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《吉林省医疗工伤生育保险异地就医管理办法(征求意见稿)》发布

2017-09-25 11:36:54   央广网

异地生育人员自经办机构审核异地生育申请通过之日起异地生育待遇生效,其有效期至本次生育结束。

异地就医有效期满后异地就医待遇自动终止,本地就医待遇自动恢复。医疗费用直接结算的长期异地就医人员有效期间发生的定点医疗机构变更、居住地和参保地就医变更、急诊、转诊,纳入居住地经办管理范围。医疗费用直接结算的异地转诊人员有效期间发生的再转诊的登记手续纳入就医地管理,医疗费用回参保地报销。

跨省长期异地就医人员可在居住地(市级统筹区)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(市级统筹区)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:临时异地就医人员选择1家异地就医定点服务机构就医。跨省长期异地就医人员,其异地就医待遇生效期间,非因本人原因门诊医疗费用不能直接结算的,可向参保地经办机构提出提取个人账户资金申请,经办机构核对后于次年1月末前将本人个人账户余额按实际情况定额划转给个人,供其在门诊购药时使用。

异地就医可直接结算的参保人员出院时,参保人员可持社会保障卡直接结算,医疗、工伤、生育保险基金按规定支付后,个人承担部分由个人支付。异地就医可直接结算的长期异地就医人员发生的临时异地就医医疗费用,参保人员向参保地经办机构备案登记后,持社会保障卡直接结算。异地就医暂不能直接结算的参保人员,本人先全额垫付异地就医医疗费用,再返回参保地按规定处理。异地就医人员发生的非直接结算费用,由经办机构核准后,回参保地报销。

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