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    • 办事指南
    • 科尔沁区2016年新型农村合作医疗政策
    • 2016-05-23
      <div class=TRS_Editor><div style="text-align: center;"><span style="font-size: 12pt;">&nbsp;</span><span style="font-family: 方正小标宋简体; font-size: 22pt; letter-spacing: 0pt; line-height: 28pt; text-align: center; text-indent: 0pt;">科尔沁区2016年新型农村合作医疗政策</span></div><p class="MsoNormal" style="margin-right:0.0000pt;margin-left:-18.0000pt;mso-para-margin-right:0.0000gd;mso-para-margin-left:0.0000gd;text-indent:0.0000pt;mso-char-indent-count:0.0000;padding:0pt 0pt 0pt 0pt ;text-autospace:ideograph-numeric;mso-pagination:widow-orphan;text-align:center;line-height:28.0000pt;mso-line-height-rule:exactly;"><span style="font-family: 方正小标宋简体; letter-spacing: 0pt; font-size: 22pt; background-position: initial initial; background-repeat: initial initial;"><o:p>&nbsp;</o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt; background-position: initial initial; background-repeat: initial initial;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  </span><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">1、根据《通辽市新型农村牧区合作医疗2016年统筹补偿方案》规定,未办理转诊手续的所发生的医疗费用,报销比例降低20%(可按照住院治疗总费用去除起付线后的25%给予住院治疗保底补偿),转市外其它医疗机构(非定点、非公立、一级公立)就诊的,新农合不予报销。</span><span style="font-family: 微软雅黑; letter-spacing: 0pt; font-size: 9pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  2、门诊统筹基金按人均120元列入,其中:10元用于核销一般诊疗费;20元用于补偿参合患者在乡镇卫生院进行的Ⅱ期及以上高血压病、有并发症的糖尿病、急性脑血管病后遗症、冠心病、肺心病等慢病,门诊治疗费用均按照80%的补偿比例予以补偿,封顶线为1000元/年/人。患者凭门诊处方、门诊发票、诊断书等相关手续按照补偿方案及补偿标准统一进行补偿;90元用于参合患者在乡镇卫生院、卫生室进行的其他门诊医疗补偿。</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  3、妇女乳腺癌、宫颈癌、肺癌、食道癌、胃癌、结肠癌、直肠癌、急性心肌梗死、唇腭裂、肾病综合征、血友病、艾滋病机会性感染(包括艾滋病)、儿童先天性心脏病、儿童急性白血病、终末期肾病透析治疗、精神疾病、耐多药结核病及其他活动性结核病、急性期布氏杆菌病、乙肝母婴传播阻断项目、新生儿疾病筛查、儿童苯丙酮尿症、儿童尿道下裂、产科急危重症抢救、慢性粒细胞白血病、器官移植抗排异治疗、I型糖尿病、甲亢、再生障碍性贫血、骨髓异常增生综合症(MDS)、系统性红斑狼疮、急性白血病、紫癜性肾炎列为特殊/重大疾病管理的病种。</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  4、当年在缴费期过后至下一个缴费期之间出生的新生儿(婴儿)随父亲或母亲享受新农合待遇。2016年2月28日至2016年12月31日出生的新生儿(婴儿)随父亲或母亲享受新农合待遇。</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  5、有下列情形之一的,医疗费不纳入新农合报销范围:</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ①使用的药品、诊疗项目未列入新型农村牧区合作医疗药品报销目录、诊疗项目报销目录并且没有特殊政策的(如保底补偿、特殊重大疾病等);</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ②应当由第三人负担医疗费用的;</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ③应当由公共卫生负担的;</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ④境外就医的;</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ⑤因故意犯罪、吸毒、酒驾、斗殴造成自身伤害发生医疗费用的;</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ⑥因美容、整形等非基本医疗需要发生医疗费用的;</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right: 0pt; margin-left: 0pt; text-indent: 0pt; padding: 0pt; line-height: 28pt;"><span style="font-family: 仿宋_GB2312; letter-spacing: 0pt; font-size: 16pt; background-position: initial initial; background-repeat: initial initial;">  ⑦国家、自治区规定和通辽市新农合相关规定不予报销的其他情形。</span><span style="mso-spacerun:'yes';font-family:微软雅黑;font-size:9.0000pt;mso-font-kerning:1.0000pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-right:0.0000pt;mso-para-margin-right:0.0000gd;text-indent:0.0000pt;mso-char-indent-count:0.0000;text-autospace:ideograph-numeric;mso-pagination:none;line-height:28.0000pt;mso-line-height-rule:exactly;"><span style="mso-spacerun:'yes';font-family:Calibri;mso-fareast-font-family:宋体;mso-bidi-font-family:'Times New Roman';font-size:10.5000pt;mso-font-kerning:1.0000pt;">&nbsp;</span></p></div>