2015医疗保险报销流程

2015医疗保险报销 导读:职工基本医疗保险作用是为了减轻职工由于疾病或者其他身体伤害造成的经济损失和负担，保障职工生活水平不会因为花钱治病而降低过多，是现代社会保险的一种。而医保制度如果细分，有城镇居民医保、职工医保和新农合医保三种。今天我主要讲讲职工医保的报销流程和需要什么材料，住院医保怎么报销流程。 社会医疗保险如何报销 社会医疗保险报销流程图 购药医保报销须知: strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 参保人员可持医疗保险卡在所有定点医疗机构、定点零售药店购药，其医药费用可用卡直接结算，购药时不计入社会统筹，全部由个人账户支付，如果个人帐户金用完，可以用现金支付。 门诊医保报销流程及注意事项: 报销时需携带以下:1.身份证或社会保障卡的原件;2.定点医疗机构专科医生开具的疾病诊断证明书原件;3.门诊病历、检查、检验结果单等就 医资料原件;4.财政、税务统一医疗机构门诊收费收据原件;5.医院电脑打印的门诊费用明细清单或医生开具处方的付方原件;6.定点药店:税务商品销售统 一发票及电脑打印清单原件;7.如果是代人办理则需要提供代办人身份证原件。 带齐以上资料到当地社保中心相关部门申请办理，经审核，资料齐全、符合条件的，就可以即时办理。申请人办理门诊医疗费用报销时，先扣除本社保年度内划入医疗保险个人帐户的金额，再核定应报销金额。 住院医保报销流程及注意事项: 1.入院或出院时都必须持医疗保险IC卡到各定点医疗机构医疗保险管理窗口办理出入院登记手续。住院时个人先预交医疗费押金，strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 出院结帐后多还少补。未 办理住院登记手续前发生的医疗费不纳入基本医疗保险支付范围。因急诊住院未能及时办理住院登记手续的，应在入院后次日凭急诊证明到医疗保险管理窗口补办住 院手续(如遇节假日顺延)，超过时限的医疗费自负。 2.参保人员住院后统筹基金的起付线:起付线各地标准各有不同一般为上年度全市职工年平均工资的10,，在一个基本医疗保险结算年度内，多次住院的医疗费累计计算。 3.参保人员因病情需要转诊或转院的，须经三级以上定点医疗机构副主任医师或科主任诊断后提出转诊(院)意见，由所在单位填报申请表，经定点医疗机构医疗保险管理部门审核同意报市(区)社保机构批准后办理转诊(院)手续。 转院限于省特约医院，其费用先由本人垫付，其报销标准要先自负10%，再按本地规定计算可报销金额。 4.在定点医疗机构出院时，各定点医疗机构会按照相关政策计算医保报销金额和个人应该自付的金额，其报销金额由定点医疗机构和市区社会保险经办机构结算，个人应该自付的金额由定点医疗机构和参保人员本人结算。 strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 商业医疗保险怎么报销 情形一:额外补充费用报销型保险的人群 根据社会保险优先于商业保险的原则，一般由社会医疗保险支付后，保险公司再对剩余部分医疗费进行理赔。 优保网专家称，保险公司会先根据保险条款确定可以赔付的项目(一般和社保的理赔范围一致)，再扣除社保已经赔付的额度，得到实际赔付数。 示例:假设商业险保额5000元，发生医疗总费用10000元，都在可保范围内的。商业保险的赔付率是90%，免赔额100元。那么，商保可赔付数为 (10000-100)×90%=8910元。社保报销80%后，还余2000元，在8910的赔付范围内，且不超过保额，所以2000元全部由保险公司 承担。 以上，如果商业险保额低于2000元，则保险公司的理赔以保额为限。 优保网专家提示，不论社保机构还是保险公司，都是凭发票报销，尤其是社保要求出示原件。所以，在申请报销社保时，要提醒工作人strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 员开分隔发票，供之后商业险报销申请使用。 对于用人单位支付医疗费用的，个人投保时视同为社会保险。 情形二:额外补充重大疾病保险和津贴型保险的人群 这两种类型的商业保险和社会医疗保险在理赔时并不冲突。优保网专家称，商业重大疾病保险一般是确诊即给付的。即使申请时还没有开始治疗，被保险人可凭借医院开具的确诊证明，一次性获得保险金额，保证了在第一时间能够有充足的治疗经费，使后续治疗可以顺利进行。 同样，津贴型的保险也不是凭发票进行报销的。只要提供发生手术或是住院证明(具体产品规定)，就能从保险公司获得保险金，作为误工费或营养费的补偿。 被保险人在得到重疾保险金或津贴后，仍可凭借医疗费用的发票向社保机构申请治疗费用的报销。 从报销情况可以看出，商业健康险可对社会医疗保险进行适当的补充，以提高保障额度，增强保险的及时性，增加保障项目。 strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 如何按规定享受基本医疗保险待遇, 连续参加基本医疗保险1年以上的参保人，因工作变动，在1个医疗保险年度内累计中断参保不超过3个月的，重新缴费后其中断前后的连续参保年限可合并计算，并享受基本医疗保险待遇;在医疗保险年度内累计中断参保超过3个月的重新计算参保年限。 退休后累计缴纳基本医疗保险费男满25年、女满20年的，按照国家规定办理了退休手续，按月领取基本养老金或者退休费的人员，享受退休人员的基本医疗保险待遇，不再缴纳基本医疗保险费。 个人账户支付下列医疗费用:门诊、急诊的医疗费用;到定点零售药店购药的费用;基本医疗保险统筹基金起付标准以下的医疗费用;超过基本医疗保险统筹基金起付标准，按照比例应当由个人负担的医疗费用。个人账户不足支付部分由本人自付。 基本医疗保险统筹基金支付下列医疗费用:住院治疗的医疗费用;急诊抢救留观并收入住院治疗的，其住院前留观7日内的医疗费用;恶性肿瘤放射治疗和化学治疗、肾透析、肾移植后服抗排异药的门诊医疗费用。 基本医疗保险基金不予支付下列医疗费用:在非本人定点医疗机strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality 构就诊的，但急诊除外;在非定点零售药店购药的;因交通事故、医 疗事故或者其它责任事故造 成伤害的;因本人吸毒、打架斗殴或者 因其它违法行为造成伤害的;因自杀、自残、酗酒等原因进行治疗的; 在国外或者香港、澳门特别行政区以及台湾地区治疗 的;按照国家 和本市规定应当由个人自付的。 相关阅读: 1.家庭财产险【包括哪些_费率_怎么买】 企业补充医疗保险【是什么_政策_规定】 厦门医保卡【余额查询_使用范围_设置密码】 年最新保险公司排名_历年中国保险公司名 , work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, and other issues. To establish and perfect the muddle along Bureau staff conduct work regulations, standardize the behavior of personnel. 2. To strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 5)," Hunan province safety supervision and management responsibilities of the provisions on the production (Hunan Zhengban made 2013 No. 4) And resolutely implement the safety production of the party with responsibility, a pair of responsibility. "Two is issued safety production administration and inspection to promote the responsibilities bear safety production supervision departments strictly and effectively assumed responsibility. The three is to establish risk self correction self reporting system for safety in production enterprises, promote the enterprises to implement the main responsibility for production safety is introduced. Four strengthen the county safety production supervision ability construction work, promote safe production responsibility to the grassroots. 3, strict accountability and target management. Adhere to the" who is in charge, who is responsible for the pipe industry must be safe, Guan Sheng production and operation must be safe, pipe business must control security "principle, the implementation of safety The production of "cure." stagnation supervision and leadership responsible system. The safety production of key towns, key enterprises and key problems, by the township government and the Department responsible for the stagnation led the lump sum, to tackle tough. To further increase the production safety index assessment, strictly implement the safety production of the "one vote veto" and the reward system, strengthen the safety incentive and restraint mechanism. (six) the implementation of the work force is not strong. The documents, meeting, long work arrangement, check and supervise the implementation of small, poor implementation of the system, the work is not effective. Some leading cadres sense of purpose, consciousness of the masses is not strong, the ruling " For the people "," the interests of the masses no matter "concept understanding is not in place. The specific work treats with the deployment, a few leading cadres complain that work is too complicated, too much responsibility, the pressure is too large, too much emphasis on the difficulty of the work, such as underground mines to avoid the disaster of" six systems "construction and construction of mechanical ventilation to file the form, forwarding arrangements work, no in-depth mining enterprises to promote the specific work, the increase in the number of files, but the effect is not good, not according to the actual situation of non coal mines in the county, to engage in" across the board ", and the quality