2025年徐州职工/居民医保待遇
<section data-role="outer" label="edit by 135editor" data-pm-slice="0 0 []"><section data-role="paragraph"><section style="text-align:justify;-webkit-tap-highlight-color: transparent;outline: 0px;letter-spacing: 0.544px;line-height: 2em;visibility: visible;font-family:system-ui, -apple-system, BlinkMacSystemFont, Arial, sans-serif;" nodeleaf=""></section></section><section data-role="paragraph" style="visibility: visible;"><section style="-webkit-tap-highlight-color: transparent;outline: 0px;line-height: 2em;text-align: center;visibility: visible;"><section data-role="paragraph"><section data-role="paragraph"><p style="text-align:center;line-height: 2em;"><span leaf=""><br/></span></p><section><p style="text-align:center;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">徐州市医疗保障局公布了</span><span leaf=""><br/></span></span></p><p style="text-align:center;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2025年徐州市职工医保待遇、</span></span></p><p style="text-align:center;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">城乡居民医保待遇</span><span leaf=""><br/></span></span></p><p style="text-align:center;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">一起来了解一下吧</span></span></p><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124020"><section style="margin: 10px auto;text-align: center;"><section style="display: inline-block;"><section style="display: flex;justify-content: center;align-items: center;flex-direction: column;"><section style="font-size: 16px;letter-spacing: 1.5px;padding: 6px 1.5em;color: #ffffff;background-image: -webkit-linear-gradient(left, #4083ff, #4083ff);box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">2025年徐州市职工医保待遇</span></strong></section><section style="width: 10px;height: 10px;border-left: 4px solid #fff;border-top: 3px solid #fff;align-self: flex-end;margin-top: -10px;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">0</span></strong><strong data-num="2"><span leaf="">1</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">普通门诊 （含异地就医、转诊转院备案）</span></strong></section></section></section></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:center;line-height: 2em;"><span style="font-size: 12px;color: #595959;letter-spacing: 1px;"><span leaf="">图源：徐州医保（下同）</span></span></p><p style="text-align:center;line-height: 2em;"><span style="font-size: 12px;color: #595959;letter-spacing: 1px;"><span leaf=""><br/></span></span></p><section data-pm-slice="0 0 []" style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;color: rgb(51, 51, 51);font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;font-size: 17px;font-style: normal;font-variant-ligatures: normal;font-variant-caps: normal;font-weight: 400;letter-spacing: normal;orphans: 2;text-indent: 0px;text-transform: none;widows: 2;word-spacing: 0px;-webkit-text-stroke-width: 0px;caret-color: rgb(255, 0, 0);white-space: normal;background-color: rgb(255, 255, 255);text-decoration-thickness: initial;text-decoration-style: initial;text-decoration-color: initial;text-align: justify;"><p style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;clear: both;min-height: 1em;cursor: text;line-height: 2em;"><span style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;cursor: text;font-size: 15px;color: rgb(89, 89, 89);letter-spacing: 1px;"><span leaf=""><span textstyle="" style="font-weight: bold;">备注：</span></span></span></p></section><p style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;clear: both;min-height: 1em;cursor: text;color: rgb(51, 51, 51);font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;font-size: 17px;font-style: normal;font-variant-ligatures: normal;font-variant-caps: normal;font-weight: 400;letter-spacing: normal;orphans: 2;text-indent: 0px;text-transform: none;widows: 2;word-spacing: 0px;-webkit-text-stroke-width: 0px;caret-color: rgb(255, 0, 0);white-space: normal;background-color: rgb(255, 255, 255);text-decoration-thickness: initial;text-decoration-style: initial;text-decoration-color: initial;text-align: justify;line-height: 2em;"><span style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;cursor: text;font-size: 15px;color: rgb(89, 89, 89);letter-spacing: 1px;"><span leaf="">1. A级、B级定点药店起付线和报销比例等同一级定点医疗机构；</span></span></p><p style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;clear: both;min-height: 1em;cursor: text;color: rgb(51, 51, 51);font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;font-size: 17px;font-style: normal;font-variant-ligatures: normal;font-variant-caps: normal;font-weight: 400;letter-spacing: normal;orphans: 2;text-indent: 0px;text-transform: none;widows: 2;word-spacing: 0px;-webkit-text-stroke-width: 0px;caret-color: rgb(255, 0, 0);white-space: normal;background-color: rgb(255, 255, 255);text-decoration-thickness: initial;text-decoration-style: initial;text-decoration-color: initial;text-align: justify;line-height: 2em;"><span style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;cursor: text;font-size: 15px;color: rgb(89, 89, 89);letter-spacing: 1px;"><span leaf="">2. C级定点药店仅享受个人账户、家庭共济和起付线；</span></span></p><p style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;clear: both;min-height: 1em;cursor: text;color: rgb(51, 51, 51);font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;font-size: 17px;font-style: normal;font-variant-ligatures: normal;font-variant-caps: normal;font-weight: 400;letter-spacing: normal;orphans: 2;text-indent: 0px;text-transform: none;widows: 2;word-spacing: 0px;-webkit-text-stroke-width: 0px;caret-color: rgb(255, 0, 0);white-space: normal;background-color: rgb(255, 255, 255);text-decoration-thickness: initial;text-decoration-style: initial;text-decoration-color: initial;text-align: justify;line-height: 2em;"><span style="max-inline-size: 100%;margin: 0px;padding: 0px;box-sizing: border-box !important;overflow-wrap: break-word !important;cursor: text;font-size: 15px;color: rgb(89, 89, 89);letter-spacing: 1px;"><span leaf="">3. 异地未备案门诊待遇报销比例降低20%。</span></span></p><section style="margin-bottom: 0px;-webkit-tap-highlight-color: transparent;outline: 0px;font-family: PingFang SC, system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;background-color: rgb(255, 255, 255);text-align: left;line-height: 1.6em;visibility: visible;" data-pm-slice="0 0 []"><span style="-webkit-tap-highlight-color: transparent;outline: 0px;color: rgb(0, 0, 0);visibility: visible;"><strong style="-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;"><span style="-webkit-tap-highlight-color: transparent;outline: 0px;letter-spacing: 0.5px;font-size: 15px;visibility: visible;"><span leaf=""><br/></span></span></strong></span></section><section data-tools="135编辑器" data-id="132397"><section style="margin: 10px auto;"><section style="margin: 0 0 -15px;display: flex;justify-content: flex-start;align-items: flex-end;"><section style="flex-shrink: 0;padding: 0 0 0 10px;z-index: 9;box-sizing:border-box;"><section style="width: 30px;box-sizing: border-box;height: 0px;"><span leaf=""><br/></span></section></section><section style="background-color: #52b0ff;border-radius: 25px 0 0 25px;padding: 3px 3px 3px 40px;margin: 0 0 0 -40px;box-sizing:border-box;"><section style="font-size: 16px;color: #52b0ff;text-align: center;background-color: #ffffff;padding: 3px 15px;box-sizing:border-box;"><p><strong data-brushtype="text"><span leaf="">职工门诊案例</span></strong></p></section></section></section><section style="background-color: #f1f9ff;padding: 25px 10px 10px;box-sizing:border-box;"><section data-autoskip="1" style="text-align: justify;line-height:1.75em;letter-spacing: 1.5px;font-size:14px;color:#333333;background-color: transparent;"><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">刘某，退休职工。</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2025年在一级医院门诊共花费3000元，其中甲类2000元，乙类10%药品950元，丙类50元。那职工医保可以报销多少?</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">一级医院门诊报销：3000元(总费用)-50元(自费费用)- 95元(先行自付950x10%)-350元(退休门诊起付线)=2505元，2505元x85%=2129.25元，即本次职工医保报销2129.25元。</span></span></p></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">02</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">普通住院 （含异地就医备案）</span></strong></section></section></section></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">备注：</span></span></strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf=""><br/></span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">1.多次住院起付线依次递减 100元，设置下限(在职三级300元、二级200元、一级100元，退休按照50%执行);</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2.异地未备案住院起付标准每次为在职1500元，退休750元;</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">3.异地未备案住院、门特待遇报销比例降低20%，且不享受大病保险待遇。</span></span></p><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">03</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">转诊转院住院</span></strong></section></section></section></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">提示：</span></span></strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">同一统筹年度内，政策范围内医疗费用（含门诊、普通住院、转诊转院住院、异地未备案）的最高支付限额为40万元。</span></span></p><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">04</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">大病保险(含门特和住院)</span></strong></section></section></section></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">备注：</span></span></strong><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">低保、特困、重残、退休人员，报销比例提高5%。</span></span></p><p><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="132397"><section style="margin: 10px auto;"><section style="margin: 0 0 -15px;display: flex;justify-content: flex-start;align-items: flex-end;"><section style="flex-shrink: 0;padding: 0 0 0 10px;z-index: 9;box-sizing:border-box;"><section style="width: 30px;box-sizing: border-box;height: 0px;"><span leaf=""><br/></span></section></section><section style="background-color: #52b0ff;border-radius: 25px 0 0 25px;padding: 3px 3px 3px 40px;margin: 0 0 0 -40px;box-sizing:border-box;"><section style="font-size: 16px;color: #52b0ff;text-align: center;background-color: #ffffff;padding: 3px 15px;box-sizing:border-box;"><p><strong data-brushtype="text"><span leaf="">职工住院案例</span></strong></p></section></section></section><section style="background-color: #f1f9ff;padding: 25px 10px 10px;box-sizing:border-box;"><section data-autoskip="1" style="text-align: justify;line-height:1.75em;letter-spacing: 1.5px;font-size:14px;color:#333333;background-color: transparent;"><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">张某，在职职工。</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2025年2月在三级医院第一次住院共15天，花费200000元，其中甲类197800元，乙类25%药品2000元，丙类200元，那职工医保可以报销多少呢？</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">三级医院住院报销：200000元（总费用）-500元（先行自付2000x25%）-200元（个人自费）-1000元（在职三级医院起付线）=198300元，198300元x86%=170538元；</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">职工大病保险报销：200000元（总费用）-200元（自费费用）-170538元（统筹报销）-18000元（大病保险起付线）=11262元，11262元x70%=7883.4元。</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">本次职工医保总报销：170538元+7883.4元=178421.4元。</span></span></p></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124020"><section style="margin: 10px auto;text-align: center;"><section style="display: inline-block;"><section style="display: flex;justify-content: center;align-items: center;flex-direction: column;"><section style="font-size: 16px;letter-spacing: 1.5px;padding: 6px 1.5em;color: #ffffff;background-image: -webkit-linear-gradient(left, #4083ff, #4083ff);box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">2025年徐州市城乡居民医保待遇</span></strong></section><section style="width: 10px;height: 10px;border-left: 4px solid #fff;border-top: 3px solid #fff;align-self: flex-end;margin-top: -10px;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section></section></section><p style="text-align:center;line-height: 2em;visibility: visible;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">01</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">普通门诊 （含异地就医、转诊转院备案）</span></strong></section></section></section></section></section></section></section><p style="text-align:center;line-height: 2em;visibility: visible;"><span leaf=""><br/></span></p><section style="text-align: justify;line-height: 2em;visibility: visible;" nodeleaf=""></section><p style="text-align:center;line-height: 2em;visibility: visible;"><span style="font-size: 12px;color: #595959;letter-spacing: 1px;visibility: visible;"><span leaf="">图源：徐州医保（下同）</span></span></p><p style="text-align:justify;line-height: 2em;visibility: visible;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;visibility: visible;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;visibility: visible;"><strong><span leaf="">备注：</span></strong></span></p><p style="text-align:justify;line-height: 2em;visibility: visible;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;visibility: visible;"><span leaf="">1. 实行药品零差率销售的基层医疗机构不设起付标准；</span></span></p><p style="text-align:justify;line-height: 2em;visibility: visible;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;visibility: visible;"><span leaf="">2. 异地未备案门诊待遇报销比例降低20%。</span></span></p><p style="text-align:justify;line-height: 2em;visibility: visible;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;visibility: visible;"><span leaf="">3. 纳入家庭医生签约服务管理的务人员，一个统筹年度政策范围内医疗费用最高支付限额为1800元。</span></span></p><p><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">02</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">“两病”门诊 （含异地就医、转诊转院备案）</span></strong></section></section></section></section></section></section></section><p><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span textstyle=""><strong><span leaf="">备注：</span></strong></span><span leaf="">异地未备案门诊两病待遇报销比例降低20%。</span></span></p><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="132397"><section style="margin: 10px auto;"><section style="margin: 0 0 -15px;display: flex;justify-content: flex-start;align-items: flex-end;"><section style="flex-shrink: 0;padding: 0 0 0 10px;z-index: 9;box-sizing:border-box;"><section style="width: 30px;box-sizing: border-box;height: 0px;"><span leaf=""><br/></span></section></section><section style="background-color: #52b0ff;border-radius: 25px 0 0 25px;padding: 3px 3px 3px 40px;margin: 0 0 0 -40px;box-sizing:border-box;"><section style="font-size: 16px;color: #52b0ff;text-align: center;background-color: #ffffff;padding: 3px 15px;box-sizing:border-box;"><p><strong data-brushtype="text"><span leaf="">居民“两病”案例</span></strong></p></section></section></section><section style="background-color: #f1f9ff;padding: 25px 10px 10px;box-sizing:border-box;"><section data-autoskip="1" style="text-align: justify;line-height:1.75em;letter-spacing: 1.5px;font-size:14px;color:#333333;background-color: transparent;"><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">李某，城乡居民参保人员</span></span></p><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">李某同时患有高血压和糖尿病，已按规定申请“两病”待遇，2025年在一级医院发生门诊费用共3000元，其中甲类2700元，丙类100元，乙类10%药品200元（符合规定的降血压、降血糖药品用药范围），那今年门诊统筹共报销多少元？</span></span></p><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">3000元（总费用）-20元（先行自付200x10%）-100元（丙类个人自费）=2880元；2880>2400（已超出年度上限），本次居民医保报销：2400元x50%=1200元。</span></span></p></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">03</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">普通住院（含异地就医备案）</span></strong></section></section></section></section></section></section></section><p><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><strong><span leaf="">备注：</span></strong></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">1. 多次住院起付线依次递减 100元，设置下限（三级1100元、二级300元、一级100元）； </span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2. 异地未备案门特待遇报销比例降低20%且不享受大病保险待遇； </span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">3. 低保、特困、重残起付线降低50%。</span></span></p><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="132397"><section style="margin: 10px auto;"><section style="margin: 0 0 -15px;display: flex;justify-content: flex-start;align-items: flex-end;"><section style="flex-shrink: 0;padding: 0 0 0 10px;z-index: 9;box-sizing:border-box;"><section style="width: 30px;box-sizing: border-box;height: 0px;"><span leaf=""><br/></span></section></section><section style="background-color: #52b0ff;border-radius: 25px 0 0 25px;padding: 3px 3px 3px 40px;margin: 0 0 0 -40px;box-sizing:border-box;"><section style="font-size: 16px;color: #52b0ff;text-align: center;background-color: #ffffff;padding: 3px 15px;box-sizing:border-box;"><p><strong data-brushtype="text"><span leaf="">居民住院案例</span></strong></p></section></section></section><section style="background-color: #f1f9ff;padding: 25px 10px 10px;box-sizing:border-box;"><section data-autoskip="1" style="text-align: justify;line-height:1.75em;letter-spacing: 1.5px;font-size:14px;color:#333333;background-color: transparent;"><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">王某，城乡居民参保人员</span></span></p><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">居民医保王某，2025年3月在二级医院第一次住院共8天，花费30000元，其中甲类28700元，乙类10%药品1000元，丙类300元。那居民医保可以报销多少呢？</span></span></p><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">30000元（总费用）-100元（先行自付）-300元（个人自费）-700元（居民二级医院起付线）＝28900*80%＝23120元</span></span></p><p><span style="font-size: 15px;color: #595959;letter-spacing: 1px;line-height: 2.27em;"><span leaf="">本次居民医保报销：23120元。</span></span></p></section></section></section></section><section style="line-height: 2em;text-align:justify;"><p leaf=""><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">04</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">转诊转院住院</span></strong></section></section></section></section></section></section></section><p leaf=""><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span textstyle=""><strong><span leaf="">备注：</span></strong></span><span leaf="">低保、特困、重残起付线降低50%。</span></span></p><p><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">05</span></strong><strong data-num="10"><span leaf="">0</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">异地未备案住院</span></strong></section></section></section></section></section></section></section><p><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><strong><span leaf="">备注：</span></strong></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">1. 异地未备案住院不享受大病保险待遇；</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">2. 低保、特困、重残起付线降低50%。</span></span></p><p><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="124016"><section style="margin: 10px auto;"><section style="display: flex;justify-content: center;"><section><section style="display: flex;justify-content: flex-start;"><section style="background-color: #ffca42;padding: 2px;border-radius: 100%;box-sizing: border-box;"><section style="background-color: #ffffff;border-radius: 100%;width: 10px;height: 10px;overflow: hidden;box-sizing:border-box;"><span leaf=""><br/></span></section></section></section><section style="padding: 0px 0px 0px 7px;margin-top: -6px;box-sizing: border-box;"><section style="display: flex;align-items: flex-start;"><section style="font-size: 16px;letter-spacing: 1.5px;color: #ffffff;background: linear-gradient(to right,#4083ff,#4083ff);width: 30px;height: 30px;text-align: center;line-height: 30px;box-sizing:border-box;"><strong><span leaf="">06</span></strong><strong data-num="12"><span leaf="">2</span></strong></section><section style="font-size: 16px;color: #0d4cbf;text-align: center;padding: 0px 20px;background-color: #f4f8ff;height: 30px;line-height: 30px;box-sizing: border-box;"><strong data-brushtype="text"><span leaf="">大病保险（门特和住院）</span></strong></section></section></section></section></section></section></section><p><span leaf=""><br/></span></p><section style="text-align:justify;line-height: 2em;" nodeleaf=""></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><section data-tools="135编辑器" data-id="132397"><section style="margin: 10px auto;"><section style="margin: 0 0 -15px;display: flex;justify-content: flex-start;align-items: flex-end;"><section style="flex-shrink: 0;padding: 0 0 0 10px;z-index: 9;box-sizing:border-box;"><section style="width: 30px;box-sizing: border-box;height: 0px;"><span leaf=""><br/></span></section></section><section style="background-color: #52b0ff;border-radius: 25px 0 0 25px;padding: 3px 3px 3px 40px;margin: 0 0 0 -40px;box-sizing:border-box;"><section style="font-size: 16px;color: #52b0ff;text-align: center;background-color: #ffffff;padding: 3px 15px;box-sizing:border-box;"><p><strong data-brushtype="text"><span leaf="">居民转诊转院及大病保险案例</span></strong></p></section></section></section><section style="background-color: #f1f9ff;padding: 25px 10px 10px;box-sizing:border-box;"><section data-autoskip="1" style="text-align: justify;line-height:1.75em;letter-spacing: 1.5px;font-size:14px;color:#333333;background-color: transparent;"><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">赵某，城乡居民参保人员</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">赵某，已办理转诊转院备案，2025年2月在备案地三级医院第一次住院共20天，花费250000元，其中甲类费用235000，乙类10%诊疗10000元，丙类5000元，那居民医保可以报销多少钱？</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">转诊转院三级医院报销：250000元（总费用）-1000元（先行自付10000x10%）-5000元（丙类个人自费）-1800元（起付线）=242200元，242200元x60%=145320元；</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">大病保险报销：250000元（总费用）-5000元（丙类个人自费）-145320元（统筹报销）-18000元（居民大病保险起付线）=81680元，81680元x60%=49008元。</span></span></p><p style="text-align:justify;line-height: 2em;"><span style="font-size: 15px;color: #595959;letter-spacing: 1px;"><span leaf="">本次居民医保总报销：145320元+49008元=194328元。</span></span></p></section></section></section></section><p style="text-align:justify;line-height: 2em;"><span leaf=""><br/></span></p><p style="text-align:left;line-height: 2em;"><br/></p></section></section><section style="line-height: 2em;text-align:justify;"><section style="font-size: 12px;padding: 6px;line-height: 1.5em;text-align: justify;box-sizing:border-box;"><section style="visibility: visible;"><section style="line-height: 2em;text-align:justify;"><section style="line-height: 2em;text-align:justify;"><section style="line-height: 2em;text-align:center;"><section style="line-height: 2em;text-align:center;"><section data-role="paragraph" style="visibility: visible;"><section data-role="paragraph"><p style="text-align:center;letter-spacing: 0.578px;line-height: 2em;font-family:mp-quote, system-ui, -apple-system, BlinkMacSystemFont, Arial, sans-serif;"><span style="color: #595959;letter-spacing: 1px;text-decoration: underline;"><span leaf=""><span style="color: rgb(153, 153, 153); font-size: 0.8em; letter-spacing: 0.578px; text-align: left; caret-color: rgba(0, 0, 0, 0); font-family: sans-serif;">转载声明：本文转载自徐州本地宝</span></span></span></p></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><br/></p><link rel="stylesheet" href="//bbs.221700.com/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_EX5" id="wcn_editor_css"/>
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