厦门医保政策新调整 农民看病报销条件抢先看

厦门医保政策新调整 农民看病报销条件抢先看 www.soufun.com 房地产门户-搜房网 2011-11-13 11:41:00 来源:厦门日报 我要评论我要评论 [提要]近期，我市医保政策出现调整，超过18万的被征地人员也全部被纳入医保范围。那么我市对农村居民有哪些医保政策,农村居民在什么情况下可以享受到国家基本药物每年最高可以报销500元的待遇;已参保农村居民要到外地就诊时应该办理哪些手续等等问题，是许多读者关注的。 近期，我市医保政策出现调整，超过18万的被征地人员也全部被纳入医保范围。那么我市对农村居民有哪些医保政策,农村居民在什么情况下可以享受到国家基本药物每年最高可以报销500元的待遇;已参保农村居民要到外地就诊时应该办理哪些手续等等问题，是许多读者关注的。 11日上午9时到10时30分，本报嘉宾接热线专题栏目的话题是“关注我市农村居民医保政策”，我们邀请的嘉宾是市社保管理中心的工作人员郭达群。您还可以登录本报百家村社区www.100cun.net查看嘉宾更详细的答疑释惑问题。 本报讯 (记者 卢天娇)农民朋友，有病不要再扛着啦，即使是小病，也要赶快到乡镇医院去看，只要持卡看病，就可以享受医保待遇。嘉宾接热线期间，嘉宾多次呼吁农民朋友有病就要就诊。 最高医保待遇额度为21万元 据了解，我市一些农村家庭出现贫困的原因源于家中有重疾病患者，高昂的治疗费用会将一个原本小康的家庭彻底拖垮。 嘉宾说，目前我市农村居民筹资为每个年度380元，其中财政补助300元(低保、残疾农村居民免缴个人应缴纳的医疗保险费)，但可获得的医保待遇，已经与城镇职工相同，即一个社保年度为10万元;超过医保基金最高支付额度以上的医疗费用，还可由补充医疗保险支付，达到11万元——二者相加，每个社保年度最高可获得21万元的医保保障额度。 常见病药基本可由基金支付 据介绍，目前我市有超过42万名的农村居民参加了医保。但是，相关数字和调查都显示，农村参保居民就医的积极性还是远低于城镇参保居民，原因之一就是农民怕花钱，有了病都是先扛着，实在扛不住了才就诊，这时候往往就错过了治疗疾病的最佳时机，很多大病也由此酿成。 the Communist Party of China, and a deep understanding of the party's nature, purpose, guiding principles, goals, organization, good style, deeply understand the conditions, rights and obligations of members, code of conduct, bearing in mind that oath, clear Members of the standards and conditions, enhance respect, abide by the Constitution, maintaining the party Constitution consciousness of the party Constitution. Read through the familiar with the code of self-discipline of the CPC, the CPC disciplinary regulations, members of the Communist Party of China party regulations on rights protection Ordinance, mastering self-discipline standards of "four must", the "four upholdings", mastering various types of disciplinary offence and punishment provisions and clear what you can do, what they can't do. 2. speech understanding learning series XI series the basic spirit of an important speech by General Secretary, learn to understand the Party Central Committee on governance of the new concept of basic elements of new ideas and new strategies, master and strengthen the party spirit, fulfills the purpose ideas, moral character, conservation related to the basic requirements. Learning of the XI series read the important speech by General Secretary (2016), XI Henan work research guide, General Secretary's important speech. Learning series speech, main understand master following aspects content: (1) ideal faith 嘉宾说，针对这种情况，要让医保基金切实起到为患病农村居民遮风挡雨的作用，避免农村居民因病返贫的现象发生，就需要保证农村居民最基本的用药需求，需要有措施鼓励农村居民养成有病积极就诊的习惯。 因此，我市实行农村居民基本医疗保险以来，出台了一系列提高其待遇的政策，包括“基药新政”，鼓励农村居民积极到乡镇公立基层卫生医疗机构看病。即农村居民只要持医保卡到乡镇卫生医疗机构看病，发生在国家基本药物中的费用，每年都有500元的额度由社会统筹医疗基金支付，个人不必再承担。这意味着农民朋友看感冒、发烧之类的常见病，在乡镇卫生医疗机构就诊时，钱将是由医保基金支付的。 看病刷卡 才能享受报销待遇 热线期间，一些读者来电咨询到哪里享受医保报销待遇。 嘉宾说，农村居民参保人员手中都有一张社保卡，看病时只要持这张卡在医保定点医疗机构刷卡，就能自动享受医保报销待遇。因为医保基金是通过参保人员刷卡，自动与各家医疗机构结算费用的，所以，就不存在参保人员再持其他什么证明或者就诊费用单子到社保经办机构报销的问题了。 据介绍，不少农村参保人员不习惯刷卡看病，总是想先自己垫付现金、病好了再到社保机构报销。 嘉宾说，过去，我市对新农合参保人员看病报销确实实行这一模式，但是目前这一模式已经不再实行了。农村参保人员必须像城镇参保人员一样，就诊时通过及时刷卡才能够自动享受医保基金报销待遇。否则，只能自己承担就诊费用。 【相关新闻】 卡里“没钱” 也能享受待遇 本报讯 (记者 卢天娇)海沧区新阳街道祥露村的读者来电说，自己去医院看病时，发现卡里没钱。为什么已经参保了卡里却没钱,卡里没钱，看病还可以享受医保待遇吗,享受标准怎样定的, 嘉宾说，可以。因为农村居民参加的城乡居民基本医疗保险，未设立个人账户，也就是俗称的卡里没钱。虽说“卡里没钱”，但只要参加了医疗保险，就可以享受医保各种待遇。 医保待遇标准是，在门诊起付标准(1000元)内合理的医疗费用，在海沧区东孚卫生院、海沧街道石塘社区卫生服务中心、海沧街道海沧社区卫生服务中心、新阳街道社区卫生服务中心等公立基层医疗卫生机构门诊就医发生的在国家基本药物内的药品费用，不超过500元部分由社会统筹医疗基金全部报销。 the Communist Party of China, and a deep understanding of the party's nature, purpose, guiding principles, goals, organization, good style, deeply understand the conditions, rights and obligations of members, code of conduct, bearing in mind that oath, clear Members of the standards and conditions, enhance respect, abide by the Constitution, maintaining the party Constitution consciousness of the party Constitution. Read through the familiar with the code of self-discipline of the CPC, the CPC disciplinary regulations, members of the Communist Party of China party regulations on rights protection Ordinance, mastering self-discipline standards of "four must", the "four upholdings", mastering various types of disciplinary offence and punishment provisions and clear what you can do, what they can't do. 2. speech understanding learning series XI series the basic spirit of an important speech by General Secretary, learn to understand the Party Central Committee on governance of the new concept of basic elements of new ideas and new strategies, master and strengthen the party spirit, fulfills the purpose ideas, moral character, conservation related to the basic requirements. Learning of the XI series read the important speech by General Secretary (2016), XI Henan work research guide, General Secretary's important speech. Learning series speech, main understand master following aspects content: (1) ideal faith 在其他定点医疗机构就医发生的符合规定的医保医药费用，起付段1000元内需现金支付，超过1000元部分进入统筹，由医保基金按比例支付。 【读者问 专家答】 在哪些地方就诊可以享受待遇 问:我是翔安新店镇杨厝村的村民，以前没看过病，我想知道是在所有地方看病都可以享受医保待遇吗, 答:不是。必须在挂有厦门市医保定点的医疗机构看病才能享受待遇。要享受“基药新政”的，必须在我市公立基层医疗卫生机构(目前是岛内15家，岛外22家)。翔安的5家分别是厦门市翔安区大嶝医院、厦门市翔安区新店中心卫生院、厦门市翔安区马巷卫生院、厦门市翔安区新圩中心卫生院、厦门市翔安区内厝卫生院。 住院可以享受什么待遇 问:我是翔安新圩镇乌山村的农民，以前没住过院，上个月去门诊看病说要住院，大概要花2万多元，咨询可以报销多少?芽一年内最多可以报销多少, 答:住院发生的费用中，非医保部分要自己现金支付，所以在可能情况下，您可以请医生尽量为您使用医保范围内的药物和治疗项目。医保费用中，如果你在二级医院住院，首先自己要支付起付段费用1007.1元，扣除起付段后，假设医保总费用为21000元，那么你还需自付20%即4200元。本年度基本医疗保险费统筹最高支付限额为10万元;本年度补充医疗保险赔付最高限额为11万元(其中个人负担30%) 异地就医如何报销 问:我是集美后溪村的农民，准备去广东打工，如果在那里生病了怎么办,费用如何报销, 答:您必须事先在我市的社保中心办理备案手续，备案后在广东指定的医疗机构、药店发生的费用，可以在我市社保中心按规定报销。 早产新生儿咋获得待遇 问:我是翔安马巷的村民，上个月小孩早产，出生后住大医院新生儿科，花了8000多元，可以报销吗,要怎么办理手续, 答:小孩出生三个月内，父母或监护人持新生儿户口簿向所在地的地方税务机关办理登记申报手续，按规定缴纳全年的医疗保险费80元后，从出生之日起就能享受未成年人医疗保险待遇;出生三个月后办理登记申报的，从缴纳医疗保险费的当月起享受未成年人医疗保the Communist Party of China, and a deep understanding of the party's nature, purpose, guiding principles, goals, organization, good style, deeply understand the conditions, rights and obligations of members, code of conduct, bearing in mind that oath, clear Members of the standards and conditions, enhance respect, abide by the Constitution, maintaining the party Constitution consciousness of the party Constitution. Read through the familiar with the code of self-discipline of the CPC, the CPC disciplinary regulations, members of the Communist Party of China party regulations on rights protection Ordinance, mastering self-discipline standards of "four must", the "four upholdings", mastering various types of disciplinary offence and punishment provisions and clear what you can do, what they can't do. 2. speech understanding learning series XI series the basic spirit of an important speech by General Secretary, learn to understand the Party Central Committee on governance of the new concept of basic elements of new ideas and new strategies, master and strengthen the party spirit, fulfills the purpose ideas, moral character, conservation related to the basic requirements. Learning of the XI series read the important speech by General Secretary (2016), XI Henan work research guide, General Secretary's important speech. Learning series speech, main understand master following aspects content: (1) ideal faith 险待遇。未成年人目前归入城乡居民医疗保险中，享受城乡居民统一待遇，符合规定的医保费用先付起付段(三级医院是1611.36元)，然后进入统筹段按比例支付。 为啥我不能使用这500元 问:我是同安的村民，我和我母亲参加了同样的医疗保险，为什么我的卡拿到卫生院去开“病毒唑”要自己付钱，而我母亲用她的卡去开，却可以不用自己付钱, 答:有可能是你的卡信息未处于正常的参保状态中。比如中断缴费时，就会处于统筹冻结状态中，就不能使用。因此你要立刻查看银行代扣账户是否有足够金额。另外，你所开的药费还必须含在门诊起付标准1000元内，否则，也不能再享受。 哪些病可用500元基本药物, 问:我是农村的，有高血压和糖尿病，是否可以在卫生院开500元内的对参保人员免费的药物，可以开哪些药, 答:我市公立基层医疗卫生机构使用的基本药物品种共计546种，包括2009年先期公布的《国家基本药物目录(基层医疗卫生机构配备使用部分)》，含化学药品和生物制品205种，中成药102种，共307个药品品种;我省增补的非目录品种148种(化学药品和生物制品99种，中成药49种);厦门市新增临时用药91种。具体可到各卫生院咨询，或者登录厦门市社会保障卡信息网(www.xm12333.com)查询。 可查询目录中包含了治疗高血压、糖尿病等大多数常见病、多发病所需的基本药品名称。 啥条件下可领取 自付医疗费困难补助 问:我舅舅是同安的农民，得了白血病，花了很多钱，听说还有一种自付医疗费困难补助，有吗,需要什么条件才能获得, 答:有。符合以下两种条件之一的就可以获得补助: (1)参加城乡居民基本医疗保险，属于本市居民最低生活保障、残疾、五保户、“三无”(无劳动能力、无生活来源，无法定抚养、扶养、赡养)的本市户籍人员，在基本医疗保险年度内(当年7月1日至次年6月30日)发生个人自付的医疗费用累计高于1500元且低于5000元(含5000元)的部分，给予补助50%;5000元以上的部分，给予补助70%。 (2)参加城乡居民基本医疗保险、年龄在70周岁以上(含70周岁)的本市户籍满五年的老年居民，在基本医疗保险年度内个人自付的医疗费用累计高于3000元且低于6000the Communist Party of China, and a deep understanding of the party's nature, purpose, guiding principles, goals, organization, good style, deeply understand the conditions, rights and obligations of members, code of conduct, bearing in mind that oath, clear Members of the standards and conditions, enhance respect, abide by the Constitution, maintaining the party Constitution consciousness of the party Constitution. Read through the familiar with the code of self-discipline of the CPC, the CPC disciplinary regulations, members of the Communist Party of China party regulations on rights protection Ordinance, mastering self-discipline standards of "four must", the "four upholdings", mastering various types of disciplinary offence and punishment provisions and clear what you can do, what they can't do. 2. speech understanding learning series XI series the basic spirit of an important speech by General Secretary, learn to understand the Party Central Committee on governance of the new concept of basic elements of new ideas and new strategies, master and strengthen the party spirit, fulfills the purpose ideas, moral character, conservation related to the basic requirements. Learning of the XI series read the important speech by General Secretary (2016), XI Henan work research guide, General Secretary's important speech. Learning series speech, main understand master following aspects content: (1) ideal faith 元(含6000元)的部分，给予补助50%;6000元以上的部分，给予补助70%。以上补助分 段计算。 the Communist Party of China, and a deep understanding of the party's nature, purpose, guiding principles, goals, organization, good style, deeply understand the conditions, rights and obligations of members, code of conduct, bearing in mind that oath, clear Members of the standards and conditions, enhance respect, abide by the Constitution, maintaining the party Constitution consciousness of the party Constitution. Read through the familiar with the code of self-discipline of the CPC, the CPC disciplinary regulations, members of the Communist Party of China party regulations on rights protection Ordinance, mastering self-discipline standards of "four must", the "four upholdings", mastering various types of disciplinary offence and punishment provisions and clear what you can do, what they can't do. 2. speech understanding learning series XI series the basic spirit of an important speech by General Secretary, learn to understand the Party Central Committee on governance of the new concept of basic elements of new ideas and new strategies, master and strengthen the party spirit, fulfills the purpose ideas, moral character, conservation related to the basic requirements. Learning of the XI series read the important speech by General Secretary (2016), XI Henan work research guide, General Secretary's important speech. Learning series speech, main understand master following aspects content: (1) ideal faith