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吉林拟发新规:外地工作半年可办长期异地就医

2017-09-25 04:31:51   中国青年网

近日,省人社厅发布《吉林省医疗工伤生育保险异地就医管理办法(征求意见稿)》(以下简称《意见稿》),对异地就医待遇标准、就医登记做出详细规定。欢迎社会各界人士请将相关意见和建议以电子邮件形式反馈至信箱jlyb0556@126.com。征求意见从即日开始,到9月28日结束。

异地就医类别

据了解,此次《意见稿》适用于吉林省城镇职工医疗保险(以下简称“职工医保”)、城乡居民医疗保险(以下简称“居民医保”)及工伤保险、生育保险(包括一体化结算的由商业保险经办机构经办的险种)参保人员的异地就医管理。

根据参保人员异地就医的时效不同,异地就医管理分以下情况:(一)长期异地就医:职工医保参保人员根据户籍管理规定取得居住地户籍或根据居住证管理规定取得居住地居住证(或居住登记6个月以上,下同)的;职工医保参保人员因公在外地长期工作6个月以上的(以下简称“长期驻外人员”);居民医保参保人员达到法定退休年龄,且在异地取得当地户籍或居住证,非因本人原因无法参加当地医疗保险的。(二)临时异地就医:参保人员(含可享受生育待遇的无工作的男职工配偶)因需要到异地生育的(以下简称“异地生育”);参保人员因参保地定点医疗机构条件所限或因危重症,符合分级诊疗和转诊转院政策规定需要转外就医的(以下简称“转诊”);参保人员因急、危、重症需要就近到医疗机构(国外及港、澳、台地区除外,包括本地非定点医疗机构)治疗的(以下简称“急诊”)。

参保人员异地就医的结算分为(一)直接结算:参保人员持社会保障卡在定点服务机构就医,直接结算医疗费用的。(二)非直接结算:参保人员在定点服务机构就医,现金垫付后回参保地按规定报销的。

支付比例

《意见稿》规定,普通转诊住院异地就医人员、居民医保长期异地就医人员医疗保险基金支付比例在参保地规定的本地就医支付比例基础上降低10%。未履行规定程序,职工医保、居民医保自行异地就医人员的医疗基金支付比例分别为30%、20%。因本人原因,应直接结算未直接结算的异地就医人员,医疗保险基金支付比例在原基础上降低10%。异地就医人员存在多种医疗保险基金降低支付比例情形时,降低的支付比例根据实际情况叠加计算。

就医办理

长期异地就医人员可在居住地(市州统筹区内非跨县域)开通直接结算的全部定点服务机构就医,在此基础上可在居住地(市州统筹区内)的定点服务机构中再选择4家(三级、二级、一级和专科各一所)就医,有异地门诊慢特病待遇的,可在长期异地就医选定医院范围内指定1家医院作为定点。同时可在居住地开通的异地定点零售药店购药;临时异地就医人员选择1家异地就医定点服务机构就医。

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