姓名：	郭**
来信时间：	2016-03-24
通讯地址：	绥德县中角镇刘家川村
邮政编码：
内容描述：	申请公开最新关于绥德县新农合方面的政策，报销规定，报销流程等方面的文件。

回复时间：	2016-03-30
受理单位：	绥德县人民政府
办理状态：	已回复
回复内容：	<p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: center; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph" align="center"><b><span style="FONT-SIZE: 22pt; FONT-FAMILY: 宋体">新农合惠民政策</span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32.15pt; tab-stops: 36.0pt"><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">一、相关政策补偿方式及发放程序： </span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; tab-stops: 20.2pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋"><span>  </span></span><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">（一）住院补偿</span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">参合农民县域内医疗机构及省内定点医疗机构就诊，按照相应起付线及比例出院时在定点医疗机构享受“直通车”报付。报付标准如下：</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">市内三级医疗机构设置起付线<span>1500</span>元，按照<span>56%</span>予以报销。市内三级中医院设置起付线<span>1500</span>元，按照<span>58%</span>予以报销；<span> </span></span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt 31.9pt; TEXT-JUSTIFY: inter-ideograph"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">二级医疗机构设置起付线<span>500</span>元，按照<span>78%</span>予以报销；二级中医院设置起付线<span>500</span>元，按照<span>80%</span>予以报销；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt 31.9pt; TEXT-JUSTIFY: inter-ideograph"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">一级医疗机构设置起付线<span>100</span>元，按照<span>90%</span>予以报销。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32.15pt"><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">市外医疗机构就诊后凭相关资料于每月<span>10-20</span>号在县合疗办政务大厅窗口予以报付，报付标准如下<span>:</span></span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">省级公立三级医疗机构设置起付线<span>3000</span>元，按照<span>55%</span>予以报销，未转诊降低<span>10%</span>。私立三级医疗机构设置起付线<span>3000</span>元，按照<span>20%</span>予以报销；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">二级医疗机构设置起付线<span>2000</span>元，按照<span>65%</span>予以报销，未转诊降低<span>10%</span>。私立二级医疗机构设置起付线<span>2000</span>元，按照<span>20%</span>予以报销；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">省外公立三级医疗机构设置起付线<span>5000</span>元，按照<span>55%</span>予以报销，未转诊降低<span>10%</span>。私立三级医疗机构设置起付线<span>3000</span>元，按照<span>20%</span>予以报销；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">省外公立二级医疗机构设置起付线<span>3000</span>元，按照<span>65%</span>予以报销，未转诊降低<span>10%</span>。私立二级医疗机构设置起付线<span>3000</span>元，按照<span>20%</span>予以报销。报付后凭报销凭证及身份证在县医院门诊领取补偿基金。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 24.1pt"><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">（二）门诊统筹补偿</span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">参合农民在乡镇卫生院及村卫生室检查、就诊、治疗后，凭合疗卡及身份证直接在就诊医院及村卫生室报销（村卫生室按照<span>80%</span>予以报销，乡镇卫生院按照<span>75%</span>予以报销。每人每年<span>100</span>元封顶，户内通用）。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 24.1pt"><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">（三）特殊慢性病补偿</span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">参合农民根据自身疾病，凭相关病历资料申报符合新农合政策规定范围的病种，经县合疗办认定后发放《特殊慢性病专用病历》后，凭专用病历、合疗卡、身份证在定点医疗机构门诊检查、治疗、用药，凭票在就诊医料机构享受“直通车”报付，年度内补偿不超相关疾病相应封顶线（一类慢性病年度内补偿封顶<span>20000</span>元；二类慢性病年度内补偿封顶<span>2000</span>元）。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 24.1pt"><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">（四）大病救助补偿</span></b></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">参合农民住院补偿后，合规自付费用达到<span>30000</span>元以上的，凭相关病史资料、银行卡、身份证及合疗卡按照相应比例给予二次救助，年度内补偿不超封顶。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">合规自付费用达<span>3</span>—<span>5</span>万元，按照<span>35%</span>予以补偿；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋"><span> </span>5</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">—<span>10</span>万元，按照<span>45%</span>予以补偿； </span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">10</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">—<span>15</span>万元，按照<span>50%</span>予以补偿；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">15</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">—<span>20</span>万元，按照<span>55%</span>予以补偿；</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph; TEXT-INDENT: 32pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">20</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋">万元以上，按照<span>60%</span>予以补偿，年度内补偿不超封顶<span>15</span>万元）。</span></p> <p style="FONT-SIZE: 10.5pt; FONT-FAMILY: 'Times New Roman','serif'; TEXT-ALIGN: justify; MARGIN: 0cm 0cm 0pt; TEXT-JUSTIFY: inter-ideograph"><b><span style="FONT-SIZE: 16pt"><span>    </span></span></b><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">二、主管部门：县卫生局，电话：</span></b><b><span style="FONT-SIZE: 16pt">5622118</span></b><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">；主管领导：李小平，电话：</span></b><b><span style="FONT-SIZE: 16pt">5648101</span></b><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">;</span></b><b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体">经办股室：合疗办，电话：<span>5648111,5648118.</span></span></b></p>