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新农合省外就医也只需付个人费用

2017-08-24 05:21:35   中国青年网

本报讯(记者章鸽 实习生董子昂)23日,记者从省人社厅获悉,根据最新发布《省人力资源和社会保障厅关于做好城乡居民基本医疗保险整合过渡期间原新农合人员跨省异地就医住院医疗费用直接结算工作的通知》,8月底前,全省城乡居民要全部纳入跨省异地就医住院医疗费用直接结算范围。原新农合人员持社会保障卡在省外异地就医定点医疗机构就医,出院时住院医疗费用直接结算,只需支付个人负担的费用。

8月底前,全省各地要将原新农合人员全部纳入备案覆盖范围,按照跨省异地转诊人员类别进行备案登记和管理。对于原新农合业务系统未与省级异地就医结算系统对接的地区,原新农合人员跨省异地就医可持社会保障卡(或身份证)在参保地申请办理跨省转诊手续。医保经办机构将申请人基本信息录入城镇居民医保系统,做好身份备注标识,再按城镇居民的管理办法办理转诊备案手续,同时暂停其新农合报销待遇。备案信息通过各地医保业务系统的跨省备案界面录入,实时上报至部、省级异地就医结算系统。

在实施统一的城乡居民医疗保险政策前,对已办理跨省备案的原新农合参保人员发生的跨省住院医疗费用,其基本医疗保险和大病保险报销的部分,均按照参保地城镇居民医保参保人员相应的报销待遇标准和规定执行,不受原新农合个人年度封顶线(含基本医疗保险和大病保险)限制;属民政救助、精准扶贫、其他补充医疗保险等报销的部分,由其本人或委托人携带相关资料回参保地按当地原新农合相关待遇和规定进行报销。

跨省异地就医医疗费用清算后,参保地医疗保险经办机构将原新农合人员产生的跨省住院医疗费用,包括总医疗费用、政策范围内费用、基本医疗保险统筹支付费用、大病保险支付费用等数据手工录入原新农合业务系统,重新启动新农合报销待遇。

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