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索 引 号: 000345-02-2011-105936

发布日期: 2011-11-16

发布机构: 深圳市医疗保障局

文 号: 深劳社规[2008]10号

名 称: 深圳市社会医疗保险参保人就医管理办法

深圳市社会医疗保险参保人就医管理办法

发布日期: 2011-11-16 12:35 来源:秒速时时彩官网_秒速时时彩注册_【官网推荐】

  diyitiao weibaozhangmiaosushishicaiguanwangshishehuiyiliaobaoxiancanbaorendequanyi,guifancanbaorendejiuyixingwei,helishiyongyiliaobaoxianjijin,genju《shenzhenshishehuiyiliaobaoxianbanfa》(yixiajiancheng《banfa》),zhidingbenbanfa。

  diertiao yicanjiashehuiyiliaobaoxianderenyuan,baokuozongheyiliaobaoxian、zhuyuanyiliaobaoxian、nongmingongyiliaobaoxian、shengyuyiliaobaoxiandecanbaorenjiuyiguanligongzuoshiyongbenbanfa。

  disantiao canbaorendaodingdianyiliaojigoujiuyiyingchushiqibenrenshehuibaozhangka,jiangqizuoweicanbaorenjiuyijizhang、baoxiaodepingzheng,tongshichishiweishengxingzhengbumentongyigeshide《menzhenbingliben》jiuzhen,yinbingshizhi、heliyongyao;jiuzhenshidebingqing、jianchazhiliaoheyongyaodengqingkuangyingzai《menzhenbingliben》shangzuoxiangxijizai。

  disitiao zhuyuanyiliaobaoxian、nongmingongyiliaobaoxiancanbaorenyinganyixiaguidingxuandingbenshiyijiashekangzhongxin,bingzaixuandingshekangzhongxinmenzhenjiuyi:

  (yi)zhuyuanyiliaobaoxianzaizhicanbaorenhenongmingongyiliaobaoxiancanbaoren,youyongrendanweidaojiujindeshequjiankangmiaosushishicaiguanwangzhongxinhuoshequyiliaomiaosushishicaiguanwangzhanshenqingxuanding;

  (er)nongcunchengshihuarenyuanyicunhuogufengongsiweidanweicanbaode,youcunhuogufengongsidaojiujindeshequjiankangmiaosushishicaiguanwangzhongxinhuoshequyiliaomiaosushishicaiguanwangzhanshenqingxuanding;

  (san)qitarenyuanyoubenrengenjuzhusuodi,daojiujindeshequjiankangmiaosushishicaiguanwangzhongxinhuoshequyiliaomiaosushishicaiguanwangzhanshenqingxuanding。

  diwutiao canbaorenzaidingdianyiliaojigoujiuyishishiyongjibenyiliaobaoxianhedifangbuchongyiliaobaoxiandemuluyaopin、zhenliaoxiangmuheyiliaomiaosushishicaiguanwangsheshifashengdeyiliaofeiyong,youjibenyiliaobaoxianjijinhedifangbuchongyiliaobaoxianjijinan《banfa》guidingzhifu。

  canbaorenzaidingdianyiliaojigoujiuyishifashengdeshuyubenbanfafujianyisuoliedeyiliaofeiyong,jibenyiliaobaoxianjijinbuyuchangfu。

  shengyuyiliaobaoxiancanbaorenzaijiuyishifashengdeshuyubenbanfafujianerguidingdeyiliaofeiyongyoushengyuyiliaobaoxianjijinzhifu。

  diliutiao canbaorendaodingdianyiliaojigoumenzhenjiuyishi,yinganyixiaguidingjinxing:

  (yi)chimenzhenbingliben、benrenshehuibaozhangkajiuzhen;

  (er)huanmenzhendabingdecanbaorenjiuyishiyingchibenshishehuiyiliaobaoxianmenzhendabingzhuanyongmenzhenbingliben;

  (san)canbaorenmenzhenjiuyishibudejiangbenrenshehuibaozhangkazhuanjietarenshiyong,budeyaoqiuchaoliangkaiyao、feizhiliaoxingdeyaopin、xiugaibingli,budeyiyaohuanyao、yiyaohuanwu、taoquxianjin。

  diqitiao canbaorendaodingdianyiliaojigouzhuyuanjiuyishi,yinganyixiaguidingjinxing:

  (yi)banliruyuanshouxushiyingtigongbenrenshehuibaozhangka、shenfenzheng、zairuyuanzhengmingshushangyoubenrenhuoqijiashuqianmingbinganzhiwen;

  (er)banliruyuanshouxushibunengtigongshehuibaozhangkade,yingzaibanliruyuanshouxuzhiriqisanrineitigong,yuqibutigongde,qizhuyuanyiliaofeiyongbuyujizhang;

  (san)zhuyuanzhiliaoqijian,yingpeiheyishengjijizhiliao;

  (si)budeguachuang、maomingzhuyuan,budeqingbingruyuan;

  (wu)fuhechuyuantiaojiande,budeyanchichuyuan;

  (liu)chuyuanshibudechaoliangdaiyao、daizhenliaoxiangmu,canbaorenchuyuanhousuozuojiancha、huayandefeiyongbudejiruzhuyuanzhangmunei;

  (qi)nongmingongyiliaobaoxiancanbaorenyingzaixuandingshekangzhongxindejiesuanyiyuanzhuyuanzhiliao;

  (ba)nongmingongyiliaobaoxiancanbaorenyinbingqingxuyaozhuanzhende,yingyouyuanjiesuanyiyuanchujuzhuanzhenzhengmingzhujizhuanzhen,huozhuanzhendaoshineitongjihuoshangyijiyouzhuanketezhangdeyiliaojigou。

  (jiu)canbaorenbudeweifanyiliaoyuanze,tichuqitabuhelideyiliao、yongyaoyaoqiu;

  dibatiao canbaorenbanlishiwaizhuanzhenjiuyishi,yinganyixiaguidingjinxing:

  (yi)suohuanjibingbenshinengzhenzhide,budeyaoqiushiwaizhuanzhen;

  (er)shiwaizhuanzhenshiyingansuozhuanzhendexiangmuzhiliao,ruozaizhuanzhendexuzaikaijuzhuanzhenzhengming;

  (san)zhuanzhenzhengminghuoyididingdianyiliaojigoujiuyijieshaoxinbudeduocishiyong;

  (si)zhuanzhenzhengminghuoyididingdianyiliaojigoujiuyijieshaoxinyigeliaochengyouxiao;xuhuiyuanshouzhenyiliaojigouzhuyuanfuzhende,buyongbanlizhuanyuanshouxu,danyingzaifuzhenqiandaoshehuibaoxianjigoubanlifuzhenbeianshouxu;xuzaicizhuanzhenshiwaijiuyide,xuzhongxinbanlizhuanzhenshenpishouxu;

  (wu)zhuanchuyiyuanyingweidangdifeiyinglixingde、sanjiyishangdedingdianyiliaojigou。

  dijiutiao zhangqipaizhuzaiguoneiqitachengshigongzuodebenshihujicanbaorenhuozhetuixiuhoujuzhuzaiguoneiqitachengshidecanbaorenzaidangdijiuzhenshi,yinganyixiaguidingjinxing:

  (yi)canbaorenxuanzesanjiadangdidedingdianyiliaojigouzuoweidangdijiuyideyiliaojigou,bingxiangshishehuibaoxianjigoubeian;

  (er)canbaorenzaidangdixuandingdeyiliaojigoujiuyi,an《banfa》guidingxiangshouyiliaobaoxiandaiyu;canbaorenbeianzhiqianzaidangdiyiliaojigoujiuyisuofashengdeyiliaofeiyong,anzixingshiwaijiuyichuli;

  (san)canbaorencanfanhuibenshigongzuohuodingjude,yingjishixiangshishehuibaoxianjigouquxiaobeian。

  dishitiao zhangqipaizhuzaiguoneiqitachengshigongzuodebenshihujicanbaorenhuozhetuixiuhoujuzhuzaiguoneiqitachengshidecanbaorenzaidangdixuanzedingdianyiliaojigouyinganyixiaguidingjinxing:

  (yi)tianxie《shenzhenshishehuiyiliaobaoxiancanbaorenyidijiuyidingdianyiliaojigoudengjibiao》(yishisanfen);

  (er)xuanzesanjiadangdizhen(xiang)jiyishangdegongliyiliaojigouzuoweiqijiuyideyiliaojigou,jinggaiyiliaojigougaizhanghou,baodangdishebaojigoushenhegaizhang;

  (san)youcanbaodanweihuobenrenchigaizhanghoudedengjibiaodanweidaosuoshushehuibaoxianjigoubanlibeian;

  (si)fuhedangdijiuyibeiantiaojiande,youshehuibaoxianjigouchujubeianpingzheng。

  dishiyitiao jingshishehuibaoxianjigoushenhequedingweimenzhendabingdecanbaorenjiuyide,an《shenzhenshishehuiyiliaobaoxianmenzhendabingguanlibanfa》deguidingzhixing。

  dishiertiao shengyuyiliaobaoxiancanbaoren,fuhejihuashengyuzhengcede,qijinxingweichanqichanqianjiancha、fenmianzhuyuan、chanhoufangshi、jihuashengyushoushu(buhanyingerfeiyong)shi,yinganyixiaguidingjinxing:

  (yi)zaibenshidingdianyiliaojigoujiuyishichujubenrenshehuibaozhangka、benrenshenfenzheng、bingliben、jiehunzhenghejihuashengyumiaosushishicaiguanwangzheng(jihuashengyuzhengming);

  (er)zaiguoneiqitachengshijinxingweichanqichanqianjiancha、fenmianzhuyuan、chanhoufangshihejihuashengyushoushu(buhanyingerfeiyong)de,an《shenzhenshishehuiyiliaobaoxianxianjinbaoxiaoguanlibanfa》zhixing。

  dishisantiao canbaorenyouyixiaqingxingzhiyide,shishehuibaoxianjigoukejinxingdiaocha,canbaorenyingyuyipeihe,rushifanyingqingkuang,bingtigongxiangguancailiao:

  (yi)yueputongmenzhenjiuzhencishuleiji15ciyishangde;(meisixiaoshirenci)

  (er)lianxusangeyueneiputongmenzhenjiuzhencishuleiji30ciyishangde;(meisixiaoshirenci)

  (san)yueneimenzhenyiliaofeiyongleiji6000yuanyishangde;

  (si)tongyiyibaonianduneiputongmenzhenyiliaofeiyongleiji20000yuanyishangde。

  (wu)zhuyuanbaoxiancanbaorenzaiyigeyiliaobaoxiannianduneimenzhenfeiyongzongechaoguo800yuan。

  (liu)zhongliufang、hualiaodengyuemenzhenfeiyongdayu1wanyuande;

  (qi)niaoduzhengtouxiyuemenzhenfeiyongdayu1.5wanyuande;

  (ba)shenyizhishuhoukangpaiyizhiliaoyuemenzhenfeiyongdayu1.5wanyuande;

  (jiu)nongxuzuojiacanbaode;

  (shi)jiangbenrendeshehuibaozhangkazhuanjietarenshiyongde,maoyongtarenshehuibaozhangkade;

  (shiyi)jiangbenrenshehuibaozhangkacunfangdingdianyiliaojigouhuodingdianlingshouyaodiande;

  (shier)jingjubaoyouweifan《banfa》guidingxingweide;

  (shisan)qitaweiguiqingxing。

  dishisitiao canbaorenyoubenbanfadishisantiaoqingxingde,shehuibaoxianjigouketongzhicanbaorenzai10gegongzuorinei,xiedaibenrenshehuibaozhangka、shenfenzheng、bingliben、yiliaofeiyongshoufeishoujudengziliao,daoshehuibaoxianjigoushuomingqingkuang。canbaorenyuqibushuomingqingkuanghuoshuomingliyoubuchongfende,shehuibaoxianjigoukeliandiaocha,bingziliandiaochazhiriqizantingqishehuiyiliaobaoxianjizhang,bingshumiantongzhicanbaoren。

  zantingshehuiyiliaobaoxianjizhangdecanbaorenrengxiangshoushehuiyiliaobaoxiandaiyu,dangaiweixianjinjiesuan,qixianjinzhifudeyiliaofeiyongan《shenzhenshishehuiyiliaobaoxianxianjinbaoxiaoguanlibanfa》deguidingshenhebaoxiao。

  shishehuibaoxianjigouyingdangzaizantingshehuiyiliaobaoxianjizhangzhiriqi90rineiwanchengheshigongzuo,bingyu10gegongzuorineisongda。

  dishiwutiao diaochaheshihou,shishehuibaoxianjigoujianganyixiaguidingchuli:

  (yi)weiweifanshehuiyiliaobaoxianguidingde,ziheshizhiriqi5gegongzuorinei,huifuqishehuiyiliaobaoxianjizhang;

  (er)youweifanshehuiyiliaobaoxianguidingde,youshishehuibaoxianjigouan《banfa》xiangguanguidingchachu;

  (san)canbaorenyoufanzuixianyide,shishehuibaoxianjigouyingdangyisongsifajiguanchuli。

  dishiliutiao lixiurenyuanjiyizhiliujicanjijunrendejiuyiguanlicanzhaocibanfazhixing

  dishiqitiao benbanfazi2008nian4yue1riqishixing。yuan《shenzhenshichengzhenzhigongshehuiyiliaobaoxiancanbaorenjiuyiguanlibanfa》(shenshebaofa〔2003〕82hao)zibenbanfashishizhiriqifeizhi。

  fujian: 1.jibenyiliaobaoxianbuyuchangfudezhiliaofeiyongheqitafeiyong

        2.shengyuyiliaobaoxianxiangmuyilanbiao

  fujian1:

  jibenyiliaobaoxianbuyuchangfudezhiliaofeiyongheqitafeiyong

  yi、zhiliaoxiangmuleiyiliaofeiyong

  (yi)gezhongqiguanhuozuzhiyizhishi,qigoumaiqiguanyuanhuozuzhiyuanfeiyong。

  (er)chuxinzangbanmo、rengongjingti、rengongguanjiezhiwaiderengongqiguananzhuanghezhihuandefeiyong;

  (san)chushenzang、xinzangbanmo、jiaomo、gu、pifu、xueguan、gusuiyizhiyiwaideqiguanhezuzhiyizhifeiyong。qiguanhezuzhiyizhishigongtidesuoyoujianchahezhiliaofei。

  (si)jinshihexieshijiaoxingshufeiyong。

  (wu)jieyan、jiedudefeiyong。

  (liu)qigongliaofa、yinleliaofa(zhuyuanjingshenbingrenchuwai)、pinghengyixueliaofa、yingyangliaofahegezhongciliaodengfuzhuxingzhiliaoxiangmufeiyong。

  (qi)rengongganzhiliao。

  (ba)kangzhongliuxibaomianyiliaofa※(rulakexibaozhiliaodeng), tiyemianyizhiliao、jiyinzhiliao。

  er、qitayiliaofeiyong

  (yi)gezhongbuyun(yu)zheng、xinggongnengzhangai、bianxingshoushudezhenliaoxiangmufeiyong。

  (er)weifanjihuashengyudeyiqieyiliaofeiyong,yijiweihunhuanzhedeliuchan、yinchan、baotai、gongwaiyun、fenmiandengfeiyong。

  (san)zhuyuanqijianshiyongbushuyujibenyiliaobaoxianzhengcefanweineidezifeiyaopin、zifeizhenliaoxiangmuhezifeicailiaodefeiyong;yijiguamingzhuyuan、maomingzhuyuan、bufuheruyuanbiaozhundengqitaweifanjibenyiliaobaoxianguidingsuofashengdeyiliaofeiyong。

  (si)zhuyuanbingrenyingdangchuyuanerjubuchuyuan,jingyiliaobaoxianzhuanjiaweiyuanhuijiandinghouquedingyingdangchuyuande,congquedingchuyuanzhiriqifashengdeyiqieyiliaofeiyong;huohuanzhezhuyuanyingyoudingdianyiliaojigoujizhangerbujizhang,ranhounafeiyongdanjuyaoqiubaoxiaodefeiyong。

  (wu)yinzisha、guyizishang、zican(jingshenbingchuwai)、dajia、douou、xujiu、xidujiqitaweifaluanjidengxingweiyinqideyiqiefeiyong。

  (liu)yintarenqinhaixingweizaochengshanghaideyiliaofeiyong。

  (qi)youyugongshang、jiaotongshigu、yiliaoshiguyijiqitazerenshiguyinfadezhenliaoxiangmufeiyong。

  (ba)wu、liu、qixiangyuanyinyinqideyiqiehouxuzhiliaofeiyong。

  (jiu)bufuheshiwaizhuanzhenhexianjinbaoxiaoguidingdefeiyong。

  (shi)bufuheshidaxingyiliaoshebeijianchahezhiliaoxiangmuguanlibanfaguidingdefeiyong。

  (shiyi)gezhongjiaoxuexing、keyanxinghelinchuangyanzhengxingdezhenliaoxiangmufeiyong。

  (shier)weijingguangdongshenghuoshenzhenshiweishengting(ju)、wujiating(ju)、caizhengting(ju)zhengshipizhundezhenliaoxiangmufeiyong。

  (shisan)weixiangshishehuibaoxianjigoubanlishenbaoshouxu,huoyishenbaodanweidedaoshishehuibaoxianjigouhezhunshiyongdegezhongjianchazhiliaoxiangmujiyiyuanzizhiyaopindefeiyong。

  (shisi)zhigongshehuibaoxianzhengshengxiaozhiqianhuoyishidanweiguashiqijiansuofashengdeyiqieyiliaofeiyong。

  (shiwu)guojia、sheng、shishehuibaoxianjigouheweishengzhuguanbumenyoujutiguidingbulierubaoxiaofanweideqitafeiyong。

  zhu: fanyoushangbiao※dexiangmuzhiyinarudifangbuchongyiliaobaoxianzhenliaoxiangmumuluhemiaosushishicaiguanwangsheshifanweineidexiangmu。

  fujian2:

  shengyuyiliaobaoxianxiangmuyilanbiao

  yi、chanqianjianchabaokuoyixiajibenxiangmu:

  diyicijiancha: (13zhouzhiqian)jianli《shenzhenshimuzibaojianshouce》;niaohcg、fukejiancha、xuechanggui、niaochanggui、xindiantu、bchao、xuehongdanbaidianyongshiyan(dipinshaicha);

  diercijiancha: (16—18zhou)chankejiancha(junhantaixinduopule)、xuexing(abo、rh)、xuechanggui、niaochanggui、shengongneng(3xiang)、gangongneng(5xiang)、yiganliangduiban、bingganbingdukangti、meiduxueqingkangti、xuetang;

  disancijiancha: (20—24zhou)chankejiancha、niaochanggui、caisebchao;

  disicijiancha: (24—28zhou)chankejiancha、niaochanggui、xuetangshaicha;

  diwucijiancha: (28—30zhou)chankejiancha、niaochanggui、abokangtijiance;

  diliucijiancha: (30—32zhou)chankejiancha、xuechanggui、niaochanggui、bchao;

  diqicijiancha: (32—34zhou)chankejiancha、niaochanggui;

  dibacijiancha: (34—36zhou)chankejiancha、taierjianhu、niaochanggui;

  dijiucijiancha: (37zhou)chankejiancha、niaochanggui、bchao、xuechanggui、ganshengongneng、taierjianhu;

  dishicijiancha: (38zhou)chankejiancha、taierjianhu、niaochanggui;

  dishiyicijiancha: (39zhou)chankejiancha、niaochanggui、bchao、taierjianhu;

  dishiercijiancha: (40zhou)chankejiancha、taierjianhu、niaochanggui。

  er、jihuashengyushoushuxiangmubaokuo:

  (yi)fangzhi(quchu)gongneijieyuqi;

  (er)rengongzhongzhirenshen(liuchanshu),baokuorengongliuchan(fuyaxiyinshu、qianguashu)、zhongqirenshenyinchanshu、yaowuzhongzhirenshen;

  (san)fangzhi、quchupixiamaizhibiyunji;

  (si)shuluanguanjueyushu、shujingguanjueyushu;

  (wu)shuluanguanfutongshu、shujingguanfutongshu。

  

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