2016医保汇编2016医保汇编.doc

台州市城镇职工基本医疗保险 汇编 台州市医疗保险事业管理中心编 二○一一年二月 目录 第一部分 政策文件 试行办法···································1 实施细则··································21 第二部分 基础知识 参保与缴费································38 参保范围及参保对象··························38 缴费标准及待遇类别··························38 医保费缴纳及中断处理·························39 医保最低缴费年限···························40 医保个人账户·····························40 个账划入·································40 个账用途·································41 个账查询·································41 个账转移、提取、补还························41 医保待遇及费用结算························41 不属医保支付的医疗费用························41 定点医疗机构·······························41 药品目录、医疗服务项目目录······················42 企业门诊统筹支付····························42 门诊个账及公务员补助支付······················42 住院统筹··································44 重大疾病保险支付····························45 住院个账、公务员补助支付······················45 第三部分 办事指南 办事窗口、电话及网站························46 单位及个体新参保须知·······················47 医保表格说明·······························47 参保变动变更业务··························48 缴费基数调整······························49 医保关系转移流程··························49 退休补缴流程······························50 卡证领取、挂失流程·························50 第四部分 就医指南 本地就医··································51 转外就医··································52 异地安置··································53 外地急诊··································54 零星报销··································55 特殊病种··································57 医保发票说明·······························57 定点医疗机构名单··························58 第五部分 违规稽查 重点审核对象及处理·························66 台州市城镇职工基本医疗保险试行办法 （台政发〔2010〕34号） 第一章 总 则 第一条 为保障职工的基本医疗，促进社会稳定和经济发展，根据国家、省有关完善城镇职工基本医疗保险制度的规定，结合本市实际，制定本办法。 第二条 本规定适用于本市行政区域内的下列单位和个人： （一）各类企业、国家机关、事业单位、社会团体、民办非企业单位、个体工商户（以下统称用人单位）及其职工（雇工）。 （二）经人力资源社会保障行政主管部门及授权部门批准退休（含退职，下同）按规定参加基本医疗保险的人员（以下简称退休人员）。 （三）按规定参加职工基本养老保险，尚未达到法定退休年龄的统筹地区户籍城乡居民，以及原已参加统筹地区职工医疗保险现与用人单位终止或解除劳动关系的非统筹地区户籍人员（以下统称灵活就业人员）。 第三条 建立和完善职工基本医疗保险制度必须坚持下列原则： （一）医疗保险的筹资和保障水平应当与经济和社会发展水平相适应