[{"gicategorycode":"社会保障 ","giinfoid":"285476","giindentifier":"11532300mb16168868-/2023-1106010","giuuid":"533E91C7B0AF4FF0B22E020F7B0E40C3","gititle":"【云•医保问答】这些情况下,医保不能报销,您都知道吗?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局","gidate":"2023-01-05 17:38:35","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:这些情况下,医保不能报销,您都知道吗?答:按照《社会保险法》《国家医保局 财政部关于建立医疗保障待遇清单制度的意见》规定,下列医疗费用不纳入基本医疗保险基金支付范围:(一)应当从工伤保险基金中支付的。(二)应当由第三人负担的。(三)应当由公共卫生负担的。(四)在境外就医的。(五)体育健身、养生保健消费、健康体检。(六)国家规定的基本医疗保险基金不予支付的其他费用。遇对经济社会发..."},{"gicategorycode":"社会保障 ","giinfoid":"285473","giindentifier":"11532300mb16168868-/2023-1106009","giuuid":"C909367D69574FA2AFD3B24AE792BAB9","gititle":"【云•医保问答】同样是医保参保人,为什么有时候报销比例不一样?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局、","gidate":"2023-01-04 17:43:39","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:同样是医保参保人,为什么有时候报销比例不一样?答:可能有以下几种情况:(一)不同等级的医疗机构,报销比例有所差异。从效率上讲,有序就医是社会最优选择,国家鼓励患者小病在基层医院看,大病再去大医院看。医保部门为了对患者起到引导作用,在基层医院报销比例比在大医院高,而且基层医院的起付线也设置得比大医院低。因此同样类型的参保人在不同等级的医疗机构里产生的医疗费用,报销比例会不同。(二)在就..."},{"gicategorycode":"社会保障 ","giinfoid":"285471","giindentifier":"11532300mb16168868-/2023-1106008","giuuid":"587CB8ACDC2C4479B6D6566B4348BB87","gititle":"【云•医保问答】参保人的医保报销费用,如果超出基本医保封顶线的费用怎么办?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局、","gidate":"2022-12-01 17:52:34","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:参保人的医保报销费用,如果超出基本医保封顶线的费用怎么办?答:超过基本医保封顶线的部分,可根据实际医疗费用负担情况,纳入职工大额医疗费用补助和城乡居民大病保险范围。大病保险是基本医疗保障制度的拓展和延伸,主要对大病患者高额医疗费用在基本医保支付基础上再给予进一步支付。我省职工大病补充保险政策范围内费用支付比例达到90%,封顶线各统筹区不同,大部分统筹地区在40万左右,部分统筹地区没有封顶限额..."},{"gicategorycode":"社会保障 ","giinfoid":"285470","giindentifier":"11532300mb16168868-/2023-1106007","giuuid":"D5F1A62B76C44D2E83F747C07696E066","gititle":"【云•医保问答】如何计算医保报销金额?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局、","gidate":"2022-11-25 16:50:30","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:如何计算医保报销金额?答:参保人就医后,发生了药品、诊疗等费用,其中药品又包括“甲类”药品和“乙类”药品,那么报销的方法是:乙类药扣除先自付后的费用,加上“甲类”药品全部费用,再加上诊疗等费用中符合医保规定的费用,可用于累计参保人当年的起付线。对于超过起付线、未达封顶线的费用,依据患者本人参保类型、就医医院级别等按规定比例报销。简单来说:医保报销的钱=(“甲类”药品的全部费用+乙类药..."},{"gicategorycode":"社会保障 ","giinfoid":"285468","giindentifier":"11532300mb16168868-/2023-1106006","giuuid":"4C540E0008F9404CBFE9EE00CEBBB217","gititle":"【云•医保问答】什么是“起付线”和“封顶线”?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局、","gidate":"2022-11-23 17:45:12","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:什么是“起付线”和“封顶线”?答:起付线指的是医保基金的起付标准,是参保人员在定点医疗机构实际发生在医保报销范围内的医疗费用,自己要先承担起付标准以下的费用,起付标准以上的部分再由医保基金按规定、按比例报销。根据地区、医疗机构、门诊或住院等情况的不同,起付线标准也各不相同。封顶线指的是医保基金的最高支付限额,也就是参保人在一个年度内累计能从医保基金获得的最高报销金额。封顶线以外的医疗费..."},{"gicategorycode":"社会保障 ","giinfoid":"285467","giindentifier":"11532300mb16168868-/2023-1106005","giuuid":"AD5FC55BF471401CB90FA0FACFD12815","gititle":"【云•医保问答 】哪些人员可以参加居民医保?如何参保?","subcatcode":"","gitcatcode":"","giccatcode":"","gipubcodes":"楚雄州医保局、","gidate":"2022-11-07 16:41:12","gidocno":"","gisubterm":"","gipubcode":"cxzybj","summary":"问:哪些人员可以参加居民医保?答:除职工以外的其他所有城乡居民,包括农村居民、城镇非从业居民、在校就读学生、在园儿童、婴幼儿、新生儿、宗教教职人员、长期投资经商和务工的外来人员的未成年子女、以及国家和我省规定的其他人员都纳入城乡居民参保范围。问:如何参加城乡居民基本医疗保险?答:(1)本州、市户籍新参保人员,本人携带身份证、户口册,于每年居民医保参保期到就近、就便的社区居委会办理参保业务。续..."}]