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《关于调整梧州市城镇职工基本医疗保险待遇有关问题的通知》政策解读

2019-01-03 15:32     来源:极速时时彩|官网
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weijinyibuwanshanwuzhoushichengzhenzhigongjibenyiliaobaoxian(yixiachengzhigongyibao)zhidu,tigaocanbaorenyuandeyiliaodaiyushuiping,kuodacanbaorenyuandeshouyimian,yizhaoyiliaobaoxianjijin“shouzhipingheng,lveyoujieyu”deyuanze,wuzhoushirenliziyuanheshehuibaozhangju、caizhengjuchutaile《guanyudiaozhengwuzhoushichengzhenzhigongjibenyiliaobaoxiandaiyuyouguanwentidetongzhi》(wurenshegui〔2018〕6hao,yixiajiancheng《tongzhi》),cong2019nian1yue1riqiduiwuzhoushizhigongyibaoyouguandaiyuzhengcejinxingdiaozheng,xianjiuyouguanneirongjieduruxia:

一、问: 《通知》文件出台的背景是什么?

极速时时彩da: an《wuzhoushirenminzhengfuguanyuyinfawuzhoushishenhuayiyaoweishengtizhigaigeshisanwuguihuadetongzhi》(wuzhengfa〔2017〕49hao)、《wuzhoushirenminzhengfuguanyuyinfawoshi2018nianzhengfugongzuobaogaozhongdiangongzuojibumenfengongfangandetongzhi》(wuzhengfa〔2018〕2hao)zhongguanyuwenbutigaojibenyiliaobaozhangshuiping,jiangdigerenyiliaozifeibilidegongzuoyaoqiuherenwu,weilejinyibuwanshanwoshizhigongyibaozhidu,tigaocanbaorenyuandeyiliaodaiyushuiping,kuodacanbaorenyuandeshouyimian,genjuwoshizhigongyibaojijinyunxingqingkuang,yizhaoyiliaobaoxianjijin“yishoudingzhi,shouzhipingheng”deyuanze,cong2019nian1yue1riqiduiwoshizhigongyibaojizhigongdabingbuzhuzhengcejinxingdiaozheng,shidangtigaoyiliaodaiyushuiping。

二、问: 本次政策调整涉及人员范围是什么?

da: quanshizhigongyibaocanbaorenyuan。

三、《通知》的主要内容是什么?

极速时时彩da: diaozhengwoshizhigongyibaojizhigongdabingbuzhuzhengce,jutiruxia:

(yi)diaozhengzhigongyibaoyiliaodaiyuzhengce。

1.tigaozhigongyibaotongchoujijinzuigaozhifuxiane。

canbaorenyuanyibaotongchouzhifufanweineifeiyongzuigaozhifuxianeyoumeirenmeinian15wanyuandiaozhengwei: shangnianduwoshizhigongnianpingjungongzi6bei(yishangniandutongjinianjianshujuweiyiju)。

2.diaozhengzhigongyibaomenzhenteshumanxingbingzhengce。

(1)zengjiazhigongyibaomenzhenteshumanxingbingbingzhong。jianggaoxueyabing(gaoweizu)、guanxinbing、jiakang、manxingganyanzhiliaogongguqi4gemanxingbingbingzhongzengjiaweizhigongyibaomenzhenteshumanxingbingbingzhong。

(2)diaozhengmenzhenteshumanxingbingbaoxiaoqifubiaozhun。woshizhigongyibaomenzhenteshumanxingbingbaoxiaoqifubiaozhunyoubenrennianjiaofeijishude10%diaozhengwei5%。

极速时时彩(3)guifanmenzhenteshumanxingbingjiuyigouyaoguanli。genjuyishangzhigongyibaomenzhenteshumanxingbingbingzhongjibaoxiaozhengcediaozhengqingkuang,guifanmenzhenteshumanxingbingjiuyigouyaoguanli。

极速时时彩(er)diaozhengzhigongyibaodabingyiliaofeiyongbuzhuzhengce。diaozhengzhigongyibaodabingyiliaofeiyongbuzhubaoxiaoqifubiaozhun,jiangzhigongdabingbuzhubaoxiaoqifubiaozhunyouanbencanbaonianduzhigongyibaozuidinianjiaofeijishude50%diaozhengwei12000yuan。

四、提高职工医保统筹基金最高支付限额的设定是居于何种考虑?

da: an《guangxizhuangzuzizhiqurenminzhengfuguanyushixingchengzhenzhigongjibenyiliaobaoxianshijitongchoudetongzhi》(guizhengfa〔2010〕30hao)yaoqiu,getongchoudiquzhubujiangchengzhenzhigongjibenyiliaobaoxianzuigaozhifuxianetigaodaodangdizhigongnianpingjungongzide6beizuoyou。2018nianqianwoshizhigongjibenyiliaobaoxianzuigaozhifuxianeweimeirenmeinian15wanyuan,an2017nianwoshizhigongnianpingjungongzijisuan,shangweidadao“zuigaozhifuxianetigaodaodangdizhigongnianpingjungongzide6beizuoyou”deyaoqiu。genjuwoshizhigongyibaojijinyunxingqingkuang,yizhaoyiliaobaoxianjijin“yishoudingzhi,shouzhipingheng”deyuanze,jingcesuan,jiangzhigongyibaotongchouzhifufanweineifeiyongzuigaozhifuxianediaozhengweishangnianduwoshizhigongnianpingjungongzi6beihou,tongchoujijinzhichuzengjiajinezaiwoshizhigongyibaojijinchengshoufanwei。yinci,cong2019nianqi,jiangwoshizhigongyibaotongchouzhifufanweineifeiyongzuigaozhifuxianediaozhengweishangnianduwoshizhigongnianpingjungongzi6bei。

五、增加职工医保门诊特殊慢性病病种的设定是居于何种考虑?

da: zengjiagaoxueyabing(gaoweizu)、guanxinbing、jiakang、manxingganyanzhiliaogongguqi4gebingzhongweizhigongyibaomenzhenteshumanxingbingbingzhongzhuyaojiyuyixiayinsukaolv: yishian《guangxichengxiangjuminjibenyiliaobaoxianzanxingbanfa》(guirenshefa〔2017〕1hao)guiding,zhei4gemanxingbingnaruleguangxichengxiangjuminyibaomenzhenteshumanxingbingbingzhongfanwei;ershishijinnianzheileimanxingbingfabingrenqunzhubuzengduoqiemenzhenzhiliaofeiyongbuduanzengzhang,canbaorenyuanyaoqiujiangzhei4gebingzhongnaruzhigongmenzhenteshumanxingbingbingzhongfanweiyaoqiujiaoda。sishijingcesuan,zengjia4gebingzhonghou,tongchoujijinzhichuzengjiajinezaiwoshizhigongyibaojijinchengshoufanwei。

六、调整门诊特殊慢性病报销起付标准的设定是居于何种考虑?

da: muqianwoshizhigongyibaomenzhenteshumanxingbingbaoxiaoqifubiaozhunweibenrennianjiaofeijishude10%。suizhegongzidebuduantigao,zhigongyibaojiaofeijishuzhuniantigao,shidemenzhenteshumanxingbingbingrendeshouyimiansuoxiao,bingrendemenzhenyiliaofudanzengjia。genjuwoshizhigongyibaotongchoujijinshouzhiqingkuang,cong2019nianqi,jiangwoshizhigongyibaomenzhenteshumanxingbaoxiaoqifubiaozhunyoubenrennianjiaofeijishude10%diaozhengwei5%,yijianqinggerenmenzhenyiliaofudan。

七、为什么要规范门诊特殊慢性病就医购药管理?

极速时时彩da: zengjiazhigongyibaomenzhenteshumanxingbingbingzhong,diaozhengbaoxiaoqifubiaozhunhou,kexiangshoumenzhenteshumanxingbingdaiyurenshuzengjia,kebaoxiaoyiliaofeiyongfanweikuoda,yibaojijinzhichuzengjia,yincibixugenjuzhengceqingkuangdiaozhengxiangguandeguanliguiding,baozhangyibaojijinanquan。

八、调整职工医保大病医疗费用补助政策是居于何种考虑?

答: 调整职工医保大病医疗费用补助政策主要基于以下因素考虑: 一是大病补报销起付标准提升较快,职工大病补助的受益面逐年缩小。我市职工大病补助是利用职工医保大额医疗保险结余基金建立,对参保职工年度内发生的住院及门诊特殊慢性病合规费用,个人负担累计超过年度职工医保最低缴费基数50%的(即: 大病补报销起付标准),可获得再次报销。随着社平工资的增长,职工医保缴费基数不断增长,大病补报销起付标准已由2015年的12792元增长到2018年的17010元,使可获得大病补助再次报销的人数逐年减少,个人负担加重。二是提高职工医保统筹基金最高支付限额后大病补助基金收入增加,支撑能力提高。职工医保统筹基金最高支付限额由每人每年15万元调整为职工年平均工资6倍后,职工大额医保支出将减少,大病补助基金极速时时彩收入增加,支撑能力提高,为政策调整提供了资金支持。三是结合职工医保最高支付限额调整后大病补助基金收入增加及目前大病补助基金累计结余情况,以不影响职工大病补助制度的可持续性为原则,经测算,职工大病补助起付标准的适宜金额为12000元。综合以上因素,决定将职工大病补助起付标准由职工医保最低年缴费基数的50%调整为12000元。

九、申请新增加的职工医保门诊特殊慢性病病种待遇资格需要的条件是什么?

da: 4gexinzengjiadezhigongyibaomenzhenteshumanxingbingbingzhongdaiyuzigeshenqingtiaojian(rendingbiaozhunyuyiju)yu《wuzhoushichengxiangjuminjibenyiliaobaoxianmenzhenteshumanxingbingguanliguiding》(wushebaojuzi〔2017〕2hao)guidingyizhi,jutiruxia:

(yi)gaoxueyabing(gaoweizu)

极速时时彩rendingbiaozhun: cunzaibaqiguansunhai,huohebingyoutangniaobingdegaoxueyabing。yiju: 1.xueyadadaozhenduanbiaozhun,bingzhishaoyouyixiayizhongqiguansunhaibiaoxian: (1)xxian、xindiantuhuoxinzangcaichaoxianshizuoxinshifeida,(2)yandicaichaoshishiwangmodongmaipubianhuojuxianxingbianzhai,(3)xuejigannongdushenggaoshenzhidadaoshengongnengshuaijiedebiaozhun,(4)naoxueguanyiwaihuogaoxueyanaobing;2.xueyadadaozhenduanbiaozhun,hebingyoutangniaobing。

(er)guanxinbing

极速时时彩rendingbiaozhun: youxinjiaotong、xinjigengsibingshiguanxinbing,yijizhiruguanmaizhijiahoudeguanxinbingkangningzhiliaoqi。yiju: 1.youxinjiaotonghuoxinjigengsaibingshi;2.xindiantuhuodongtaixindiantuchengxinjiquexueyangxinggaibian;3.xinjimeijiancejieguoyichang;4.guanmaizaoyingxueguanyichang。

(san)jiakang

rendingbiaozhun: quezhenweijiakang。yiju: youquezhenweijiakangdezhengzhuang、tizhengjixiangguanjianchabaogao。

(si)manxingganyanzhiliaogongguqi

rendingbiaozhun: quezhenweimanxingganyanbingshuyumanxingganyanzhiliaogongguqi。yiju: 1.quezhenweimanxingganyandejianchabaogao;2.altshuipingyibanyaoqiuchixushenggaodayuhuodengyu2beizhengchangzhishangxian;ruyongganraosuzhiliao,yibanqingkuangxiaaltyingxiaoyuhuodengyu10beizhengchangzhishangxian,xueqingzongdanhongsu<2beizhengchangzhishangxian;3.cunzaimingxiandeganzangyanzheng(2jiyishang)huoxianweihua,tebieshiganxianweihua2jiyishang。

十、如何申请职工医保门诊特殊慢性病待遇资格?

da: woshizhigongyibaomenzhenteshumanxingbingdaiyuzigeshenqingchengxuruxia:

(yi)zhunbeishenbaocailiao,jutiruxia: 《wuzhoushichengzhenzhigongyibaomenzhenteshumanxingbingdaiyushenqingbiao》,yuanjian1fen;jibingzhengmingshu,fuyinjian1fen;bingshiziliao(menzhenbingli、churuyuanjilu,jiwangshoushujilu),fuyinjian1fen;youquezhenyiyidejianchabaogao,fuyinjiange1fen。yishangziliaobixuyouerjiyishangyibaodingdianyiyuanchujuqiejingyiyuandeyibaokehuoyiwukeshenhegaizhangfangweiyouxiao。

(er)banlishenbaoshouxu,ketongguoyixia2zhongfangshishenbao:

1.dingdianyiliaojigoubanli

canbaorenyuanjiangshenbaocailiaodijiaozhiwoshijuyouzhigongyibaomenzhenteshumanxingbingdaiyuzigeshenqingshouliquanxiandedingdianyiliaojigouyibaokebanli。yikaitongshibenjicanbaorenyuanshenqingshouliquanxiandedingdianyiliaojigouruxia: wuzhoushihongshizihuiyiyuan、wuzhoushigongrenyiyuan、wuzhoushirenminyiyuan、wuzhoushizhongyiyiyuan、wuzhoushifuyoubaojianyuan、guidongrenminyiyuan、wuzhoushidierrenminyiyuan、wuzhoushidisanrenminyiyuan。

2.jingbanjigoubanli

canbaorenyuanjiangshenbaocailiaodijiaozhicanbaodiyibaojingbanjigoubanli。shibenjicanbaorenyuanbanlidizhiweiwuzhoushixinxingsanlu63haowuzhoushishehuibaoxianshiyeju5loubanshidating。lianxidianhua: 0774-6029119,6029120。

woshisuoxiagexian(shi)canbaorenyuanshenqingshoulijutidingdianyiliaojigoujijingbanjigoudizhiqingzixungexian(shi)yibaojingbanjigou。lianxidianhua: cenxishi0774-8212900,cangwuxian0774-2673532,tengxian0774-7291637,mengshanxian0774-6289826。

(san)banjieshixian

zaifuheguidingshoulitiaojian、shenbaocailiaoqiquandejichushang,yibaojingbanjigoushoudaoshenbaocailiaozhiriqi20gegongzuorineibanjie。

十一规范门诊特殊慢性病就医购药管理后要提醒参保人员注意的事项有那些?

极速时时彩da: guifanmenzhenteshumanxingbingjiuyigouyaoguanlihoucanbaorenyuanzhuyishixiangruxia:

(一)门诊特殊慢性病极速时时彩定点医疗机构的确定与选择。门诊特殊慢性病患者原则上选择一家三级或二级医疗机构,一家基层医疗机构作为本人门诊特殊慢性病定点机构,并与基层医疗机构签订家庭医生极速时时彩协议;如同时合并传染病、精神病等专科门诊特殊慢性病,可加选一家治疗对应疾病的专科医疗机构。定点医疗机构一年一定,中途允许变更一次。

极速时时彩(er)menzhenteshumanxingbinghuanzhebixuchibenren《wuzhoushichengzhenzhigongyibaomenzhenteshumanxingbingjiuzhenzheng》、《shehuibaozhangka》daoxuandingdedingdianyiliaojigoujiuzhen、quyao,huopingdingdianyiliaojigoudianzichufangdaomenzhenteshumanxingbingzhijiejiesuandechufanggongxiangyaodiangouyao,fuhemenzhenteshumanxingbingbaoxiaoguidingdefeiyong,zhijieshiyongshehuibaozhangkashuakajiesuan,canbaohuanzhezhixuzhifuyingyougerenzifudefeiyong,shuyuyibaojijinzhifudeteshumanxingbingfeiyongyouyibaojingbanjigouyudingdianyiyaojigoujiesuan。

(san)fuhemenzhenteshumanxingbingbaoxiaoguidingdeguojiahezizhiquyibaotanpanyaopin,zaixuandingdedingdianyiyuanqueyaoshi,fuheyongyaozhizhengdecanbaohuanzhedaojisushishicaibanliteshuyaopingouyaoshenqingshouxuhou,kechidingdianyiyuanchufanghejingbanjigouchujudegouyaozhengmingdaomenzhenteshumanxingbingzhijiejiesuandechufanggongxiangyaodiangouyao,anguidingshiyongshehuibaozhangkashuakazhijiejiesuan。

(si)menzhenteshumanxingbingmenzhenzhiliaochufangyingfuhechufangguanliguiding,zhiliaoyongyaoyicijiesuanliangzuidabuchaoguoyigeyueyongliang。

(wu)chuyinxinxixitongguzhangzaochengdebunengshuakajiesuan,yijijingpiyidijiuyideteshumanxingbingyiliaofeiyongdengteshuqingkuangwai,feizhijiejiesuandeyiliaofeiyong,yibaojijinbuyuzhifu。

十二、职工门诊特殊慢性病就医购药管理新旧政策如何衔接?

da: weituoshanjiejuezhigongmenzhenteshumanxingbingjiuyigouyaoguanlixinjiuzhengcexianjiewenti,baozhangcanbaorendehelidaiyuxiangshou,teshedingxinjiuzhengcexianjieguoduqi。xianjieguoduqidingwei2019nian1yue1rizhi4yue30ri,guoduqineifashengdemenzhenteshumanxingbingyiliaofeiyongkeanzhaoyuanguidingbanlibaoxiaojiesuanshouxu,2019nian4yue30rihoubuanzhaoxinzhengceguidingjiuzhengouyaofashengdemenzhenteshumanxingbingfeiyong,yibaojijinbuzaishoulibaoxiao。yiji2019nian5yue1riqi,chuyinxinxixitongguzhangzaochengdebunengshuakajiesuan,yijijingpiyidijiuyideteshumanxingbingyiliaofeiyongdengteshuqingkuangwai,fashengdebuzaixuandingmenzhenteshumanxingbingdingdianyiliaojigouhechufanggongxiangyaodianzhijiejiesuanbaoxiaodemenzhenteshumanxingbingyiliaofeiyong,yibaojijinbuzaishoulibaoxiao。

wenjianxiazai:

guanlianwenjian:

    xiangguanlianjie

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