeyibaoxiao。


3、什么是医保的“三个目录”?

da:youyuyibaojijinyouxian,bukenengfugaisuoyoudeyiliaoxuqiu,yinciweibaozhangcanbaorenyuandejibenyiliaoyongyaoxuqiu,helikongzhiyiliaofeiyongzhichu,guifanjibenyiliaobaoxianyongyao、zhenliaodengfangmiandeguanli,baozhengjibenyiliaobaoxianzhidudejiankangyunxing,yiliaobaozhangbumenguidinglejibenyiliaobaoxianduiyaopin、zhenliaoxiangmuheyiliaofuwusheshidebaoxiaofanwei,sucheng“sangemulu”。canbaorenyuanshiyongyaopin、fashengzhenliaoxiangmuhuoshiyongyiliaofuwusheshifashengdefeiyong,ruguoshuyu“sangemulu”neide,keyianguidingjinxingbaoxiao;bushuyu“sangemulu”neide,yibaobuyubaoxiao。zhaodayekaideshiyibaoyaopinbaoxiaomuluwaideyaopin,suoyiwufabaoxiao。muqianchangjianbing、duofabingdezhuyaozhiliaoyongyaodouyinarumulu。

yibaoyaopinmuluzhongdeyaopinhaifen“jialei”he“yilei”,lianggefenleideyaopinzaijisuanbaoxiaojineshi,narubaoxiaofanweidebiliyebutong

yibaoyaopinmuluneidejialeiyaopinshilinchuangzhiliaobixu、shiyongguangfan、liaoxiaohao,tongleiyaopinzhongjiagedideyaopin。canbaorenshiyongzheileiyaopinshi,keyiquanenarubaoxiaofanwei,anguidingbilibaoxiao。yileiyaopinshikegonglinchuangzhiliaoxuanzeshiyong、liaoxiaohao,tongleiyaopinzhongbijialeiyaopinjiagegaodeyaopin。canbaorenshiyongyileiyaopinshi,yaoxiananbili(gedibutong)kouchuyidingdegerenzifufeiyonghou,jiangyuxiafeiyongzainarubaoxiaofanwei,anguidingbilibaoxiao。


4、什么是“起付线”和“封顶线”?

da:qifuxianzhideshiyibaojijindeqifubiaozhun,canbaorenyuanzaidingdianyiliaojigoushijifashengde“sangemulu”neideyiliaofeiyong,zijiyaoxianchengdanqifubiaozhunyixiadefeiyong,qifubiaozhunyishangdebufenzaiyouyibaojijinanguiding、anbilibaoxiao。genjudiqu、yiliaojigou、menzhenhuozhuyuandengqingkuangdebutong,qifuxianbiaozhunyegebuxiangtong,congjibaiyuandaoyiqianduoyuanbudeng。

fengdingxianzhideshiyibaojijindezuigaozhifuxiane,yejiushicanbaorenzaiyigenianduneileijinengcongyibaojijinhuodedezuigaobaoxiaojine。fengdingxianyiwaideyiliaofeiyong,canbaorenkeyitongguocanjiabuchongyiliaobaoxian、shangyeyiliaobaoxiandengbanfajiejue。


5、如何计算医保报销金额?
答:参保人就医后,发生了药品、诊疗等费用,其中药品又包括甲类药品和乙类药品,那么报销的方法是:乙类药扣除自付后的费用,加上甲类药全部费用,再加上诊疗等费用中符合医保规定的费用,可用于累计参保人当年的起付线。对于超过起付线、未达封顶线的费用,依据患者本人参保类型、就医医院级别等按规定比例报销。

biru——

jiashechengzhenzhigonglaoguomoucijiuyizhuyuanfashengleyibaomulufanweineidezhenliaodengfeiyong 2000 yuan,jialeiyaopinfeiyong 3000 yuan,yileiyaopinfeiyong 5000 yuan,yileiyaopindezifubilishi 10%,dangdiqifuxianshi 1300 yuan,bencijiuyidefeiyongweichaoguofengdingxian,chengzhenzhigongyibaozaigaijibieyiyuandebaoxiaobiliwei 80%。neimebaoxiaofangfashi:

jialeiyaoquanbufeiyong 3000 yuan,jiashangjiangyileiyaopinkouchuzifuwaideqiyufeiyong 4500 yuan(yileiyaopinzifubufenwei 5000*10%=500 yuan),zaijiashangfuheyibaoguidingdezhenliaodengfeiyong 2000 yuan,heji 9500 yuan。kouchu 1300 yuandeqifuxian,narubaoxiaofanweidefeiyongshi 8200 yuan。zebencilaoguodeyiliaofeiyong,yibaonenggoubaoxiao 8200*80%=6560 yuan,laoguoxuyaozijichengdan 3440 yuan(qifuxian 1300 yuan + yileiyaozifude 500 yuan + yibaozhengcefanweineianbiliyougerenfudande 1640 yuan)。


6、超出医保封顶线的费用怎么办?
答:超过基本医保封顶线的部分,可根据实际医疗费用负担情况,纳入城乡居民大病保险范围。大病保险是基本医疗保障制度的拓展和延伸,主要对大病患者高额医疗费用在基本医保支付基础上再给予进一步支付。对参保居民经基本医保支付后,超出大病保险起付线的费用,按规定纳入大病保险支付范围。

muqianlaikan,dabingbaoxianzhengcefanweineifeiyongzhifubilidadao 50% yishang,bingqiebaozhangshuipingzaijinyibutisheng,2019 nian《zhengfugongzuobaogao》mingque“jiangdibingtongyidabingbaoxianqifuxian”“baoxiaobiliyou 50% tigaodao 60%”。2019 nian 4 yueguojiayibaojulianhecaizhengbuyinfa《guanyuzuohao 2019 nianchengxiangjuminjibenyiliaobaozhanggongzuodetongzhi》,yemingqueqifuxianjiangdizhishangyiniandujuminrenjunkezhipeishourude 50%,tongshiyaoqiujinyibujiadaduipinkunrenkoudezhifuqingxielidu,pinkunrenkouqifuxianjiangdi 50%,zhifubilitigao 5gebaifendian,bingquanmianquxiaojiandanglikapinkunrenkoufengdingxian,jinyibujianqingdabinghuanzhe、kunnanqunzhongyiliaofeiyongfudan。

ruguocanbaorenshipinkunrenkouhuodibaoduixiang,haikeyishenqinghuodexiangyingyiliaojiu。


相关阅读:
[2020-03-26] 太仓市职工医保待遇有提高
[2020-03-26] 基本医保有哪些类型?如何选择适合自己的医保?
[2020-03-26] 职工医保和居民医保有什么区别?
[2020-03-26] 医保政策问答 | 医保待遇及报销(二)
[2020-03-26] 医保政策问答 | 医保待遇及报销(三)

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本页更新时间:2020-12-06 01:48:23 []