晴天780
发表于 2023-2-4 19:47:42
@福清人，这些因素会影响医保报销比例
<!----><style type="text/css">html{font-size:375%}</style><link href="https://pic.app.fqlook.com/static/publish/css/style.css?v=1605251010499" rel="stylesheet" position="1" data-qf-origin="/static/publish/css/style.css?v=1605251010499"><!-- 付费贴--> <div class="preview_article "> <!----> <p>近年来</p><p>随着医保制度的日益完善</p><p>医疗保险报销</p><p>也逐渐成为日常生活中经常遇到的问题</p><p>医保报销费用怎么算？</p><p>哪些因素会影响报销比例？</p><p>这些都是市民关心的问题</p><p>记者对此进行详细的解析</p><p class="qf_image big noneditable" contenteditable="false"><img src="https://pic.app.fqlook.com/forum/20230204194448front1_0_155891_FnUWAbNP_9InGwc0R3qXIf8jSHdD.jpg?watermark/3/image/aHR0cHM6Ly9waWMuYXBwLmZxbG9vay5jb20vYWRtaW5fRnYyNzVpbW1Hd0xnX0dTQ29mTWFoR3VkOHBiRC5wbmc=/dissolve/100/gravity/South/dx/10/dy/65/text/QOaZtOWkqTc4MA==/fontsize/400/dissolve/100/gravity/South/fill/I2E4YThhOA==/font/5b6u6L2v6ZuF6buR/dx/10/dy/35" alt="" width="969" height="602" data-qf-origin="forum/20230204194448front1_0_155891_FnUWAbNP_9InGwc0R3qXIf8jSHdD.jpg?watermark/3/image/aHR0cHM6Ly9waWMuYXBwLmZxbG9vay5jb20vYWRtaW5fRnYyNzVpbW1Hd0xnX0dTQ29mTWFoR3VkOHBiRC5wbmc=/dissolve/100/gravity/South/dx/10/dy/65/text/QOaZtOWkqTc4MA==/fontsize/400/dissolve/100/gravity/South/fill/I2E4YThhOA==/font/5b6u6L2v6ZuF6buR/dx/10/dy/35" /></p><p>首先</p><p>先来了解一下几个与</p><p>医保报销费用相关的概念</p><p> </p><section data-support="96编辑器" data-style-id="42871"><section><section class="js_darkmode__0" data-style="background-color: rgb(248, 248, 248); padding: 1px 15px 15px; border-radius: 6px; box-sizing: border-box;"><section><section class="js_darkmode__1" data-style="background-color: rgb(255, 196, 51); padding: 5px 2px 3px 13px; border-radius: 5px 0px 0px 5px; box-sizing: border-box;"><section><p><strong class="js_darkmode__text__11">1.<span class="js_darkmode__text__12">统筹基金支付</span></strong></p></section></section><section class="js_darkmode__2" data-style="height: 0px; border-top-width: 15px; border-top-style: solid; border-top-color: transparent; border-left-width: 15px; border-left-style: solid; border-bottom-width: 14px; border-bottom-style: solid; border-bottom-color: transparent; border-left-color: rgb(255, 196, 51); box-sizing: border-box; margin-left: -1px;"></section></section><section><section><p><span class="js_darkmode__text__13">实际发生的医疗费用中按规定由医保统筹基金支付的金额。（通俗来讲，就是医保报销的金额。）</span></p></section></section><section><section><section class="js_darkmode__3" data-style="background-color: rgb(255, 196, 51); padding: 5px 2px 3px 13px; border-radius: 5px 0px 0px 5px; box-sizing: border-box;"><section><p><strong class="js_darkmode__text__14">2.<span class="js_darkmode__text__15">政策范围内费用</span></strong></p></section></section><section class="js_darkmode__4" data-style="height: 0px; border-top-width: 15px; border-top-style: solid; border-top-color: transparent; border-left-width: 15px; border-left-style: solid; border-bottom-width: 14px; border-bottom-style: solid; border-bottom-color: transparent; border-left-color: rgb(255, 196, 51); box-sizing: border-box; margin-left: -1px;"></section></section><section><section><p><span class="js_darkmode__text__16">参保人发生的符合基本医疗保险支付范围内的医疗费用。</span></p></section></section></section><section><section><section class="js_darkmode__5" data-style="background-color: rgb(255, 196, 51); padding: 5px 2px 3px 13px; border-radius: 5px 0px 0px 5px; box-sizing: border-box;"><section><p><strong class="js_darkmode__text__17">3.<span class="js_darkmode__text__18">报销比例</span></strong></p></section></section><section class="js_darkmode__6" data-style="height: 0px; border-top-width: 15px; border-top-style: solid; border-top-color: transparent; border-left-width: 15px; border-left-style: solid; border-bottom-width: 14px; border-bottom-style: solid; border-bottom-color: transparent; border-left-color: rgb(255, 196, 51); box-sizing: border-box; margin-left: -1px;"></section></section><section><section><p><span class="js_darkmode__text__19">医保统筹基金按一定比例支付参保人政策范围内医疗费用，比例越高，能报销的钱越多。</span></p></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="42871"><section><section class="js_darkmode__7" data-style="background-color: rgb(248, 248, 248); padding: 1px 15px 15px; border-radius: 6px; box-sizing: border-box;"><section><section class="js_darkmode__8" data-style="background-color: rgb(255, 196, 51); padding: 5px 2px 3px 13px; border-radius: 5px 0px 0px 5px; box-sizing: border-box;"><section><p><strong class="js_darkmode__text__20">4.<span class="js_darkmode__text__21">起付线</span></strong></p></section></section><section class="js_darkmode__9" data-style="height: 0px; border-top-width: 15px; border-top-style: solid; border-top-color: transparent; border-left-width: 15px; border-left-style: solid; border-bottom-width: 14px; border-bottom-style: solid; border-bottom-color: transparent; border-left-color: rgb(255, 196, 51); box-sizing: border-box; margin-left: -1px;"></section></section><section><section><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">医保统筹基金对参保人发生的属于政策范围内医疗费用进行补偿的计算起点，在该起点以下的医疗费用，医保统筹基金不予支付。（通俗来讲，就是符合医保报销标准的医疗费用达到一定数额才能开始报销。）</span></p><p> </p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">5.基金最高支付限额</span></p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">医保统筹基金对参保人一个医保年度内发生的属于政策范围内医疗费用进行补偿的最高限额。超过基金最高支付限额部分，统筹基金不再支付。</span></p><p> </p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">医保报销计算公式:（政策范围内费用一起付线）X报销比例医保能报销的金额（统筹基金支付）【不可超过基金最高支付限额】。</span></p><p> </p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">举个例子</span></p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">小陈参加的是福州市城乡居民医保，因病在某二级医院住院治疗，住院总医疗费用9000元，其中医保政策范围内费用8000元，根据福州市居民医保政策，一级医院住院起付线300元，支付报销比例为80%。</span></p><p> </p><p><span class="js_darkmode__10 js_darkmode__text__22" data-style="letter-spacing: 2px; background-color: rgb(248, 248, 248); font-size: 16px;">具体报销如下：医保报销的金额一（政策范围内费用起付线）×报销比例，即：（8000-300）×80%=6160元，所以小陈此次住院仅需支付9000-6160=2840元。</span></p><p class="qf_image big noneditable" contenteditable="false"><img src="https://pic.app.fqlook.com/forum/20230204194609front1_0_155891_Fo1fGdJ-SU0J4qG2DXtOun-Cy6cz.jpg?watermark/3/image/aHR0cHM6Ly9waWMuYXBwLmZxbG9vay5jb20vYWRtaW5fRnYyNzVpbW1Hd0xnX0dTQ29mTWFoR3VkOHBiRC5wbmc=/dissolve/100/gravity/South/dx/10/dy/65/text/QOaZtOWkqTc4MA==/fontsize/400/dissolve/100/gravity/South/fill/I2E4YThhOA==/font/5b6u6L2v6ZuF6buR/dx/10/dy/35" alt="" width="1213" height="805" data-qf-origin="forum/20230204194609front1_0_155891_Fo1fGdJ-SU0J4qG2DXtOun-Cy6cz.jpg?watermark/3/image/aHR0cHM6Ly9waWMuYXBwLmZxbG9vay5jb20vYWRtaW5fRnYyNzVpbW1Hd0xnX0dTQ29mTWFoR3VkOHBiRC5wbmc=/dissolve/100/gravity/South/dx/10/dy/65/text/QOaZtOWkqTc4MA==/fontsize/400/dissolve/100/gravity/South/fill/I2E4YThhOA==/font/5b6u6L2v6ZuF6buR/dx/10/dy/35" /></p><p>此外</p><p>相关人员温馨提示</p><p>根据福建省医疗保障局</p><p>待遇清单（2021年版）规定</p><p>下列医疗费用</p><p>不纳入医保基金支付范围</p><p>↓↓↓</p><p> </p><p>1.应当从工伤保险基金中支付的。</p><p>2.应当由第三人负担的。</p><p>3.应当由公共卫生负担的。</p><p>4.在境外就医的。</p><p>5.体育健身、养生保健消费、健康体检。</p><p>6.国家规定的基本医疗保险基金不予支付的其他费用。遇到对经济社会发展有重大影响的，经法定程序，可做临时调整。</p><p> </p><p>那么什么因素会影响医保报销比例呢？</p><p> </p><section data-support="96编辑器" data-style-id="43290"><section><section class="js_darkmode__bg__0 js_darkmode__24" data-style="background-image: linear-gradient(90deg, rgb(246, 246, 246) 20%, rgb(254, 254, 254) 0%); padding-top: 20px; padding-bottom: 20px; box-sizing: border-box;"><section><section><p><strong><span class="js_darkmode__text__47">参保险种类型</span></strong></p></section></section><section><section class="js_darkmode__25" data-style="background-color: rgb(253, 253, 253); display: inline-block; font-size: 22px; color: rgb(86, 105, 180); letter-spacing: 1px; padding-top: 7px; padding-bottom: 7px; padding-left: 10px; box-sizing: border-box;"><p><strong class="js_darkmode__text__48" data- data-num="1">01</strong></p></section></section><section><p><span class="js_darkmode__text__49">参加职工医保与城乡居民医保的参保人，因基础缴费数额不同，会造成医保待遇的差异。在同一级别的定点医疗机构，职工医保的报销比例要高于城乡居民医保。</span></p></section><section><section><section class="empty_paragraph"></section><section><p><strong class="js_darkmode__text__50">定点医疗机构的等级</strong></p></section></section><section><section class="js_darkmode__26" data-style="background-color: rgb(253, 253, 253); display: inline-block; font-size: 22px; color: rgb(86, 105, 180); letter-spacing: 1px; padding-top: 7px; padding-bottom: 7px; padding-left: 10px; box-sizing: border-box;"><p><strong class="js_darkmode__text__51" data- data-num="2">02</strong></p></section></section><section><p><span class="js_darkmode__text__52">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。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。</span></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="43290"><section><section class="js_darkmode__bg__1 js_darkmode__27" data-style="background-image: linear-gradient(90deg, rgb(246, 246, 246) 20%, rgb(254, 254, 254) 0%); padding-top: 20px; padding-bottom: 20px; box-sizing: border-box;"><section><section class="empty_paragraph"></section><section><p><strong class="js_darkmode__text__53">是否属于医保目录内</strong></p></section></section><section><section class="js_darkmode__28" data-style="background-color: rgb(253, 253, 253); display: inline-block; font-size: 22px; color: rgb(86, 105, 180); letter-spacing: 1px; padding-top: 7px; padding-bottom: 7px; padding-left: 10px; box-sizing: border-box;"><p><strong class="js_darkmode__text__54" data- data-num="2">03</strong></p></section></section><section><p><span class="js_darkmode__text__55">基本医疗保险按照规定的药品、医用耗材和医疗服务项目支付范围支付，非医保目录内的医保基金不予支付。</span></p></section><section><section><section class="empty_paragraph"></section><section><p><strong class="js_darkmode__text__56">医保是否连续续费</strong></p></section></section><section><section class="js_darkmode__29" data-style="background-color: rgb(253, 253, 253); display: inline-block; font-size: 22px; color: rgb(86, 105, 180); letter-spacing: 1px; padding-top: 7px; padding-bottom: 7px; padding-left: 10px; box-sizing: border-box;"><p><strong class="js_darkmode__text__57" data- data-num="3">04</strong></p></section></section><section><p><span class="js_darkmode__text__58">医保中断缴费后，就无法享受医保待遇了。中断3个月内完成补缴的，待遇不受影响；中断超过3个月后再进行补缴，会导致报销比例变低。</span></p><p> </p><p> </p><p> </p><p><span class="js_darkmode__text__58">来源 福清融媒体中心</span></p></section></section></section></section></section></section></section></section></section></section> <!----></div>
阿tom
发表于 2023-2-4 22:34:43
非常棒，就需要这种
晴天小仔仔
发表于 2023-2-4 22:49:28
感谢楼主分享感谢楼主分享
暖心
发表于 2023-2-4 23:00:32
楼下进来科普一下
你在就好
发表于 2023-2-4 23:46:56
了解。。。。。。
随缘666
发表于 2023-2-4 23:56:23
说明的很详细，再加上举例让人更明白！{:5_248:}{:5_248:}{:5_248:}
英英
发表于 2023-2-5 01:31:28
{:5_248:}。
福清融强贺医生
发表于 2023-2-5 06:33:02
职工医保的报销比例要高于城乡居民医保
Mr.Liu
发表于 2023-2-5 06:38:21
让每个人老有所依是国家义务
好心情wzo
发表于 2023-2-5 07:17:35
{:5_248:}{:5_248:}{:5_248:}{:5_248:}{:5_248:}