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云南交通职业技术学院学生基本医疗保险实施办法(试行)

发布时间: 2017年02月10日 作者:  点击: []

yabo手机版daxueshengcanjiajibenyiliaobaoxianshiyidengxiaopinglilunhe“sangedaibiao”zhongyaosixiangweizhidao,jianchiyirenweiben,luoshikexuefazhanguandebiranyaoqiu;jianliyidabingtongchouweizhudedaxueshengjibenyiliaobaoxianzhidu,shitigaodaxueshengyiliaodaiyushuiping,jiejuehuanteshubingxueshengdeyiliaofeiyong,jianqinggerenhejiatingjingjifudandeyixiangcuoshi。weilezuohaoxueshengjibenyiliaobaoxiantongchouguanli,baozhangxueshengdeliyi,genju《yunnanshengdaxueshengjibenyiliaobaoxianshishixize(shixing)》wenjianjingshenyaoqiu,tezhidingyunnanjiaotongzhiyejishuxueyuandaxueshengjibenyiliaobaoxianshishibanfa。

一、门诊用药及诊疗项目报销范围、报销比例

1、menzhenxueshengyongyaofanweishixing《yunnanshengjibenyiliaobaoxianhegongshangbaoxianyaopinmulu》dejialei、yileiyaowu,chaochuciyongyaofanweideyaofei,youxueshengzixingchengdan。

2、menzhenzhenliaoxiangmubaoxiaofanwei: ①menzhenzhenliaoxiangmufuheyunnanshengchengzhenjuminjibenyiliaobaoxiandeguiding。

yabo手机版②jianchaxiangmu: xguangjiancha、bxingchaoshengjiancha、xindiantuhezhiliaofeidengxiaoyiyuanjizhidingyiyuanyaboshoujibandezhenliaoxiangmu。

3、menzhenyaofei、jianchafei、zhiliaofeibaoxiaobili: menzhenyaofei、jianchafei、zhiliaofeibaoxiaobiliwei60%,xueshengzifu40%。

二、住院医疗待遇

1、qifubiaozhun

yabo手机版xuenianneidiyicizhuyuan: yijiyiliaojigou100yuan,erjiyiliaojigou200yuan,sanjiyiliaojigou300yuan;diercizhuyuanqifufeijianban;disanci(han)yishangzhuyuandebuzaijiaonaqifufei。

yabo手机版2、zhuyuanqijianfashengdeteshujiancha、teshuzhiliaoheyileiyaopingerenzifu。ruoshiyongleyaopinmuluyiwaideqiangjiuyaopinshi,yousuozaidingdianyiliaojigoushenpibeianhoufangkeshiyong,yaopinfeiyougerenzifu。

3、baoxiaobilihezuigaozhifuxiane

(1)jibenyiliaobaoxian

xuenianneifuhejibenyiliaobaoxianfanweineidezhuyuanyiliaofeiyongbaoxiaobiliwei60%;tongchoujijinzuigaozhifuxianewei1.6wanyuan,youdingdianyiyuancanzhaoyibaoguidingyugerenjiesuan。

(2)buchongyiliaobaoxian

xueniannei,zaicanjiajibenyiliaobaoxiandetongshi,youcanjialebuchongyiliaobaoxiandedaxuesheng,fuhejibenyiliaobaoxianbaoxiaofanweineidezhuyuanyiliaofeiyongbaoxiaobilitigaodao90%;buchongyiliaobaoxianzuigaozhifuxianeshangbufengding,bingchengdanyiwaishanghaishengu、jibingshengu10000yuandepeifuzeren,chengdanyiwaishangcanandengjizuigao10000yuandepeifuheyiwaishanghaimenzhenfeiyong100yuanyishang5000yuanyinei90%depeifuzeren。

三、有下列情形之一的,门诊统筹医疗费不予报销

yabo手机版1、jibenyiliaoyaopindemulu、zhenliaoxiangmuheyaboshoujibansheshibiaozhunyiwaidefeiyong。

yabo手机版2、jiankangtijian、jihuamianyi、yufangbaojian、jiankangjiaoyudengweishengyaboshoujibanfeiyong。

3、weibanlizhuanzhenzhuanyuanshenpibeianshouxuzixingwaichujiuyifashengdeyiliaofeiyong(jizhenchuwai)。

yabo手机版4、zhengxing、meirong、xidu、dajiadouou、zishazican、zifen、xujiudengxingweisuozhideyiliaofeiyong,yijiyinyiliaoshigusuozengjiadefeiyong。

yabo手机版5、anyouguanguidingbuyuzhifudeqitafeiyong。

四、就医管理

yabo手机版1、benbanfashiyongfanwei: canjialeyunnanshengdaxueshengjibenyiliaobaoxiandequanrizhibenzhuankexueshenghefeizaizhiyanjiusheng。

2、xinshengcongbaodaozhiriqi,sangeyueneiweiruxuetijianfuchaqi。yiyuanjianggenju“putonggaodengyaboshoujibanzhaoshengtijianbiaozhun”jinxingtijian,hegezhe,sangeyuehoufangnengqudexueji。xinshengzaitijianfuchaqineibuxiangshoujibenyiliaomenzhenbaoxiao。

yabo手机版3、xueshengdeshouzhenyiyuanweixiaoyiyuan,jiuyishibixuxiedaibenrenjibenyiliaobaozhangkajixueshengzheng。

4、xueshengdaoyuanwaijiuzhen、jianchafeiyongzili。zaijiaqi、shixi、xiuxueqijianyinjiweizhongzhengxujizhenjiuyihuoyidizhuyuanzhiliaozhe,yuanzeshangzaidangdiyibaodingdianyiliaojigoujiuyi,bingzaiyizhouneixiangxiaoyiyuanbaogaobeian,suofashengdeyiyaofeiyougerenquanedianfu。zhiliaozhongjiehou,menzhenfeiyongfuheyaopinmulu、zhenliaoxiangmufanweidepingmenzhenjizhenbingli、shuangchufangyouxiaoyiyuananguidingbaoxiao;zhuyuanfeiyongyouyibaozhongxinanguidingbaoxiao。

5、xueshengyinbingqingxuyaozhuanzhenzhuanyuanzhiliaode,youjingzhuzhiyishengtichuyijianjingyiyuanlingdaotongyihou,kaijuzhuanzhenzhuanyuanzhengming,fangkedaozhidingdeyibaodingdianyiyuanjiuzhen(jizhenqiangjiuchuwai)。zhuanshengwaijiuyide,xutigongzhishaoersuosanjidingdianyiliaojigouzhurenyishihuizhenyijian,youzhuanchuyiyuangaizhanghousongyibaozhongxinshendingbeian,gerenzifubilizaiyuanjichushangtigaoergebaifendian,feiyongyouyaboshoujibanhuoxueshengbenrenquanedianfu。

6、huanteshubingdedaxuesheng,youbenrentichushumianshenqing,anzhaoyibaozhongxindeyaoqiuzhunbeixiangjiaocailiao,youxiaoyiyuansongyibaozhongxinshenhehoufaji《teshubingjiuzhenka》,chiyou《teshubingjiuzhenka》dehuanzhe,fangkexiangshouxiangyingdeteshubingyiliaodaiyu。

yabo手机版7、fashengwuzerenrendeyiwaishanghaizhuyuan,qifeiyongkepingdingdianyiliaojigouzhenduanzhengmingjixiaoyiyuanchujudexiangguanzhengminganguidingbaoxiao。

8、xueshengruxueqiansuohuanjibing(yiruxuetijianjilinchuangzhenduanweiyiju),ruxuehoufufachanshengdemenzhenyiliaofeizili。xiuxue、tuixuechanshengdemenzhenyiliaofeiyongyoubenrenzili。

五、参保登记及缴费

daxueshengcanbaodengjishijianweimeinian9yue1rizhicinian8yue31rizhi,zaixiaoshengmeinian6yuejinxingxinxidengji,bingtongshishouqubuchongyiliaobaoxianfei。xinshengruxueshitianxiedaxueshengcanbaoshenqingdengjibiao,tongshishouqushehuibaozhangkakafeijibuchongyiliaobaoxianfei,9yuediyiqianwanchengxinxishoujihuizong,baosongshengyibaozhongxinshencha、faka。

六、上述实施办法未阐明部分按照《云南省城镇居民基本医疗保险试点实施办法》(云政发[2007]130号)和《云南省学生基本医疗保险实施细则(试行)》(云劳社发[2008]8号)文件执行。

七、未尽事宜另行规定。

八、yabo手机版本实施办法自发布之日起执行。

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