仙桃资讯 发表于 2024-8-23 09:04:10

解析仙桃市医疗救助政策

<div class="wx_rich_media_content" id="jsWxContainer"><section style="box-sizing: border-box; text-align: justify; font-size: 16px;" data-mpa-powered-by="yiban.io"><section><span style="font-size: 14px; text-align: start;">https://picapp.jhrx.cn/forum/20240823090445front1_1_146362_loqKjXpyEUJhQyinq94h3_hvRclX.MP4?803</span></section><section style="display: flex;width: 100%;flex-flow: column;box-sizing: border-box;"><section style="z-index: 1;box-sizing: border-box;"><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: 10px; box-sizing: border-box;"><section style="display: inline-block;width: auto;vertical-align: top;align-self: flex-start;flex: 0 0 auto;background-color: rgb(110, 193, 245);min-width: 5%;max-width: 100%;height: auto;padding: 5px 17px 5px 11px;border-top-right-radius: 122px;border-bottom-right-radius: 122px;overflow: hidden;box-sizing: border-box;"><section style="text-align: justify;color: rgb(255, 255, 255);box-sizing: border-box;"><p style="box-sizing: border-box;"><strong style="box-sizing: border-box;">医疗救助对象</strong></p></section></section></section></section></section><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: -20px; margin-bottom: 10px; box-sizing: border-box;"><section style="display: inline-block;width: 100%;vertical-align: top;align-self: flex-start;flex: 0 0 auto;border-style: solid;border-width: 0px 0px 0px 1px;border-color: rgb(14, 178, 172) rgb(14, 178, 172) rgb(14, 178, 172) rgba(14, 178, 172, 0.07);background-color: rgba(14, 178, 172, 0.07);padding: 34px 23px 23px;box-sizing: border-box;"><section style="text-align: justify;line-height: 2;letter-spacing: 1.5px;box-sizing: border-box;"><p style="text-indent: 2.1875em; box-sizing: border-box;"><span style="text-indent: 2.1875em;box-sizing: border-box;">一类救助对象:城乡特困人员、孤儿;</span></p><p style="text-indent: 2.1875em; box-sizing: border-box;">二类救助对象:城乡最低生活保障对象、返贫致贫人口;</p><p style="text-indent: 2.1875em; box-sizing: border-box;">三类救助对象:城乡低保边缘家庭成员、纳入监测范围的农村易返贫致贫人口(包含脱贫不稳定人口、边缘易致贫人口和突发严重困难人口);</p><p style="text-indent: 2.1875em; box-sizing: border-box;">四类救助对象:因病致贫重病患者和仙桃市人民政府规定的其他特殊困难人员。</p></section></section></section><section style="display: flex;width: 100%;flex-flow: column;box-sizing: border-box;"><section style="z-index: 1;box-sizing: border-box;"><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: 10px; box-sizing: border-box;"><section style="display: inline-block;width: auto;vertical-align: top;align-self: flex-start;flex: 0 0 auto;background-color: rgb(110, 193, 245);min-width: 5%;max-width: 100%;height: auto;padding: 5px 17px 5px 11px;border-top-right-radius: 122px;border-bottom-right-radius: 122px;overflow: hidden;box-sizing: border-box;"><section style="text-align: justify;color: rgb(255, 255, 255);box-sizing: border-box;"><p style="box-sizing: border-box;"><strong style="box-sizing: border-box;">医疗</strong><strong style="box-sizing: border-box;">救助方式</strong></p></section></section></section></section></section><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: -20px; margin-bottom: 10px; box-sizing: border-box;"><section style="display: inline-block;width: 100%;vertical-align: top;align-self: flex-start;flex: 0 0 auto;border-style: solid;border-width: 0px 0px 0px 1px;border-color: rgb(14, 178, 172) rgb(14, 178, 172) rgb(14, 178, 172) rgba(14, 178, 172, 0.07);background-color: rgba(14, 178, 172, 0.07);padding: 34px 23px 23px;box-sizing: border-box;"><section style="text-align: justify;line-height: 2;letter-spacing: 1.5px;box-sizing: border-box;"><p style="text-indent: 2.1875em; box-sizing: border-box;">(一)<strong style="box-sizing: border-box;">参保缴费资助。</strong>对符合规定的救助对象参加居民医保按相关政策给予资助。</p><p style="text-indent: 2.1875em; box-sizing: border-box;">(二)<strong style="box-sizing: border-box;">医疗费用救助。</strong>对救助对象在定点医药机构发生的门诊慢特病(含“单独支付”药品)和住院费用,经基本医保、大病保险支付后剩余的政策范围内医疗费用按相关政策给予救助。医疗费用救助包括基本救助和倾斜救助。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">对救助对象身份认定前发生的住院等高额医疗费用,按统筹区相关政策给予依申请救助。</strong></p></section></section></section><p style="box-sizing: border-box;"><br style="box-sizing: border-box;"></p><section style="display: flex;width: 100%;flex-flow: column;box-sizing: border-box;"><section style="z-index: 1;box-sizing: border-box;"><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: 10px; box-sizing: border-box;"><section style="display: inline-block;width: auto;vertical-align: top;align-self: flex-start;flex: 0 0 auto;background-color: rgb(110, 193, 245);min-width: 5%;max-width: 100%;height: auto;padding: 5px 17px 5px 11px;border-top-right-radius: 122px;border-bottom-right-radius: 122px;overflow: hidden;box-sizing: border-box;"><section style="text-align: justify;color: rgb(255, 255, 255);box-sizing: border-box;"><p style="box-sizing: border-box;"><strong style="box-sizing: border-box;">大病保险和医疗救助待遇</strong></p></section></section></section></section></section><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: -20px; margin-bottom: 10px; box-sizing: border-box;"><section style="display: inline-block;width: 100%;vertical-align: top;align-self: flex-start;flex: 0 0 auto;border-style: solid;border-width: 0px 0px 0px 1px;border-color: rgb(14, 178, 172) rgb(14, 178, 172) rgb(14, 178, 172) rgba(14, 178, 172, 0.07);background-color: rgba(14, 178, 172, 0.07);padding: 34px 23px 23px;box-sizing: border-box;"><section style="text-align: justify;line-height: 2;letter-spacing: 1.5px;box-sizing: border-box;"><p style="text-indent: 2.1875em; box-sizing: border-box;">城乡居民大病保险<strong style="box-sizing: border-box;">对一类、二类医疗救助对象实施大病保险起付线降低50%、报销比例提高5%、不设置封顶线</strong>的倾斜支付政策。</p><p style="text-indent: 2.1875em; box-sizing: border-box;">按照“先保险后救助”的原则,对基本医疗保险、大病保险支付后,政策范围内个人自付医疗费用负担仍然较重的救助对象按规定实施救助,主要包括<strong style="box-sizing: border-box;">资助参保、门诊慢特病医疗救助</strong>和<strong style="box-sizing: border-box;">住院医疗救助</strong>。困难群众具有多重特殊身份属性的,按就高不重复原则给予救助。<br style="box-sizing: border-box;"></p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">资助参保:</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">全面落实城乡居民基本医保参保财政补助政策。</p><p style="text-indent: 2.1875em; box-sizing: border-box;">一类救助对象:按城乡居民基本医保年度个人缴费标准给予全额资助;</p><p style="text-indent: 2.1875em; box-sizing: border-box;">二类救助对象:按城乡居民基本医保年度个人缴费标准90%比例给予定额资助(不低于320元);</p><p style="text-indent: 2.1875em; box-sizing: border-box;">三类救助对象:纳入监测范围的农村易返贫致贫人口过渡期内按城乡居民基本医保年度个人缴费标准50%比例给予定额资助。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">门诊慢特病医疗救助:</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">享受我市门诊特殊慢性病待遇的救助对象,当月基本医疗保险门诊慢性病限额用完后,再发生的政策范围内医疗费用,最高可按对应门诊慢性病限额的60%予以医疗救助。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">住院医疗救助:</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">住院(含视同住院、“双通道”管理药品)发生的政策范围内的个人自付医疗费用,医疗救助起付标准和救助比例为:</p><p style="text-indent: 2.1875em; box-sizing: border-box;">一类救助对象:不设起付标准,按100%比例救助;</p><p style="text-indent: 2.1875em; box-sizing: border-box;">二类救助对象:不设起付标准,按75%比例救助;</p><p style="text-indent: 2.1875em; box-sizing: border-box;">三类救助对象:年度内起付标准为2700元(过渡期内纳入监测范围的脱贫不稳定人口、边缘易致贫人口医疗救助年度内起付标准按1500元执行),按65%比例救助;</p><p style="text-indent: 2.1875em; box-sizing: border-box;">四类救助对象:年度内起付标准为6500元,按55%比例救助。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">救助限额:</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">一类救助对象<strong style="box-sizing: border-box;">不设年度救助限额</strong>,二类、三类、四类救助对象年度最高救助限额5万元,门诊慢特病医疗救助和住院医疗救助共用年度医疗救助限额。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;"> 托底保障:</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">对规范转诊且在省域内就医的医疗救助对象,经三重制度综合保障后,政策范围内个人自付医疗费用<strong style="box-sizing: border-box;">超过6500元以上</strong>的部分,<strong style="box-sizing: border-box;">市域内按70%</strong>给予倾斜救助;<strong style="box-sizing: border-box;">市域外省域内按60%</strong>给予倾斜救助,倾斜救助年度<strong style="box-sizing: border-box;">封顶线为8万元</strong>。农村低收入人口过渡期内倾斜救助待遇按巩固拓展医疗保障脱贫攻坚成果有效衔接乡村振兴战略相关政策规定执行。</p></section></section></section><section style="display: flex;width: 100%;flex-flow: column;box-sizing: border-box;"><section style="z-index: 1;box-sizing: border-box;"><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: 10px; box-sizing: border-box;"><section style="display: inline-block;width: auto;vertical-align: top;align-self: flex-start;flex: 0 0 auto;background-color: rgb(110, 193, 245);min-width: 5%;max-width: 100%;height: auto;padding: 5px 17px 5px 11px;border-top-right-radius: 122px;border-bottom-right-radius: 122px;overflow: hidden;box-sizing: border-box;"><section style="text-align: justify;color: rgb(255, 255, 255);box-sizing: border-box;"><p style="box-sizing: border-box;"><strong style="box-sizing: border-box;">“一站式”结算</strong></p></section></section></section></section></section><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: -20px; margin-bottom: 10px; box-sizing: border-box;"><section style="display: inline-block;width: 100%;vertical-align: top;align-self: flex-start;flex: 0 0 auto;border-style: solid;border-width: 0px 0px 0px 1px;border-color: rgb(14, 178, 172) rgb(14, 178, 172) rgb(14, 178, 172) rgba(14, 178, 172, 0.07);background-color: rgba(14, 178, 172, 0.07);padding: 34px 23px 23px;box-sizing: border-box;"><section style="text-align: justify;line-height: 2;letter-spacing: 1.5px;box-sizing: border-box;"><p style="text-indent: 2.1875em; box-sizing: border-box;">(一)救助对象参保地和认定地为<strong style="box-sizing: border-box;">同一县(市、区)</strong>的,在定点医药机构就医享受基本医疗、大病保险、医疗救助综合保障(以下简称三重制度)<strong style="box-sizing: border-box;">“一站式”结算</strong>。</p><p style="text-indent: 2.1875em; box-sizing: border-box;">(二)救助对象参保地和认定地<strong style="box-sizing: border-box;">不一致,但属于同一市(州)不同县(市、区)</strong>,在定点医药机构就医的,<strong style="box-sizing: border-box;">实现身份互认,享受三重制度“一站式”结算。</strong>定点医药机构垫付的医疗救助基金,由参保地医保部门先行划拨给定点医药机构,再按市级医保部门规定的办法予以清算。</p><p style="text-indent: 2.1875em; box-sizing: border-box;">(三)救助对象参保地和认定地<strong style="box-sizing: border-box;">不一致,且分属于不同市(州)</strong>的,在定点医药机构就医享受基本医疗和大病保险结算,<strong style="box-sizing: border-box;">不享受医疗救助“一站式”结算。</strong></p><p style="text-indent: 2.1875em; box-sizing: border-box;">(四)具有多重救助身份的,以救助待遇最高的身份,统一计算基本医疗、大病保险和医疗救助支付金额。</p></section></section></section><section style="display: flex;width: 100%;flex-flow: column;box-sizing: border-box;"><section style="z-index: 1;box-sizing: border-box;"><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: 10px; box-sizing: border-box;"><section style="display: inline-block;width: auto;vertical-align: top;align-self: flex-start;flex: 0 0 auto;background-color: rgb(110, 193, 245);min-width: 5%;max-width: 100%;height: auto;padding: 5px 17px 5px 11px;border-top-right-radius: 122px;border-bottom-right-radius: 122px;overflow: hidden;box-sizing: border-box;"><section style="text-align: justify;color: rgb(255, 255, 255);box-sizing: border-box;"><p style="box-sizing: border-box;"><strong style="box-sizing: border-box;">医疗救助对象手工(零星)办理流程:</strong></p></section></section></section></section></section><section style="text-align: left; justify-content: flex-start; display: flex; flex-flow: row; margin-top: -20px; margin-bottom: 10px; box-sizing: border-box;"><section style="display: inline-block;width: 100%;vertical-align: top;align-self: flex-start;flex: 0 0 auto;border-style: solid;border-width: 0px 0px 0px 1px;border-color: rgb(14, 178, 172) rgb(14, 178, 172) rgb(14, 178, 172) rgba(14, 178, 172, 0.07);background-color: rgba(14, 178, 172, 0.07);padding: 34px 23px 23px;box-sizing: border-box;"><section style="text-align: justify;line-height: 2;letter-spacing: 1.5px;box-sizing: border-box;"><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">1.业务申请。</strong>申请人可通过线上办理渠道填写相关信息,提交救助对象手工(零星)报销材料电子版,推送至医疗保障经办机构受理,并邮寄纸质资料到县级医保经办部门;申请人也可携带医保结算单、《医疗救助申请表》等材料,向认定地县、乡镇(街道)、村(社区)服务窗口申请办理医疗救助对象手工(零星)报销。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">2.业务受理。</strong>经办人员核对网上申报材料是否齐全完整有效。对不符合条件的不予受理,并一次性告知原因。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">3.业务审核。</strong>经办人员审核材料是否齐全、是否符合办理条件、是否合法合规。审核不通过的,一次性告知原因。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">4.待遇发放。</strong>审核结算后,业务科室向拨付单位提供支付清单。各地根据实际情况由相关部门将救助基金拨付至申请人指定的金融机构账户,并将办理结果告知申请人。</p><p style="text-indent: 2.1875em; box-sizing: border-box;"><strong style="box-sizing: border-box;">办理时限:</strong>认定地经办机构受理申请后,30个工作日内办结。</p></section></section></section><section style="max-width: 100%;box-sizing: border-box;"><section style="text-align: left;font-size: 14px;color: rgb(62, 62, 62);box-sizing: border-box;max-width: 100%;"><section style="max-width: 100%;box-sizing: border-box;"><section style="outline: 0px; font-size: 16px; letter-spacing: 0.544px; color: rgb(34, 34, 34); caret-color: rgb(0, 0, 0); -webkit-tap-highlight-color: rgba(0, 0, 0, 0); text-size-adjust: inherit; visibility: visible; max-width: 100%; box-sizing: border-box;"><p style="box-sizing: border-box;"><span style="color: rgb(136, 136, 136);font-size: 12px;letter-spacing: 0.5px;box-sizing: border-box;">来源 /仙桃医保</span></p></section></section></section></section><section style="max-width: 100%;box-sizing: border-box;"><section style="line-height: 0;box-sizing: border-box;max-width: 100%;"><section style="max-width: 100%;vertical-align: middle;display: inline-block;line-height: 0;box-sizing: border-box;"><span class="wxart_image" wx-style="display:inline-block;vertical-align: middle;max-width: 100%;width: 100%;box-sizing: border-box;"></span></section></section></section></section><p style="display: none;"><mp-style-type data-value="3"></mp-style-type></p></div><p></p>

乐小白 发表于 2024-8-23 13:42:31

是个什么意思,没看懂。医疗救助就不能一个标准执行吗?搞得五花八门的,一头雾水。

萌懂的青春 发表于 2024-8-31 09:06:56

乐小白 发表于 2024-8-23 13:42
是个什么意思,没看懂。医疗救助就不能一个标准执行吗?搞得五花八门的,一头雾水。 ...

就是要你不要救助,条条框框越多,卡的你不能申请{:225:}{:225:}{:225:}
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