寻乌人民医院门诊特殊慢性病报销与方法
<p style="text-align: center;"></p><h1 style="box-sizing: border-box;font-size: 20px;letter-spacing: 0px;text-align: justify;line-height: 2em;"><strong><span style="color: rgb(202, 101, 227);box-sizing: border-box;font-weight: bolder;font-size: 18px;">一、病种范围及待遇</span></strong></h1><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 特殊慢性病分为两类，共有30种。</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 0em;"><span style="color: rgb(240, 136, 0);box-sizing: border-box;font-weight: bolder;font-size: 16px;">一类病种：8种</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 1.恶性肿瘤；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 2.系统性红斑狼疮；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 3.再生障碍性贫血；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;">4.帕金森氏综合症；</h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 5.慢性肾功能衰竭（尿毒症期）；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 6.器官移植后抗排斥治疗；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 7.地中海贫血（含输血）；</span></h3><h3 style="box-sizing: border-box; font-size: 17px; line-height: 2em; text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 8.血友病。</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;"><span style="color: rgb(240, 136, 0);box-sizing: border-box;font-weight: bolder;font-size: 16px;"> 二类病种：22种</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;">1.精神病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;">2.高血压病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 3.糖尿病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;">4.结核病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 5.冠状动脉粥样硬化性心脏病（心梗、搭桥术、支架植入术后）；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 6.慢性心功能衰竭（心脏合并心功能不全Ⅱ级以上）；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 7.慢性房颤；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 8.心肌病(原发性)；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 9.慢性肝炎；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 10.慢性支气管炎；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 11.慢性阻塞性肺疾病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 12.慢性支气管哮喘；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 13.肝硬化；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 14.慢性肾病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 15.脑卒中后遗症；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 16.癫痫；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 17.重症肌无力；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 18.血吸虫病；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 19.儿童生长激素缺乏症；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 20.痛风；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 21.股骨头坏死；</span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;"> 22.艾滋病。</span></h3><p><span style="box-sizing: border-box;"><br></span></p><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="box-sizing: border-box;font-size: 16px;">以上30种病种可办理门诊特殊慢性病，但必须符合《赣州市城乡居民医疗保险门诊特殊慢性病鉴定标准（试行）》方可，敬请广大城乡居民朋友理解配合。</span></h3><p><span style="box-sizing: border-box;"><br></span></p><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; color: rgb(240, 136, 0);"> <strong>报销比例：</strong></span><span style="box-sizing: border-box;">一类、二类门诊特殊慢性病不设起付线，报销比例为60%。其中，年度最高基金支付限额一类与住院统筹基金最高支付限额合并计算，统一为10万元；二类为5000元。</span></span></h3><p><span style="box-sizing: border-box;"><br></span></p><h1 style="box-sizing: border-box;font-size: 20px;letter-spacing: 0px;text-align: justify;line-height: 2em;"><span style="color: rgb(202, 101, 227);box-sizing: border-box;font-weight: bolder;font-size: 16px;"> </span><strong><span style="color: rgb(202, 101, 227);box-sizing: border-box;font-weight: bolder;font-size: 18px;">二、寻乌县人民医院门诊慢性病办理时间、地点、所需材料及申报程序</span></strong></h1><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;">1.办理时间：</span><span style="box-sizing: border-box;">周一至周五，上午8:00-12:00，下午2:30-5:30；周六上午8:00-12:00。（法定节假日除外）</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;">2.领表处：</span><span style="box-sizing: border-box;">门诊大厅（一楼）导诊台慢病办理处。</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;">3.申报材料：</span><span style="box-sizing: border-box;">参保人员携本人身份证或户口本、医保卡，及按《赣州市城乡居民基本医疗保险门诊特殊慢性病鉴定标准（试行）》的规定提交能证明相关疾病的证明资料（如二级以上医院近期住院小结或近三年的门诊病历；近期的检验检查报告单等，如果现有检查材料不能认定的还需配合进一步检查）。</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;">4.受理与鉴定：</span><span style="box-sizing: border-box;">我院门诊大厅（一楼）导诊台护士陪同申请人将申报材料提交至医院相关科室进行审查、受理登记，医院按规定组织鉴定专家进行鉴定；鉴定通过后医保科工作人员将《慢性病申请表》交县医保局审批；经批准后，次月1日起享受门诊特殊慢性病费用报销待遇。</span></span></h3><p style="text-align: center;"></p><h1 style="box-sizing: border-box;font-size: 20px;letter-spacing: 0px;text-align: justify;line-height: 2em;"><strong><span style="box-sizing: border-box;font-weight: bolder;font-size: 18px;">三、就医报销</span></strong></h1><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;">1.就医：</span><span style="box-sizing: border-box;">从2018年元月1日起，经县医保局批准后的县内门诊特殊慢性病人员，从批准的次月1日起，既可在县人民医院、县中医院就诊享受门诊特殊慢性病待遇，也可到参保地乡镇卫生院就诊享受门诊特殊慢性病待遇。</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;"> 2.用药诊疗范围：</span><span style="box-sizing: border-box;">按《赣州市城乡居民基本医疗保险门诊特殊慢性病用药诊疗范围（试行）》的规定执行。</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;"> 3.处方量控制：</span><span style="box-sizing: border-box;">参保人员门诊处方量一般不超过30日量，如因异地探亲等遇特殊情况经审批不超过60日量。</span></span></h3><h3 style="box-sizing: border-box;font-size: 17px;text-align: justify;line-height: 2em;text-indent: 2em;"><span style="font-size: 16px;"><span style="box-sizing: border-box; font-weight: bolder;"> 4.费用结算：</span><span style="box-sizing: border-box;">门诊特殊慢性病除异地安置人员及恶性肿瘤、红斑狼疮、生长激素缺乏症、器官移植抗排异等个别当地不能诊治的慢性病门诊费用可进行零星报销外，其他的一般门诊特殊慢性病实行在县内定点医院直接刷卡报销，原则上不能进行零星报销。</span></span></h3><section data-role="outer" label="Powered by 135editor.com" style="max-width: 100%; box-sizing: border-box !important;"><section data-role="outer" label="Powered by 135editor.com" style="max-width: 100%; box-sizing: border-box !important;"><section data-role="outer" label="Powered by 135editor.com" style="max-width: 100%; line-height: 25.6px; box-sizing: border-box !important;"><section style="max-width: 100%; line-height: 25.6px; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box !important;"><section class="" style="max-width: 100%; line-height: normal; border-width: 0px; border-style: none; border-top-color: rgb(0, 122, 170); box-sizing: border-box !important;"><section style="max-width: 100%; box-sizing: border-box !important;"><section style="margin: 5px; max-width: 100%; border-width: initial; border-style: none; border-color: initial; box-sizing: border-box !important;"><section class="" label="Copyright © 2015 Yead All Rights Reserved." style="max-width: 100%; line-height: 23.2727px; box-sizing: border-box !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; text-align: center; box-sizing: border-box !important;"><p style="margin-top: -1px; margin-right: auto; margin-left: auto; max-width: 100%; min-height: 1em; line-height: 23.2727px; border-top: 10px solid rgb(61, 170, 214); border-left: 10px solid transparent; border-right: 10px solid transparent; height: 0px; width: 0px; box-sizing: border-box !important;"><br></p></section></section></section></section></section></section></section></section></section></section></section></section>
页:
[1]