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云南省人社厅:医保基金可先垫付“救命钱”--亲稳网络舆情监测室
2013-01-10
如果你在正常工作或者生活中,受到第三人的伤害而住院,需要大笔医疗费用,而此时无法确认伤害你的第三人,该如何办?能到哪里获得“救命钱”?
If you are in work or life,Third party damage while in hospital,Need large medical expenses,While unable to confirm the third person to hurt you,How to do?Where can get"JiuMingQian"?
针对这个假设的问题,省人力资源和社会保障厅发出通知,如果因第三人侵权行为造成伤病,又无法确定第三人的,可以直接申请基本医疗保险基金先行支付。
Aimed at the problem of the hypothesis,Notice to the provincial human resources and social security hall,If caused by third party infringement injury,And can not be sure the third person,Can directly apply for fund of insurance of primary medical treatment to advance payment.
支付对象 Pay the object
按时足额缴费的参保人 On time full specified amount payment of ginseng
这份通知中明确:医疗保险基金先行支付的对象,必须是参加基本医疗保险,并按时足额缴费的职工或者居民(以下简称参保人)。
The notice in the clear:Medical insurance fund payment in advance,Must attend insurance of primary medical treatment,And the worker of on time full specified amount payment or residents(Hereinafter referred to as "ginseng).
在参保人由于第三人的侵权行为造成伤病时,其医疗费用应当由第三人按照确定的责任大小依法承担。对第三人不支付或无法确定第三人的,属于第三人责任的医疗费用,可申请由基本医疗保险基金先行垫付。超过第三人责任部分的医疗费用,由基本医疗保险基金按照国家规定支付。
In ginseng protect people caused by the third person's tort injury,The medical expenses shall be determined by a third person in accordance with shall bear the responsibility of the size.To pay or to a third person can not be sure the third person,Belongs to the third party liability of medical expenses,Can be applied for by fund of insurance of primary medical treatment occuring.More than a third person responsibility part of the medical expenses,Pay by fund of insurance of primary medical treatment according to state regulations.
在提出医保基金先行支付的申请时,需由参保人员或家属通过法律途径或者其它途径,证明第三人拒不支付或确无能力支付医疗费用后,才可申请基本医疗保险基金先行支付。对于无法确定第三人的,可直接申请基本医疗保险基金先行支付。
When the medical insurance fund to pay in advance for your request,Need by ginseng protect personnel or family member through legal channels or other ways,Certify that third person refuses to pay or no ability to pay medical treatment fee,To apply for fund of insurance of primary medical treatment to pay first.It can not be sure the third person,Can directly apply for fund of insurance of primary medical treatment to advance payment.
申请时间 For the time
必须在医疗费用结算时提出 Must, at the time of medical treatment cost settlement
省人社厅提醒:先行支付的申请时间必须在医疗费用结算时提出。提交申请时,需一并提交所有医疗费用的预结算单等资料;属于刑事伤害的,应提供公安部门证明;属于交通事件的,应提供交通管理部门证明;属于其他第三方责任造成的,应提供主管部门的证明或人民法院的裁定判决书。
The man remind club hall:Advance payment of the application at the end of time must be in the medical treatment cost.Submit the application at,Need to submit all information such as the pre - statement of the medical expenses;Belong to criminal damage,Should provide proof of public security departments;Belong to the traffic incident,Traffic management department should be provided;Belong to other third party liability,Should provide the certificate of the competent department or the people's court ruled that judgment.
对于经审核不符合先行支付条件的,有关部门将在接到申请后5个工作日内,作出不予先行支付的决定,并书面告知申请人。对于符合先行支付条件的,则凭相关票据等证据,由申请人在获得的先行支付医疗保险基金凭据上签字确认。
For the audit is not in conformity with the first payment,Relevant departments will be 5 working days after receipt of the application,Will not pay in advance for your decision,And inform the applicant in writing.To comply with the first payment,Is evidence by relevant paper, etc,Obtained by the applicant in the advance payment of medical insurance fund proof signed confirmation.
医保基金先行支付的最高数额为参保人由于第三人的侵权行为造成伤病的,其医疗费用应当由第三人按照确定的责任依法承担的部分。
Medical insurance fund paid the highest amount of the advance to join people caused by the third person's tort injury,The medical expenses shall be determined by a third person in accordance with shall bear the responsibility of the part.
医保基金先行支付后,实行追偿制度。对第三人逾期不偿还的,经办机构将依法向人民法院提起诉讼。(杨雁)
The medical insurance fund after advance payment,A system of recovery.In the third person fails to pay,Orgnaization of agency of a lawsuit to the people's court according to law.(YangYan)
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