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                      • 肥东县城乡居民基本医保政策问答

                        访谈时间:2019-07-10

                        访谈嘉宾:

                        访谈摘要:肥东县城乡居民基本医保政策问答

                        访谈详情

                        一、城乡居民基本医保参保缴费

                        1.NAXIERENKEYICANJIAWOXIANCHENGXIANGJUMINJIBENYIBAO?

                        DA:WOXIANFANWEINEICANJIAZHIGONGJIBENYILIAOBAOXIANYIWAIDEQITASUOYOUCHENGXIANGJUMIN。BAOKUO:JUYOUBENXIANHUJIDECHENGXIANGJUMIN;FEIBENXIANHUJI,CHIYOUBENXIANJUZHUZHENGZAIYUANJIWEICANJIAYILIAOBAOXIANDECHENGXIANGJUMIN;GELEIZAIXIAOXUESHENG。

                        澳洲赛车-首页2.2018NIANCHENGXIANGJUMINJIBENYIBAOJIAOFEIBIAOZHUNSHIDUOSHAO?

                        答:2018年城乡居民基本医疗保险财政补助标准为每人520元,个人缴费标准为每人220元。

                        澳洲赛车-首页3.SHENMESHIHOUKEYICANBAOJIAOFEI?

                        答:城乡居民基本医疗保险以自然年度(每年11日至1231日)为保险年度,每年91日至1220澳洲赛车-首页日为下一保险年度集中参保期。城乡居民应在集中参保期内办理参保缴费手续。

                            XINRUXUEXUESHENGRUXUEDANGNIANZAIJIZHONGCANBAOQIJIAONAXIAYINIANDUCHENGXIANGJUMINJIBENYILIAOBAOXIANFEIDE,ZIRUXUEZHIRIQIXIANGSHOUYILIAOBAOXIANDAIYU。

                        4.NAXIERENQUNKEYIBUBANCANBAOJIAOFEISHOUXUBINGXIANGSHOUXIANGGUANYILIAOBAOXIANDAIYU?

                        答:①新生儿参保。新生儿监护人在新生儿出生之日起3个月内为新生儿办理参保缴费手续的,自出生之日起享受城乡居民基本医疗保险待遇;超过3个月参保缴费的,自缴费之日起享受城乡居民基本医疗保险待遇。

                        澳洲赛车-首页    ②TUIYISHIBING、XINGMANSHIFANGRENYUANBANLICANBAOJIAOFEISHOUXUDE,ZIJIAOFEIZHIRIQIXIANGSHOUCHENGXIANGJUMINJIBENYILIAOBAOXIANDAIYU。

                        澳洲赛车-首页    ③CHIYOUSHIJINGSHENZHANGAIHUANZHEJIUZHUKADEJINGSHENZHANGAIHUANZHEBANLICANBAOJIAOFEISHOUXUDE,ZIJIAOFEIZHIRIQIXIANGSHOUCHENGXIANGJUMINJIBENYILIAOBAOXIANDAIYU。

                            ④WEIZAIJIZHONGCANBAOQICANBAODEQITARENYUANBUYUBUBANCANBAOJIAOFEISHOUXU。

                        5.CHENGXIANGJUMINYIBAOCANBAOJIAOFEIFANGSHIYOUNAXIE?

                        DA:CHENGXIANGJUMINYOUHUJIDIHUOJUZHUDISHEQU(CUN)JUMINWEIYUANHUIZUZHICANBAODENGJI,DAISHOUDAIJIAOCANBAOFEIYONG。

                            GELEIZAIXIAOXUESHENGYOUSUOZAIXUEXIAOZUZHICANBAODENGJI,DAISHOUDAIJIAOCANBAOFEIYONG;ZAIXIAOXUESHENGYEKEYIZAIHUJIDISUIJIATINGCANBAODENGJI。

                        澳洲赛车-首页    YILIAOJIUZHUDUIXIANG(TEKUNGONGYANGRENYUAN、SHEHUISANJUGUER、DIBAODUIXIANG、PINKUNRENKOU,JIHUASHENGYUTESHUJIATINGFUMU,DISHOURUJIATINGZHONGDELAONIANREN、WEICHENGNIANREN、ZHONGBINGHUANZHE、ZHONGDUCANJIREN)GERENJIAOFEIBUFEN,YOUCHENGXIANGYILIAOJIUZHUJIJINQUANEDAIJIAO。

                            ZAIFEIJIZHONGCANBAOQIBUBANCHENGXIANGJUMINYIBAOCANBAOSHOUXUDE,YOUGUOYUANBAOXIANGONGSIYIBAOFUWUZHONGXINFUZEBANLICANBAOJIAOFEISHOUXU。

                        ER、CHENGXIANGJUMINJIBENYIBAODAIYU

                        6.CHENGXIANGJUMINJIBENYIBAOZUIDUOKEYIBAOXIAODUOSHAOYILIAOFEIYONG?

                        答:一个年度内,城乡居民基本医疗保险基金累计最高支付30万元/人。

                        (YI)ZHUYUANDAIYU

                        7.参保居民普通住院享受怎样的待遇?

                        DA:

                        定点医院

                        起付线(元)

                        基金支付比例

                        一级医院(含乡镇卫生院、社区卫生服务中心)

                        200

                        90%

                        二级医院

                        400

                        85%

                        三级医院

                        600

                        80%

                        省属三级医院

                        1000

                        75%

                            跨县域和合肥市区住院治疗的,起付线增加1倍;通过分级诊疗逐级转诊和在上级医院急诊抢救的,基金支付比例不变;未通过分级诊疗逐级转诊的,基金支付比例降低5个百分点。

                        8.NAXIERENKEYIXIANGSHOUZHUYUANQIFUXIANJIANMIAN?

                            ①参保学生、18澳洲赛车-首页周岁及以下居民住院起付线减半。

                        澳洲赛车-首页    ②TEKUNGONGYANGRENYUAN、SHEHUISANJUGUERZHUYUANBUSHEQIFUXIAN;PINKUNRENKOUZAIXIANYUNEIZHUYUANBUSHEQIFUXIAN。

                        澳洲赛车-首页    ③ZHONGDIANYOUFUDUIXIANG、DIBAODUIXIANG、JIHUASHENGYUTESHUJIATINGFUMUMIANCHUCANBAONIANDUNEISHOUCIZHUYUANQIFUXIAN。

                            ④EXINGZHONGLIUFANGHUALIAO、ZHITIKANGFU、ZHILIKANGFU、GUDUZHENGKANGFU、TINGLIHEYANYUKANGFUDENGXUYAOFENLIAOCHENGJIANDUANDUOCIZHUYUANDETESHUJIBINGHUANZHE,ZAITONGYIYILIAOJIGOUZHUYUANDE,YIGECANBAONIANDUNEIZHISHEYICIQIFUXIAN。

                            ⑤SHIXINGSHUANGXIANGZHUANZHENDE,MIANCHUSHANGZHUANSHOUCIJIXIAZHUANDIERCIZHUYUANQIFUXIAN。

                        澳洲赛车-首页9.PUTONGZHUYUANBAODIBAOXIAODAIYUSHIZENYANGGUIDINGDE?

                        答:普通住院医疗费用实行保底报销,符合规定的医疗费用,按45%比例报销。

                        澳洲赛车-首页10.ANBINGZHONGFUFEIZHUYUANDAIYUSHIZENYANGGUIDINGDE?

                        DA:SHIXINGANBINGZHONGFUFEIDEZHUYUANHUANZHE,ZHUYUANBUSHEQIFUXIAN,BUSHOUYAOPINMULU、YILIAOFUWUXIANGMUMULUXIANZHI。JUTIBANFAYOUSHIYILIAOBAOZHANGBUMENHUITONGCAIZHENG、WEISHENGJISHENGBUMENLINGXINGZHIDING。

                        澳洲赛车-首页11.ZAIRIJIANBINGFANGZHILIAOXIANGSHOUSHIZENYANGXIANGSHOUDAIYUDE?

                        澳洲赛车-首页DA:CANBAOHUANZHEZAIRIJIANBINGFANGFASHENGDEYILIAOFEIYONG,ZHIXINGTONGLEIBIEYILIAOJIGOUZHUYUANYIBAODAIYU。

                        (ER)MENZHENDAIYU

                        澳洲赛车-首页12.CANBAOJUMINZAIJICENGPUTONGMENZHENSHIZENYANGXIANGSHOUDAIYUDE?

                        DA:CANBAOJUMINZAIXIANGZHENWEISHENGYUAN(HANSHIXINGYITIHUAGUANLIDECUNWEISHENGSHI)、SHEQUFUWUZHONGXIN,FASHENGDEPUTONGMENZHENFEIYONG,NARUYIBAOBAOXIAOFANWEI。

                            普通门诊不设起付线,实行按比例封顶报销。在村卫生室、乡镇卫生院(社区卫生服中心)发生的普通门诊费用,医保基金按80%比例支付,单次分别最高支付20元、50元,年度基金累计最高支付100/人。

                        13.CANBAOJUMINZAIERJIYISHANGYIYUANPUTONGMENZHENSHIZENYANGXIANGSHOUDAIYUDE?

                        答:一个年度内,参保居民在二级以上医疗机构普通门诊(不含特殊病门诊)发生的政策范围内医药费用,单次达到300元且年度累计超过600元的,超过部分按40%比例给予报销,年度基金累计最高支付1500/人。

                        澳洲赛车-首页14.DAXUESHENGPUTONGMENZHENSHIZENYANGXIANGSHOUDAIYUDE?

                        答:在校大学生普通门诊可以按照30/澳洲赛车-首页人标准由学校包干使用,不再享受基层普通门诊和大额普通门诊待遇。

                        15.TESHUBINGMENZHENSHIZENYANGXIANGSHOUDAIYUDE?

                        答:按规定共有44种临床诊断明确、病情和治疗方案基本稳定,需要长期在门诊治疗的病种享受特殊病门诊待遇,具体参照《合肥市特殊病门诊管理暂行办法》执行。

                        (SAN)QITAYILIAOBAOXIANDAIYU。

                        澳洲赛车-首页16.CANBAOCHANFUZHUYUANFENMIANSHIZENYANGXIANGSHOUDAIYUDE?

                        答:参保产妇住院分娩发生的生育医疗费用定额补助1200元。产妇分娩期因并发症住院产生的医疗费用,按同类别医院住院医疗保险待遇执行,不再享受定额补助。

                        澳洲赛车-首页17.CANJIRENPEIFUZHUQIJUSHIZENYANGXIANGSHOUDAIYUDE?

                        答:残疾人装配辅助器具按装配费用的50%比例给予补助,补助周期为五年。下肢残疾人装配下肢假肢,每具大腿假肢最高补助2000元,每具小腿假肢最高补助1000元;7周岁以下(含7周岁)听力障碍儿童配备助听器,每只最高补助3500元。

                            FUHEGUIDINGDECANJIREN,PINGCANJIRENZHENGFUYINJIAN、FUZHUQIJUZHUANGPEIDANJIFAPIAOZAICANBAODIJINGBANJIGOUBANLIBUZHUSHOUXU。

                        澳洲赛车-首页18.CANBAOJUMINJUANZENGQIGUANHUOZUZHISHOUSHUSHIZENYANGXIANGSHOUDAIYUDE?

                        DA:CANBAOJUMINJUANZENGQIGUANHUOZUZHIDEZHUYUANYILIAOFEIYONG(BUHANQIGUANYUANHUOZUZHIYUANFEIYONGYIJIYUANWAIPEIXING、JIANCEJIANYAN、YUNSHU、CHUCUNDENGXIANGGUANFEIYONG),YOUYILIAOBAOXIANJIJINQUANEZHIFU。

                        澳洲赛车-首页19.CANBAOJUMINZAIHEFEISHIWAIZHUYUANSHIZENYANGXIANGSHOUDAIYUDE?

                        DA:CANBAOJUMINZAISHIWAIZHUYUANFASHENGDEYILIAOFEIYONG,AN《HEFEISHIYIDIJIUYIGUANLIBANFA》ZHIXING。

                        澳洲赛车-首页20.CANBAOJUMINNENGFOUXIANGSHOUDABINGBAOXIANDAIYU?

                        澳洲赛车-首页DA:CANBAOJUMINYINHUANZHONGDAJIBINGFASHENGDEGAOEYILIAOFEIYONG,ZAIXIANGSHOUCHENGXIANGJUMINJIBENYILIAOBAOXIANDAIYUHOU,YIGEBAOXIANNIANDUGERENFUDANDEHEGUIYILIAOFEIYONGLEIJICHAOGUODABINGBAOXIANQIFUXIANBUFEN,YOUDABINGBAOXIANJIYUBAOZHANG。

                        澳洲赛车-首页21.CANBAOJUMINZENYANGXIANGSHOUYIBAODAIYU?

                        DA:CANBAOJUMINCHISHEHUIBAOZHANGKA(HUOERDAISHENFENZHENG、QITAYOUXIAOSHENFENZHENGJIAN)ZAIDINGDIANYILIAOJIGOUJIUYICHANSHENGDEYILIAOFEIYONG,JIJINZHIFUBUFENYOUYIBAOJINGBANJIGOUYUXIEYIDINGDIANYILIAOJIGOUJIESUAN,GERENZIFUBUFENYOUGERENZAIYIYUANJISHIJIESUAN。

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