定兴县医保局热点医疗保障政策解答
<section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system-font, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; text-align: center; box-sizing: border-box !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section><section style="margin-right: 10px; margin-left: 10px; max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; border-style: dashed; border-width: 2px; border-color: rgb(42, 186, 174); border-radius: 5px;"><p style="max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important;"><span style="max-width: 100%; color: rgb(56, 195, 207); box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;">01</strong></span></p></section></section><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent; transform: rotateZ(0deg);"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section></section></section><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box !important;"><section style="padding: 1px 3px; max-width: 100%; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); background-color: rgb(254, 254, 254); border-radius: 50%; display: inline-block; transform: rotateZ(0deg); box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important;"><span data-form="0" style="max-width: 100%; color: rgb(104, 125, 255); box-sizing: border-box !important;">01</span></p></section><section style="margin-top: -15px; margin-left: 10px; max-width: 100%; box-sizing: border-box; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); letter-spacing: 1.5px; font-size: 16px; border-radius: 0px 8px 0px 0px;"><section style="padding-top: 5px; padding-bottom: 5px; max-width: 100%; box-sizing: border-box; border-bottom: 2px solid rgb(197, 206, 255); background-color: rgb(239, 242, 255); border-radius: 0px 12px 0px 0px;"><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; letter-spacing: 2px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 20px; font-family: 黑体; box-sizing: border-box !important;"> 异地就医备案怎么办理？</span><br style="max-width: 100%; box-sizing: border-box !important;"></p></section><section style="margin: 15px; max-width: 100%; box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">答：</span></strong><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">1</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">、参保患者因病情<span style="max-width: 100%; color: black; box-sizing: border-box !important;">等原因向外地（市域外）转诊转院的人员，需办理异地就医备案手续，依据《保定市城乡居民基本医疗保险急诊急救、转诊、异地居住管理办法》（保人社字〔2018〕258号），未按规定办理住院、转院和备案等医保手续的参保人员，在医保定点医疗机构发生的医疗费用，属于统筹基金支付范围内的，医疗费用起付线以上的部分降低支付比例10%。</span></span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; color: black; box-sizing: border-box !important;">2</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; color: black; box-sizing: border-box !important;">、异地就医备案有两种形式：一种是前往市域外住院的就医人员，需转出医院开具转诊手续，到县医保中心进行备案，就医后回定兴县医保中心报销，此种形式存在往返次数比较多、报销时间长、不便民等问题；另一种是网上备案，此种方式也是我们大力推广的一种备案方式。网上备案方式进一步减轻了参保人员因病就医跑腿垫资负担，简化异地就医住院报销手续</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">，做到了备案方便、快捷、高效。</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">3</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">、网上异地就医备案<span style="max-width: 100%; color: black; box-sizing: border-box !important;">有两种形式：</span>一种是有转院证明的可以持社会保障卡到定兴县医保中心备案，由工作人员进入国家异地就医平台实现网上备案、医院直接结算。另一种是网上自行备案。首先是利用手机微信搜索并关注“河北省医疗保障局”公众号，进入公众号后点击右下角“异地就医”，按提示完成备案；二是备案后持社会保障卡前往医院进行刷卡，出院时实现即时结算报销。</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">4</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">、异地就医网上备案注意事项：一是前往住院的医疗机构必须是可以执行<span style="max-width: 100%; color: black; box-sizing: border-box !important;">异地就医直接结算的定点医疗机构，也就是说这个医院必须是国家异地就医联网直接结算的医院；二是社会保障卡必须激活医保功能，在这里特别提示一下，银行激活的是银行卡功能，医疗机构激活的才是医保功能。居民医保卡需到县域内定点医疗机构（职工医保卡也可以到定点药店）进行激活。</span></span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; color: black; box-sizing: border-box !important;">5</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; color: black; box-sizing: border-box !important;">、了解具体政策的渠道：一是县城各级定点医院、乡镇卫生院、村卫生室均设置了“定兴县医疗保障局城乡居民政策宣传栏”，异地备案政策一栏可以随时查阅；二是可致电医保中心政策咨询电话6925136，由工作人员进行解答；三是来医保中心窗口咨询，由工作人员点对点的宣传解答，并发放政策及操作流程明白纸。</span></p></section></section></section></section><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; text-align: center; box-sizing: border-box !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section><section style="margin-right: 10px; margin-left: 10px; max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; border-style: dashed; border-width: 2px; border-color: rgb(42, 186, 174); border-radius: 5px;"><p style="max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important;"><span style="max-width: 100%; color: rgb(56, 195, 207); box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;">02</strong></span></p></section></section><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent; transform: rotateZ(0deg);"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section></section></section><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box !important;"><section style="padding: 1px 3px; max-width: 100%; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); background-color: rgb(254, 254, 254); border-radius: 50%; display: inline-block; transform: rotateZ(0deg); box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important;"><span data-form="0" style="max-width: 100%; color: rgb(104, 125, 255); box-sizing: border-box !important;">02</span></p></section><section style="margin-top: -15px; margin-left: 10px; max-width: 100%; box-sizing: border-box; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); letter-spacing: 1.5px; font-size: 16px; border-radius: 0px 8px 0px 0px;"><section style="padding-top: 5px; padding-bottom: 5px; max-width: 100%; box-sizing: border-box; border-bottom: 2px solid rgb(197, 206, 255); background-color: rgb(239, 242, 255); border-radius: 0px 12px 0px 0px;"><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; letter-spacing: 2px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 黑体; box-sizing: border-box !important;"> 参保居民同样是住院，</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; letter-spacing: 2px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 黑体; box-sizing: border-box !important;"> 为什么</span><span style="max-width: 100%; font-family: 黑体; font-size: 21px; box-sizing: border-box !important;">在各级医院的</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; letter-spacing: 2px; box-sizing: border-box !important;"><span style="max-width: 100%; font-family: 黑体; font-size: 21px; box-sizing: border-box !important;"> 报销比例不一样？</span></p></section><section style="margin: 15px; max-width: 100%; box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">答：</span></strong><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">为了切实减轻参保居民医疗费用负担，落实分级诊疗制度，引导参保居民合理就医、就近就医，国家医保部门合理设置了起付线、报销比例，医疗机构的等级不同，报销比例就会有差异，真正实现小病不出乡、大病不出县的合理分流就医流向。</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">依据《保定市城乡居民基本医疗保险实施细则》（保人社发〔2018〕34号文件）规定，对不同区域不同级别的医院设定了不同的起付标准和不同的报销比例。</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">1</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">、起付标准：</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">参保县域内的乡镇卫生院100元，一级医疗机构300元，二级医疗机构400元。参保县域外统筹市域内一级及二级医疗机构800元，三级医疗机构2000元。统筹市域外医疗机构2500元。</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">2</span><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">、政策范围内的支付比例：</span></p><p style="max-width: 100%; clear: both; min-height: 1em; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">参保县域内的乡镇卫生院（社区卫生服务中心）90%，一级及二级医疗机构75%，三级医疗机构60%。参保县域外统筹市域内的二级及以下医疗机构70%，三级医疗机构55%。统筹市域外医疗机构50%。</span></p></section></section></section></section><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; text-align: center; box-sizing: border-box !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section><section style="margin-right: 10px; margin-left: 10px; max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; border-style: dashed; border-width: 2px; border-color: rgb(42, 186, 174); border-radius: 5px;"><p style="max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important;"><span style="max-width: 100%; color: rgb(56, 195, 207); box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;">03</strong></span></p></section></section><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.3em solid rgb(167, 255, 234); border-left: 0.65em solid transparent; border-right: 0.65em solid transparent; transform: rotateZ(0deg);"><br style="max-width: 100%; box-sizing: border-box !important;"></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; vertical-align: bottom; border-bottom: 1.6em solid rgb(56, 195, 207); border-left: 0.85em solid transparent; border-right: 0.85em solid transparent;"><br style="max-width: 100%; box-sizing: border-box !important;"></section></section></section></section><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box !important;"><section style="padding: 1px 3px; max-width: 100%; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); background-color: rgb(254, 254, 254); border-radius: 50%; display: inline-block; transform: rotateZ(0deg); box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important;"><span data-form="0" style="max-width: 100%; color: rgb(104, 125, 255); box-sizing: border-box !important;">03</span></p></section><section style="margin-top: -15px; margin-left: 10px; max-width: 100%; box-sizing: border-box; border-width: 2px; border-style: solid; border-color: rgb(197, 206, 255); letter-spacing: 1.5px; border-radius: 0px 8px 0px 0px;"><section style="padding-top: 5px; padding-bottom: 5px; max-width: 100%; box-sizing: border-box; font-size: 16px; border-bottom: 2px solid rgb(197, 206, 255); background-color: rgb(239, 242, 255); border-radius: 0px 12px 0px 0px;"><p style="max-width: 100%; clear: both; min-height: 1em; text-align: left; letter-spacing: 2px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 黑体; box-sizing: border-box !important;"> 职工医保个人账户每月</span></p><p style="max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 黑体; box-sizing: border-box !important;"> 按什么标准划入，其用途有哪些？</span></p></section><section style="margin: 15px; max-width: 100%; box-sizing: border-box !important;"><p style="max-width: 100%; clear: both; min-height: 1em; font-size: 16px; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><strong style="max-width: 100%; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">答：</span></strong><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">依据《保定市城镇职工基本医疗保险市级统筹实施细则》规定，职工医保基金由统筹基金和个人账户两部分组成，划入职工个人账户的标准是：</span></p><p style="max-width: 100%; clear: both; min-height: 1em; font-size: 16px; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">（1）45周岁以下（含45周岁）的按本人缴费基数3.1%划入。 </span></p><p style="max-width: 100%; clear: both; min-height: 1em; font-size: 16px; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;">（2）45周岁以上的按本人缴费基数的3.7%划入。</span></p><p style="margin-bottom: 5px; max-width: 100%; clear: both; min-height: 1em; font-size: 16px; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 21px; font-family: 仿宋_GB2312; box-sizing: border-box !important;"> （3）退休人员按退休计发表核定退休金的4%划入，退休职工本人不缴费，由医保基金统一划入。职工个人账户基金用于支付在定点医药机构发生的合规费用，主要解决参保职工的门诊费用或支付住院费用中的自付部分。住院费用的自付部分超出个人账户余额的由职工自行支付。</span></p><p style="margin-bottom: 20px; max-width: 100%; clear: both; min-height: 1em; font-size: 16px; text-indent: 43px; line-height: 35px; box-sizing: border-box !important;"><span style="max-width: 100%; font-family: 仿宋_GB2312; font-size: 17px; box-sizing: border-box !important;">-来源：定兴县医保局</span></p></section></section></section></section></section><p style="max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system-font, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: right; box-sizing: border-box !important;"><span style="max-width: 100%; font-size: 14px; color: rgb(255, 172, 213); box-sizing: border-box !important;">来源：定兴人社</span></p><p></p>
页:
[1]