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广西新增3类人群 外省住院可刷社保卡

2017-08-18 05:01:27   中国青年网

参保地社保局应为符合规定的参保人员办理异地就医备案手续,及时将异地就医人员信息逐级上报自治区异地就医结算系统和人力资源社会保障部社会保险经办机构(以下简称部级经办机构),形成全国异地就医备案人员库,供外省就医地经办机构和定点医疗机构获取异地就医人员信息。

结算标准怎么划?支付范围等按就医地规定,支付比例等按参保地政策

各省(区)社保支付政策不同,到底是按照参保地还是就医地的标准来算?除了基本医疗保险,居民大病保险等补充类保险能不能实现异地就医直接结算?按照《通知》,就医地社保局应将异地就医人员纳入本地统一管理,在定点医疗机构确定、医疗信息记录、医疗费用审核和稽核等方面提供与本地参保人相同的服务和管理,并在定点医疗机构协议管理中予以明确。

政策待遇方面,《通知》明确, 跨省异地就医原则上执行就医地支付范围及有关规定(基本医疗保险药品目录、诊疗项目和医疗服务设施标准)。基本医疗保险统筹基金的起付标准、支付比例和最高支付限额原则上执行参保地政策。

同时,《通知》还提出,要逐步扩大结算范围。全区各市要在异地就医住院医疗费用基本医疗保险直接结算的基础上,逐步扩大异地就医直接结算的范围,将公务员医疗补助、补充医疗保险、居民大病保险及医疗救助等纳入结算范围,异地就医人员只需承担个人应支付部分,其他合规医疗费用由就医地医疗保险基金先行代付,由参保地归集后一并划拨。

随着城市医院综合改革的推进,医保政策也进行了调整,《通知》要求,定点医疗机构应按规定为异地就医人员提供合理、必要的医疗服务,不得拒绝为符合规定的异地就医人员提供医疗费用直接结算服务。各市应将异地就医服务纳入本地定点医疗机构医疗服务协议内容,细化服务条款,对未履行协议的定点医疗机构,应及时终止异地就医定点资格。

哪些人可以享受

异地就医直接结算?

参加广西基本医疗保险的下列人员可申请办理跨省异地就医住院医疗费用直接结算。

1

异地安置退休人员

指退休后在异地定居并且户籍迁入定居地的人员。

2

异地长期居住人员

指在异地居住生活 3 个月(含 3个月)以上,并符合参保地规定的人员。

3

常驻异地工作人员

指用人单位派驻异地工作 3 个月 (含 3 个月)以上且符合参保地规定的人员。

4

异地转诊转院人员

指符合参保地转诊转院规定的人员。

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