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医疗保险政策知识问答
&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是社会医疗保险？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&社会医疗保险制度就是通过国家立法，强制性地由用人单位和个人缴纳医疗保险费，建立医疗保险基金，当个人因疾病需要获得医疗服务时，由社会医疗保险机构按规定提供医疗费用补偿的一种社会保障制度。医疗保险具有社会保险的强制性、互济性、社会性等基本特征。因此，医疗保险制度通常由国家立法，强制实施，建立基金制度，费用由用人单位和个人共同缴纳，医疗保险费由医疗保险机构支付，以解决劳动者因患病的风险。医疗保险就是当人们生病后，由国家或社会给予的一种物质帮助，即提供医疗服务或经济补偿的一种社会保障制度。&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&我国五十年代初就建立了公费医疗和劳保医疗制度，实施四十多年来，在保障职工身体健康和维护社会稳定等方面发挥积极的作用。但是，随着社会主义市场经济体制的确立和国有企业改革的不断深化，这种制度已难以解决市场经济条件下的职工基本医疗保障问题。为此，国务院于&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&年&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月下发了《关于建立城镇职工基本医疗保险制度的决定》（国发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号），部署在全国范围内全面推进职工医疗保险制度改革工作，要求&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&年内全国建立职工基本医疗保险制度。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是职工基本医疗保险统筹单位？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&职工基本医疗保险原则上以地级以上行政区（包括市、州）为统筹单位，也可以县（市）为统筹单位，京、津、沪原则上在全市范围内实行统筹。所有单位及其职工都要按属地管理原则参加所在地统筹地区的基本医疗保险，执行统一政策，实行基本医疗保险基金的统一筹集、使用和管理。铁路、电力、远洋运输等跨地区生产流动性较大的企业及其职工，可以相对集中的方式异地参加统筹地区的基本医疗保险。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&职工工资总额是如何确定的？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&按国家统计局的有关规定，职工工资总额是指各单位在一定时期内直接支付给本单位全部职工的劳动报酬总额。职工工资总额的计算应以直接支付给职工的全部劳动报酬为根据，它包括&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个部分：计时工资、计件工资、奖金、津贴和补贴、加班加点工资、特殊情况下支付的工资。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗保险缴费基数是怎样确定的？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&基本医疗保险缴费基数的核定：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&职工工资总额按国家统计局现行规定列入工资总额统计的口径计算；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&新建单位从成立之月起缴纳基本医疗保险费，当年缴费基数按上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份统筹范围内职工平均工资计算；新增职工从领取工资之月起缴纳基本医疗保险费，当年缴费基数按上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份统筹范围内职工平均工资计算；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&凡与单位保留人事（劳动）关系的停薪留职、外借、外聘人员，均由原单位负责办理缴费手续；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&职工自批准退休的次月起，个人不再缴纳基本医疗保险费。单位参加基本医疗保险时，预交一个月的基本医疗保险费。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是“单基数”、“双基数”？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&所谓“单基数”是指用人单位在计算缴费基数时是以在职职工（不包括退休人员）工资总额作缴费基数。“双基数”是指以在职职工工资总额和退休人员退休费用之和作为缴费基数。目前多数统筹单位，用“单基数”计算缴费基数。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是基本医疗保险统筹基金，主要支付范围有哪些？&&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&国务院《关于建立城镇职工基本医疗保险制度的决定》（国发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，“基本医疗保险基金由统筹基金和个人帐户构成”。统筹基金主要包括：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&单位缴费划入个人帐户后的剩余部分；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&统筹基金利息收入；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&其他收入。统筹基金主要用于支付参保人员在定点医疗机构发生的住院医疗费用，有起付标准和最高支付限额。起付标准原则上控制在当地职工年平均工资的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％左右，最高支付限额原则上控制在当地职工年平均工资的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&倍左右。起付标准以下的医疗费用由个人账户支付或由个人自负。起付标准以上、最高支付限额以下的医疗费用，主要从统筹基金中支付，个人也要负担一定比例。超出最高支付限额的医疗费用由公务员医疗补助资金、企业补充医疗保险资金等解决，也可通过商业保险等办法解决。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&用人单位缴纳的基本医疗保险费如何列支？?&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&用人单位应缴纳的基本医疗保险费，机关和主要由财政供给经费的事业单位从各级财政预算内的公费医疗经费中列支；其他事业单位从事业经费中列支；企业在职职工从职工福利费中列支；退休人员从劳动保障费中列支；社会团体从社团收入中列支；民办非企业单位从民办企业单位的收入中列支。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是个人账户，有哪几部分资金组成？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&国务院《关于建立城镇职工基本医疗保险制度的决定》（国发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，“基本医疗保险基金由统筹基金和个人帐户构成”。个人账户资金来源于三部分：一是职工个人缴纳的医疗保险费全部记入个人账户；二是用人单位缴纳的基本医疗保险费&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％左右划入个人账户，具体比例由统筹地区根据个人账户的支付范围和职工年龄等因素确定；三是职工的工龄补贴。个人账户的本金和利息归个人所有，可以结转和继承。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个人如何缴费？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《甘肃省省直机关事业单位职工基本医疗保险实施方案&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&试行&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&》规定基本医疗保险费由单位和职工个人共同缴纳。职工个人按上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份本人工资收入的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％缴纳。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&单位如何缴费？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《甘肃省省直机关事业单位职工基本医疗保险实施方案&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&试行&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&》规定基本医疗保险费由单位和职工个人共同缴纳。单位按上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份职工工资总额的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％缴纳。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％左右是一个全国的控制标准，具体到各统筹地区，用人单位缴费率要根据当地财政和企业的实际承受能力合理确定。实际测算在&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％以内的，不能攀比，不能提高到&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％，确需超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％的，要从严控制、严格审批。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&降低缴费基数是否划算？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&部分单位为了少缴单位缴费部分，采取降低缴费基数的办法，这样单位缴费按比例划入个人账户的费用就少，造成单位算小账，职工吃大亏的结果。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗保险单位缴费部分如何划入个人账户？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&基本医疗保险单位缴费部分在职职工个人帐户划入额＝本人上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份工资×本人所处年龄段划入个人帐户的比例。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&基本医疗保险单位缴费部分退休人员个人帐户划入额＝本人上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份退休金×划入个人帐户的比例。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&甘肃省省直机关事业单位职工基本医疗保险划入个人帐户的比例为：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&周岁以下（含&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&周岁）划入&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&周岁至法定退休年龄划入&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％；退休人员划入&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％。个人帐户本金和利息归个人所有，可以结转使用和继承。职工在统筹范围内单位之间调动，只办理医疗保险关系转移手续，不转移资金；职工调到统筹范围外单位时，个人帐户资金随同转移。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是公务员医疗补助，如何缴费？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&实行国家公务员医疗补助是在实施城镇职工基本医疗保险制度的基础上对国家公务员的补充医疗保障，医疗补助办法要与基本医疗保险政策相衔接。国家公务员医疗补助水平要与经济发展水平和财政负担能力相适应，保证国家公务员原有医疗待遇水平不降低，并随经济发展有所提高。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&国家公务员医疗补助筹资标准应根据原公费医疗的实际支出水平、基本医疗保险的筹资水平和财政承受能力合理确定。省直单位国家公务员医疗补助筹资标准暂定为参保单位上年度职工工资总额（含退休人员退休金）的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％。省直单位医疗补助经费由省财政厅按单位性质和收支情况在预算中予以安排或补助，并按用款计划划拨到省医疗保险经办机构。其中：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省直国家公务员医疗补助范围内的单位和经省劳动保障、财政部门核定的全额供给经费事业单位的医疗补助经费由省财政列入当年财政预算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&经省劳动保障、财政部门核定的部分供给经费事业单位的医疗补助经费，省财政根据单位具体情况给予适当补助。有关单位应在每季度第一个月将自负部分上缴财政专户，由省财政厅连同财政补助部分一并按用款计划划拨到省医疗保险经办机构。?&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《医疗保险证》如何发放？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保单位在办理了参保手续并缴纳了相应的费用后，社会医疗保险经办机构根据参保单位的参保人员情况发放《省直机关事业单位职工医疗保险证》，加盖钢印后生效。《省直机关事业单位职工医疗保险证》中记载了参保人员的个人参保情况和享受医疗待遇情况，所以内容填写必须准确无误，不能涂改&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&严禁转借他人使用。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《医疗保险证》丢失如何办理挂失、补发手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《省直机关事业单位职工医疗保险证》不慎丢失后，应及时办理挂失、补发手续。参保人员先到省级新闻报纸办理遗失声明，然后将报纸交于本单位医保专管员，由医保专管员持单位介绍信、遗失声明报纸和本人&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&寸免冠照片&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&张。到省社会医疗保险经办机构办理挂失、补发手续。《省直机关事业单位职工医疗保险证》丢失后如不及时办理挂失、补发手续将影响参保人员享受正常的医疗保险待遇，其后果有参保人员个人承担。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗保险个人存折如何发放？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省直医疗保险参保单位在办理了参保手续并缴纳了相应的费用后，社会医疗保险经办机构根据参保单位的参保人员情况向中国农业银行提供相应的参保缴费信息，由中国农业银行制发参保人员个人账户专用存折。由单位医保专管员持单位介绍信统一领取后发放给单位职工。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗保险个人存折丢失如何办理挂失、补发手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省直医疗保险参保人员医疗保险个人存折不慎丢失后，应及时办理挂失、补发手续。参保人员先持单位介绍信、本人身份证到中国农业银行兰州中央广场支行办理挂失、补发手续，然后将降挂失、补发情况告知本单位医保专管员，由医保专管员到省社会医疗保险经办机构办理挂失、重新登记个人账号手续。医疗保险个人存折丢失后，如不及时办理挂失、补发手续将影响参保人员享受正常的医疗保险待遇，其后果有参保人员个人承担。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗保险个人存折如何使用？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个人帐户主要用于支付参保人员在定点医疗机构、定点零售药店发生的门诊医疗费、药费及住院医疗费中的个人自负部分。所以个人账户资金只能用于医疗费用支出，不能用于其它费用支出。参保人员在定点医疗机构、定点零售药店发生门诊医疗费、药费后，持发票和个人医保存折到附近的中国农业银行报销相关费用。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&单位新参保需提供哪些材料？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&单位新参保应提供以下资料：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）社会保险登记表（表&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）参保单位营业执照，批准成立证件或其他核准的职业证件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）国家质量技术监督部门颁发的组织结构统一代码书；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）省委组织部门下达的法人代表（负责人）文件和法人身份证；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）编制部门下发的有关单位性质及人员编制文件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）上年度&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月份在职职工工资册，退休人员退休金册；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）每个参保人员身份证复印件（不加盖单位红色印章）和近期个人一寸一张免冠照片；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）正高级专业技术职称并聘任正高级专业技术职务的高级知识分子及退休人员、经国务院批准享受政府特殊津贴的专家、省委和省政府批准的甘肃省优秀专家、国家人事部批准的有突出贡献的中青年专家、地级干部及退休人员的身份确认文件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）省社会保险机构规定的有关资料和证书。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保单位新增参保人员需提供哪些材料？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保单位新增参保人员（复转&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&统分&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&录用&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&调入）登记应提供以下资料&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&证明和材料：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）复转军人民政部函；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）同分人员派遣证；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）录用人员省人事厅文件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）调入人员调动涵；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）省人事厅工作增加变动审批表；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）参保人员身份证复印件（不加盖单位红色印章）和近期个人一寸一张免冠照片；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）正高级专业技术职称并聘任正高级专业技术职务的高级知识分子及退休人员、经国务院批准享受政府特殊津贴的专家、省委和省政府批准的甘肃省优秀专家、国家人事部批准的有突出贡献的中青年专家、地级干部及退休人员的身份确认文件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）社会保险经办机构规定的其他证明和证件等。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&在职人员退休如何办理变更？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员在职转退休时，必须达到法定年龄。由参保单位医保专管员负责办理变更手续，办理时须提供以下资料：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）参保人员身份证复印件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）参保人员退休文件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）社会保险经办机构规定的其他证明和证件等。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员辞职、调动、死亡如何办理注销手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员辞职、调动、死亡的，参保单位须在参保人员辞职、调动、死亡后一个月内，持单位证明，辞职、调动、死亡参保人员的《医疗保险证》和《医疗保险个人帐户存折》，到省社会医疗保险经办机构办理医疗保险关系变更手续，并填报《甘肃省省直机关事业单位职工医疗保险关系变更情况登记表》。省社会医疗保险经办机构审核后，参保单位凭签盖省社会医疗保险经办机构公章的证明和辞职、调动、死亡人员医疗保险个人帐户存折到省农业银行广场支行营业部，直接兑现，银行收回存折。参保单位负责将兑现的医疗保险个人帐户余额交辞职、调动、死亡参保人员本人、法定继承人或指定受益人。参保人员死亡后，没有法定继承人或指定受益人的，由参保单位办理上述手续，省社会医疗保险经办机构将其个人帐户余额转入基本医疗保险统筹基金。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是异地安置人员，如何办理？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人指已办理了异地安置手续，可以在安置地就医的人员。省直参保单位异地安置人员包括退休异地居住人员和异地工作人员。退休异地居住人员指已办理了退休手续、户口迁移证（或在当地居住的暂住证），在兰州市（区）以外居住的省直参保单位退休人员；异地工作人员指因工作需要，在兰州市（区）以外工作一年以上的参保职工。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&凡属退休异地居住人员和长期驻外工作人员，应在驻地劳动保障部门公布的定点医疗机构中选择&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个作为本人异地就医的定点医疗机构，由其所在参保单位按要求填写报表后，报省社会医疗保险经办机构审核，同意后备案存档，同时发放《省直机关事业单位职工医疗保险证》，并加盖“异地安置人员”条章&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&，《医疗保险证》上记录本人选定的定点医疗机构。定点医疗机构一经确定，一年内不得变更。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&哪些人员属于医疗照顾人员，如何确定？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗照顾人员包括：具有正高级专业技术职称并被聘任为正高级专业技术职务的高级知识分子及退休人员；经国务院批准享受政府特殊津贴的专家；省委、省政府批准的甘肃省优秀专家；国家人事部批准的有突出贡献的中青年专家；正副地级干部及退休人员。确定医疗照顾人员须由单位医保专管员持相关的聘任、任命文件到省社会医疗保险经办机构办理。确认后，由省社会医疗保险经办机构在本人《省直机关事业单位职工医疗保险证》上标注，并加盖“医疗照顾人员”条章。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&单位欠缴费用，职工医疗待遇有何变化？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&根据权利义务对等原则，单位欠缴费用后，其单位所有的参保职工原有的相应医疗待遇随之终止。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&三个目录指什么？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&三个目录指《药品目录》、《诊疗项目录》和《医疗服务设施目录》，凡是三个目录外的药品、诊疗项目和医疗服务设施基本医疗统筹基金均不与支付。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&为什么要确定定点医疗机构？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&国务院《关于建立城镇职工基本医疗保险制度的决定》（国发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，基本医疗保险实行定点医疗机构（包括中医医院）和定点药店管理。省劳动和社会保障行政部门对零售药店的定点资格进行审查；省劳动和社会保障行政部门会同卫生行政部门对医疗机构的定点资格进行审查。省医疗保险经办机构依据参保人员选择意向，根据中西医并举，基层、专科和综合医疗机构兼顾，方便职工就医的原则，负责确定定点医疗机构和定点药店，并与其签订基本医疗保险服务协议，明确各自的责任、权利和义务。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&如何识别医院是否为定点医疗机构？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员只有在确定的定点医疗机构就医才能享受医疗待遇。凡是与医疗保险经办机构签订医疗服务协议的医院，在医院显要位置都悬挂由医疗保险经办机构统一发放的医疗保险定点医疗机构标牌。参保人员选择就医时应先向本单位医保专管员或医疗保险经办机构了解确定为定点医疗机构，再查看医院标牌，才能确认其为定点医疗机构。某些医院将自己宣传为定点医疗机构的，参保人员要注意识别。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员如何办理在定点医疗机构的住院手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员患有疾病需住院治疗的，须及时办理医保患者入院手续。参保人员需持医生开具的《住院证》到本单位医保专管员处开具《省直单位职工基本医疗保险介绍信》（专用），然后持《住院证》、《省直单位职工基本医疗保险介绍信》、《医疗保险证》、身份证到定点医疗机构医保管理部门办理相关手续即可入院。参保人员《医疗保险证》，在其住院期间，交由定点医疗机构管理，不能交本人或借出，出院结账后，定点医疗机构管理交还本人。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员、《医疗保险证》正在办理人员如何办理在本地定点医疗机构的住院手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员、《医疗保险证》正在办理人员在本地定点医疗机构的住院手续，首先要确认其选择就医的医院为定点医疗机构。然后需持医生开具的《住院证》到医疗保险经办机构处开具《省直单位职工基本医疗保险确认单》，然后持《住院证》、《省直单位职工基本医疗保险确认单》、《医疗保险证》（异地安置人员）、身份证到定点医疗机构医保管理部门办理相关手续即可入院。参保人员《医疗保险证》（异地安置人员），在其住院期间，交由定点医疗机构管理，不能交本人或借出，出院结账后，定点医疗机构管理交还本人。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省直医保人员为什么要开专用介绍信，如何开具？单位放假期间如何开具？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省直医保人员要开专用介绍信，是加强参保人员住院管理的一项措施，为防止冒名顶替，定点医疗机构分解住院人次起到了很好的作用。省直医保人员住院时需持医生开具的《住院证》到本单位医保专管员处开具《省直单位职工基本医疗保险介绍信》（专用）。按照单位参保协议，节假日期间，尤其是学校等事业单位在放假期间，单位必须留有专人保管专用介绍信，以方便参保人员使用。如单位不留专人保管专用介绍信，致使无法给参保人员开具专用介绍信，造成参保人员无法正常享受医疗待遇的，其责任由单位承担。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是起付标准、最高支付限额、自付比例，分别是多少？&&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&所谓统筹基金的起付标准即通常所说的统筹基金给付的“门槛”，指在统筹基金支付参保职工费用前，职工个人按规定需先用个人账户支付或个人自负一定数额医疗费后，统筹基金才开始按规定的一定比例给付的标准。现行省直医疗保险起付标准三、二、一级医院分别为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&所谓统筹基金的最高支付限额，就是通常所说的“封顶线”，是指由统筹基金所能支付的基本医疗费用最高限额，超出最高支付限额以上的医疗费用，则不在基本医疗保险范围内解决，而要由企业补充医疗保险、商业医疗保险等途径解决。最高支付限额原则控制在当地职工年平均工资的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&倍左右。现行省直医疗保险最高支付限额为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&所谓自付比例即个人负担的比例，指起付标准以上、最高支付限额以下的医疗费用，主要从统筹基金中支付，个人也要负担一定比例。现行省直医疗保险分为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元以下、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元到&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元到最高支付限额三个自付比例段，其中在职职工以上各段的自付比例分别为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&；退休人员以上各段的自付比例分别为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&、&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定点医疗机构甲、乙类药品和诊疗项目分类的依据是什么？&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定点医疗机构甲、乙类药品和诊疗项目分类的依据是甘肃省统一执行的医疗保险药品和诊疗项目目录。目录调整工作由甘肃省劳动和社会保障厅负责完成。现行《甘肃省基本医疗保险和工伤保险药品目录》自&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&年&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&起执行，目录中包括了甲类、乙类药品。《甘肃省城镇职工基本医疗保险和生育保险诊疗项目目录》自&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&年&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&月&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&起执行，目录中包括了统筹基金准予支付诊疗项目、统筹基金部分支付诊疗项目。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&乙类药品和乙类诊疗项目为什么要首先自付一定的比例？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&为了贯彻落实《国务院关于建立城镇职工基本医疗保险制度的决定》（国发［&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&］&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号），劳动保障部、国家计委、国家经贸委、财政部、卫生部、药品监督局、中医药局制定了《城镇职工基本医疗保险用药范围管理暂行办法》（以下简称《办法》），《办法》中规定：“甲类目录”的药品是临床治疗必需，使用广泛，疗效好，同类药品中价格低的药品。“乙类目录”的药品是可供临床治疗选择使用，疗效好，同类药品中比“甲类目录”药品价格略高的药品。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&基本医疗保险参保人员使用《药品目录》中的药品，所发生的费用按以下原则支付。使用“甲类目录”的药品所发生的费用，按基本医疗保险的规定支付。使用“乙类目录”的药品所发生的费用，先由参保人员自付一定比例，再按基本医疗保险的规定支付。个人自付的具体比例，由统筹地区规定，报省、自治区、直辖市劳动保障行政部门备案。现行省直医疗保险乙类药品和诊疗项目的个人自付比例为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员住院期间如何使用自费药品和自费诊疗项目、能不能核报？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员住院期间使用自费药品和自费诊疗项目的，需由患者本人或其家属签字同意，如果定点医疗机构在患者本人或其家属不知情的情况下给患者使用自费药品和自费诊疗项目，患者在出院结账时可拒付相关费用。现在国家的医疗保险政策是基本医疗保险，统筹基金只支付三个目录内项目费用，自费药品和自费诊疗项目不能核报。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员住院期间如何转院？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《甘肃省省直机关事业单位职工基本医疗保险实施方案&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&试行&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&》规定：转院实行首诊责任制，即参保人员转院，由首诊定点医疗机构确定，所发生符合规定的转院医疗费用，由医疗保险经办机构按定额同首诊定点医疗机构结算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&经定点医疗机构批准，省社会保险经办机构备案的异地转院发生的基本医疗费用，先由参保人员或单位垫付，出院后与转出医院按规定结算。应由统筹基金支付的医疗费用，省社会保险经办机构与转出医院结算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员在基本医疗保险定点医疗机构范围内转院，一般应为下级定点医院转往上级定点医院或专科医院，并由转出医院批准，报社会医疗保险经办机构备案。转出医院医疗费用，由社会医疗保险经办机构按照一个次均定额标准的&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％与转出医院结算；未达到统筹基金起付标准的不计结算人次。转入医院医疗费用，由省社会保险经办机构按照一个次均定额标准与转入医院结算。转院的参保人员按本年度内再次住院的规定向转入医院支付起付标准以内基本医疗保险费用。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定点医疗机构定额标准是如何确定的？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定额结算标准以同级定点医疗机构上一年住院者平均住院日、日平均住院费用为基数，扣除应由参保人员自付部分及不合理医疗费用，综合考虑基本医疗服务质量等因素，合理确定每一人次出院者住院医疗费用定额结算标准，以后均以上年度住院医疗费用定额结算标准为基数，调整确定本年度住院医疗费用定额结算标准。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定点医疗机构定额标准与参保人员住院医疗费用有什么关系？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&定额标准是社会医疗保险经办机构与定点医疗机构结算医疗费用的一种办法。参保人员住院医疗费用是确定定点医疗机构定额标准的重要参考依据，但是在参保人员住院时所做的各项检查、治疗、用药等均以治愈疾病为原则，与定额标准并没有直接关系。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员住医疗费用如何结算？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员出院时，到定点医疗机构医疗保险管理部门办理出院手续，定点医疗机构应按规定及时与参保人员个人结清个人应付的费用。应由统筹基金支付的医疗费用，由省社会保险经办机构与定点医疗机构结算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员住医疗费用中个人负担包括哪几部分？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员个人负担费用包括：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）基本医疗保险用药范围、诊疗项目管理、医疗服务设施范围及支付标准以外的费用；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）乙类药品及基本医疗保险支付部分费用的诊疗项目，个人应先自付&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％的费用。其中，心脏起搏器、人工关节、人工晶体、血管支架等体内置换的人工器官、体内置换材料按国产普及型价格计算，超出部分全部由个人自负。无国产普及型价格可参照的，个人应自负&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％的费用；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）起付标准以下（含起付标准）费用；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）最高支付限额以上费用。（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）起付标准以上、最高支付限额以下个人按规定负担的费用。其中：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〔住院费用总额—&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&—（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）—（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）—（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个人自负比例。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&在非定点医疗机构住院费用能不能报销？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&国务院《关于建立城镇职工基本医疗保险制度的决定》（国发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，基本医疗保险实行定点医疗机构（包括中医医院）和定点药店管理。省医疗保险经办机构与定点医疗机构和定点药店签订基本医疗保险服务协议，明确各自的责任、权利和义务，以便加强对医院的管理，更好地为参保人员服务。非定点医疗机构没有明确其责任、权利和义务，也没有可结算的定额标准，所以在非定点医疗机构住院费用不能报销。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&哪几种情况不属于基本医疗保险支付范围？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&下列情况不属于基本医疗保险范围：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&因严重自然灾害和其他突发性因素造成的大范围急、危、重病人发生的医疗费用；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&职工因工（公）伤、职业病、女职工生育发生的医疗费用；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&因公（私）出国或赴港、澳、台地区期间发生的医疗费用；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&因交通肇事及医疗事故发生的医疗费用；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&因违法犯罪、吸毒、酗酒、斗殴、自杀、自残等发生的医疗费用；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&基本医疗保险制度建立前发生的医疗费用。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员年度内基本医疗保险统筹基金如何累计计算？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&参保人员年度内（按自然年度，以出院日期为准）每次住院结算后，均在本人《医疗保险证》上记载所发生的医疗费用、基本医疗保险统筹基金和公务员医疗补助发生情况。参保人员下次住院，结算费用就以本年度内《医疗保险证》上记载所发生的基本医疗保险统筹基金为基数，累计计算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&公务员医疗补助资金如何补助，最高补助多少？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&公务员医疗补助经费要专款专用、单独建帐、单独管理，与基本医疗保险基金分开核算。主要用于符合基本医疗保险药品目录、诊疗项目和医疗服务设施范围及支付标准的医疗费用补助。对起付标准、自负比例、乙类药品和诊疗项目退休医疗照顾人员补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&，在职医疗照顾人员补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&，一般人员补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&；对最高支付限额以上部分医疗照顾人员补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&，一般人员补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&；对床位费医疗照顾人员最高补助到&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&床日，一般人员不补助。补助医疗补助的最高支付限额不超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&万元。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗照顾人员享受哪些待遇？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医疗照顾人员主要在住院期间发生医疗费用时，公务员医疗补助较一般人员的补助标准高。具体补助标准见第&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&条问答&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&哪几类人员可在异地就医？&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员、公派出差、学习和探亲人员可在异地就医，其中异地安置人员须在其选定的定点医疗机构中就医；公派出差、学习人员突发疾病应在其出差、学习地就医；探亲人员在其探亲地就医，而且仅限于突发急性病种，待病情稳定后应转入居住地确定的定点医疗机构，对非突发急性病种异地住院治疗的，不予报销费用。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&公派出差、学习和探亲人员如何异地就医？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&公派出差、学习和探亲人员因病需住院治疗的，须在自住院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内由其所在单位医保经办人员或委托人持单位介绍信到省医疗保险经办机构办理异地住院登记备案手续，对不按要求备案的，省医疗保险经办机构不受理医疗费用审核报销工作。住院医疗费用先由本人或单位垫付，出院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内到省医疗保险经办机构办理医疗费用审核报销手续。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员如何就医？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员因病需住院治疗的，必须在其选定的定点医疗机构就医，住院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内，须由其所在单位医保经办人员或委托人持单位介绍信到省医疗保险经办机构办理异地住院登记备案手续，对不按要求备案的，省医疗保险经办机构不受理医疗费用审核报销工作。因条件所限确需转入专科医院治疗的，应由所在单位及时向省医疗保险经办机构报告并申请，经同意后可转院。住院医疗费用先由本人或单位垫付，出院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内到省医疗保险经办机构办理医疗费用审核报销手续。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是异地就医备案手续？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地就医备案，是对异地就医人员就医行为的一种管理方式，为了防止住院人员挂床、冒名顶替住院等情况的发生。省医疗保险经办机构要求住院人员所在单位医保专管员须在参保人员住院&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&天之内持单位介绍信，将参保人员住院情况报送备案，以便核查。对不按要求备案的，省医疗保险经办机构不受理医疗费用审核报销工作。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&异地安置人员、公派出差学习和探亲人员异地就医如何报销，需要哪些材料？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&　异地安置人员、公派出差学习和探亲人员住院医疗费用先由本人或单位垫付，出院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内到省医疗保险经办机构办理医疗费用审核报销手续。办理医疗费用审核报销工作应提供以下相关材料：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）单位介绍信（介绍信中需注明患者姓名、医保编码、身份证号、医保个人存折账号、职务级别等）；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）本人《医疗保险证》；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&住院病历，包括住院记录、病程记录、医嘱等原件或复印件；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&医药费清单原件；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&住院费用发票原件；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&出差、学习等人员还须提供批准出差、学习的相关文件和差旅费报销赁证（原件和复印件，原件审查后返还原单位，复印件留存）；探亲人员须提供由被探望人所在单位出具的探亲证明。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&省医疗保险经办机构应自接到申报之日起&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内，对异地住院医疗费用进行初审。经审核对材料齐全情况属实的，即予以登记，按照工作程序审批结算；对不符合条件和要求的，&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&将材料退还，并向本人说明情况。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&本地定点医疗机构转异地就医人员医疗费用如何报销，需要哪些材料？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&本地定点医疗机构转异地就医人员医疗费用先由本人或单位垫付，出院后&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&日内到转出定点医疗机构医疗保险管理部门办理核算报销。办理医疗费用审核报销应提供以下相关材料：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）本人《医疗保险证》；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）住院病历，包括住院记录、病程记录、医嘱等原件或复印件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）医药费清单原件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）住院费用发票原件；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）定点医疗机构转出审批表。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&转出定点医疗机构自接到申报之日按照本院相关规定，对异地住院医疗费用进行初审。经审核对材料齐全情况属实的，即予以核算报销；对不符合条件和要求的，将材料退还，并向本人说明情况。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&哪些病种可以申请家庭病床，如何申请？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&《省直机关事业单位职工基本医疗保险就医管理暂行办法》规定，参保人员患以下疾病，符合住院条件，但因特殊情况，可以申请设置家庭病床：（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）脑中风偏瘫丧失行动能力；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）需卧床休息和牵引固定治疗的骨折患者；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）恶性肿瘤晚期；（&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&）其它适合设置家庭病床的疾病。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&设置家庭病床，应由患者向定点医疗机构申请，符合条件的由主治医师填写《省直机关事业单位基本医疗保险设置家庭病床审批表》，提出设置家庭病床的理由，经定点医疗机构医疗保险管理部门审核同意后，报省社会保险经办机构批准。定点医疗机构应严格掌握家庭病床开设标准，坚持合理检查、合理用药，并要建立完整的家庭病床病历。家庭病床每个治疗周期一般为&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&—&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个月，最长不超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个月，超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&个月的需另行批准。参保人员每年度设立家庭病床次数原则上不超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&次。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&特殊疾病门诊补助病种有哪些，如何申请？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&甘肃省劳动和社会保障厅、财政厅《关于印发&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&甘肃省省直机关事业单位职工医疗保险特殊疾病门诊医疗费用补助暂行办法&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&的通知》（甘劳社发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，为了保障省直机关事业单位职工的门诊医疗待遇和合理的医疗消费需求，参保人员患下列疾病，在门诊治疗发生的医疗费，可以纳入基本医疗保险统筹基金补助范围：&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&恶性肿瘤放、化疗；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&肾衰竭透析治疗；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&器官移植的抗排异治疗；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&原发性高血压（属于高度危险组和极度危险组者）&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&糖尿病伴并发症；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&肺源性心脏病；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&慢性肝炎（活动期）&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&类风湿性关节炎（活动期）；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&重型系统性红斑狼疮；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&再生障碍性贫血&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&白血病（需继续化疗者）。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&凡符合规定病种和条件的参保人员，须按照甘肃省社会保险事业管理中心《关于贯彻甘劳社发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号文件的实施意见》（甘社保〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，向省社会医疗保险经办机构提供相应的材料申请。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&特殊疾病门诊补助额度是多少？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&甘肃省劳动和社会保障厅、甘肃省财政厅关于印发《甘肃省省直机关事业单位职工医疗保险特殊疾病门诊医疗费用补助暂行办法》的通知（甘劳社发〔&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&〕&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&号）文件规定，患有恶性肿瘤放、化疗，肾衰竭透析治疗，器官移植抗排异治疗的门诊医疗费中，属于统筹基金支付范围的，当年基本医疗保险最高支付限额以内部分，统筹基金补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％。其他特殊疾病的门诊医疗费中属于统筹基金支付范围的，年度内可补助金额不超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元，其中，&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元以内（含&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元）部分，统筹基金补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％；&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元以上至&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元部分，统筹基金补助&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&纳入基本医疗保险统筹基金补助范围的特殊疾病门诊医疗费，先由本人垫付，待医疗终结或医疗年度期满后，持《医保证》和专用病历、本式双处方、定点医疗机构开具的收据以及检查费、治疗费、材料费的明细清单，到所选定的定点医疗机构审核报销。垫付费用超过&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&元的，可以中途结算。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是处方外配？&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&处方外配是指参保人员在定点医疗机构就医后，持处方在定点零售药店购药的行为。&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&什么是企业补充医疗保险？&&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&考虑到一些企业原有医疗待遇较高，为保持政策的连续性，保证这部分企业职工的医疗待遇不下降，在参加基本医疗保险的同时，作为一种过渡措施，允许这类企业建立企业补充医疗保险，今后随着地区经济发展和医疗保险水平的提高逐步取消。企业补充医疗保险费在工资总额&span style=&font-family: 宋体; mso-ascii-font-family: &Times New Roman&; mso-hansi-font-family: &Times New Roman&;&&％以内的部分，以职工福利费中列支，福利费不足列支部分，经同级财政部门核准后列入成本。
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