3
05
TE5645876457341574
北京市海淀区医疗保障局
因病致贫家庭医疗救助
TE5645876457341574311054100300201
TE56458764573415743110541003002
0
d6a6944f-fc6e-4380-a78d-d1a04d600ff3
7d4d7252-28f7-4e48-a2d9-f6ff38b70798
3^5
05
海淀区医保局
110108000000
北京市海淀区医疗保障局
海淀区政务服务中心医保分中心:工作日：8:30-17:30
海淀区政务服务中心医保分中心:北京市海淀区西四环北路73号中关村人才发展中心南区306综合窗口
申请家庭应当填写《申请因病致贫家庭医疗救助经济状况和医疗费用支出情况登记表、声明书、授权书》，如实申报家庭经济状况，授权医保部门对其家庭收入、家庭财产和医疗费用支出情况进行核查。同时提交上一自然年度家庭成员的以下相关材料：
1.户口簿及身份证复印件；
2.《申请因病致贫家庭医疗救助经济状况和医疗费用支出情况登记表、声明书、授权书》；
3.年度收入情况说明及相关财产说明；
4.参加商业保险的，需要提供商业保险主管部门出具的费用结算分割单；
5.对于参加外埠基本医疗保险及参加本市基本医疗保险因特殊原因未能实时结算的本市户籍人员，仍需提交相关医疗费用票据；
6.医保部门认为需要提供的其他证明材料。
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