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马鞍山城乡居民参保可享多项待遇
2015-11-11 10:28:36

11月10日,记者从马鞍山市人社局了解到,2016年马鞍山市城乡居民基本医疗保险缴费工作将于11月30日结束,本次参保居民可从2016年1月1日至2016年12月31日享受普通门诊、规定病种门诊、住院和生育等多项待遇。人社部门提醒,要及时足额缴费,否则明年将不能享受医保待遇,且中途将不受理参保。

据了解,城乡居民基本医疗保险的参保对象为:全日制学校的在校学生和幼儿园幼儿、18周岁以下非在校居民及未参加城镇职工基本医疗保险的其他非从业居民。

普通门诊最高报销限额为160元

感冒发烧了,到社区卫生服务中心看病拿药,可能会报销一半费用。市人社局有关负责人介绍,参保居民在社区卫生服务机构、镇卫生院、村卫生室门诊发生的政策范围内的医疗费,统筹基金支付50%。单次就医费最高报销限额为30元。一个年度内最高报销限额为160元,其中,男满60周岁和女满55周岁以上的参保居民最高报销限额为240元。

对于住院治疗,参保人员在三、二、一级医院住院,一个自然年度内参保人员在三、二、一级医院首次住院支付400、300、200元起付费用,第二次住院的起付费用分别下降100元,第三次及以上住院不再支付起付费用。

参保的在校学生在本市三级、二级、一级定点医疗机构住院,起付费用以上基金支付比例分别为70%、80%、90%,其他城乡居民分别为60%、70%、80%。

特殊病可享每月限额报销

患特殊病种的,每月可享受限额报销待遇。

据介绍,参保人员患有恶性肿瘤门诊放化疗;尿毒症门诊透析治疗;组织器官移植手术后使用免疫抑制剂;饮食控制无效的糖尿病;冠心病(心绞痛、心肌梗死);慢性肾功能衰竭;心力衰 竭;Ⅱ期 以上(含Ⅱ 期)高血 压病、肝硬化(失代偿期);系统性红斑狼疮;脑血管意外功能障碍恢复期;精神病维持治疗期;肾病综合征;类风湿关节炎;慢性再生障碍性贫血;系统性硬化症;慢性阻塞性肺病;炎性肠病(溃疡性结肠炎,克罗恩病);活动性肺结核(含其他脏器活动性结核病);肿瘤巩固治疗期;肿瘤门诊随访期;多发性肌炎、皮肌炎;白塞氏病;干燥综合征;原发性骨髓纤维化;真性红细胞增多症;原发性血小板增多症;血友病;癫痫;帕金森病;强直性脊柱炎;自身免疫性肝炎;慢性活动性肝炎等33个病种,经申请确认后,享受每月限额的报销待遇。

超过2万元补充保险补助金额上不封顶

 
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