浙江省台州市城镇职工基本医疗保险汇编

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1、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··

2、··························个账划入···················个账用途···················个账查询···················个账转移、提取、补还···················医保待遇及费用结算························不属医保支付的医疗费用···················定点医疗机构···················药品目录、医疗服务项目目录···················企业门诊统筹支付···················门诊个账及公务员补助支付···········

3、········住院统筹···················重大疾病保险支付···················住院个账、公务员补助支付···················第三部分办事指南办事窗口、电话及网站············单位及个体新参保须知····················医保表格说明···················参保变动变更业务·······················缴费基数调整···························医保关系转移流程·······················退休补缴流程···················

4、········卡证领取、挂失流程···················第四部分就医指南本地就医·······························转外就医······························异地安置······························外地急诊······························零星报销······························特殊病种······························医保发票说明···························定点医疗机构名单····

5、···················第五部分违规稽查重点审核对象及处理·························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

6、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；（二）属基本医疗保险参保范围的单位和个人都应当参加基本医疗保险，并实行属地管理；（三）基本医疗保险费由用人单位和参保人员共同负担；（四）基本医疗保险的权利和义务相对应。第四条市和各县（市、区）人力资源社会保障行政部门主管基本医疗保险工作。其下属的社会（医疗）保险经办机构

7、具体负责基本医疗保险日常管理工作。卫生、财政、税务、发改（物价）、药品监督等部门应当按照各自职责协同做好本办法的实施工作。第五条基本医疗保险按照政策基本统一、基金分级管理、市级风险调剂的原则推进基本医疗保险市级统筹。市本级和椒江区、黄岩区、路桥区为同一基本医疗保险统筹单位，其他县（市）各为一个统筹单位。第二章　基本医疗保险费征缴和管理第六条各统筹地区应当建立医疗保险基金。医疗保险基金由下列项目构成：（一）用人单位及个人缴纳的基本医疗保险费和重大疾病医疗保险费；（二）医