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医保政策问答(三) | 一图读懂医保待遇及报销

来源:黑马计划 1







  weilerangguangdacanbaorengengzhiguan、bianjiedilejieyibaozhengce,guojiayiliaobaozhangjuweituozhongguoyiliaobaoxianzazhishe,genju《yibaozhengcewendashouce》bianxieleyitududongxilie,gong11pian30gedawenti,hangaileshoucedequanbuneirong,bingzuochushidangtuozhanyanshen。huanyingdajiajiehezijideshijiqingkuang,“duihaoruzuo”jiejuezishenzaicanbaohexiangshoudaiyuguochengzhongyudaodenanti。


  医保政策问答(三)


  一 图 读 懂 医 保 待 遇 及 报 销


  1、有的人去定点医疗机构就医,虽然使用的药品在医保目录里,本年度的累计医疗费用达到了起付线但还没到封顶线,为什么在有些情况下,医保还是不能报销?


黑马计划  da: heimajihuaguo《shehuibaoxianfa》disanshitiaoguidingxialieyiliaofeiyongbunarujibenyiliaobaoxianjijinzhifufanwei:


  (yi)yingdangconggongshangbaoxianjijinzhongzhifude;


  (er)yingdangyoudisanrenfudande;


黑马计划  (san)yingdangyougonggongweishengfudande;


黑马计划  (si)zaijingwaijiuyide。


  biruyindajiadououchanshengdeyiliaofeiyong,jiushuyushangshubunarujibenyiliaobaoxianjijinzhifufanweide“yingdangyoudisanrenfudande”qingxing,yincibunengyuyijibenyiliaobaoxianjijinbaoxiao。ruguoyiyuanzaizhiliaofeiyongjiesuanshishiyongleyibaobaoxiao,zeyiyuandexingweishiweifade。




  2、车祸的医保报销也有很多情况,不是所有的车祸都可以用医保报销。自己无过错情况下发生的车祸,医保能报销吗?


  da: yibanlaishuo,zheizhongqingkuangxia,yibaobunengbaoxiao。genjuheimajihuaguo《shehuibaoxianfa》disanshitiaodeguiding,jiaotongshigudengcunzaidisanfangzerenrendeqingkuang,yingyoudisanfangzerenrenchengdanyiliaofeiyong,yibaobunengyuyibaoxiao。ruguoyoudisanfangzerenrendeqingkuangxia,canbaorenzixingdaoyiyuanjiuyi,buduiyishengshuomingshoushangdezhenshiyuanyin,ershirangyishenganzhaozijiyiwaidiedaodengyuanyinlaijizijizhiliaobingliyongyibaobaoxiao,jiushejidaoleqizhapianbao,shiweifaxingwei。




 

  3、如果第三方责任人逃逸,目前找不到,医疗费用只能自己出吗?


黑马计划  da: ruguozhaoshizhetaoyiwufazhaodao,yibaojijinkeyixianxingzhifucanbaorendeyiliaofeiyong。genju《shehuibaoxianfa》disanshitiaodierkuanguiding: “yiliaofeiyongyifayingdangyoudisanrenfudan,disanrenbuzhifuhuozhewufaquedingdisanrende,youjibenyiliaobaoxianjijinxianxingzhifu。jibenyiliaobaoxianjijinxianxingzhifuhou,youquanxiangdisanrenzhuichang。”





  4、如果是上班途中发生的车祸,是否由医保来支付?


黑马计划  da: shangbantuzhongfashengdechehuo,shouxianyaoanzhaoshigudezerenlaiquedingyiliaofeiyongdezhifuzhuti。ruguoshiduifangchengdanquanbuzerenhuozhuyaozeren,zeyouduifangzhifuyiliaofeiyong;ruguozhaoshizhetaoyi,zeyaoyougongshangbaoxianxianxingzhifucanbaorendeyiliaofeiyong,gongshangbaoxianyouquanshihouzhuichang。ruguocanbaorenzaijiaotongshiguzerenrendingzhongchengdanzhuyaozeren,zewufarendingweigongshang,yiliaofeiyongyingyouyiliaobaoxianzhifu。




黑马计划1

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