산업재해보상보험 산재 요양급여 산정기준(2021년 1월)

산재보험도 건강보험이나 자동차보험처럼

요양급여 산정 기준이 있습니다.

 

고용노동부 근로복지공단에서 해당 기준을 정했습니다.

국민 건강보험과 같은부분도 있고 조금은 다른 부분도 있습니다.

 

특히 건강보험과 다른 기준이나 산재에서 추가로 인정하는 부분은

알아두면 치료받는 환자에게는 진료비 걱정을 덜할 수 있고

병원관계자나 심사하는 분들이면 환자에게 조금더 적용하는데 적극적으로 해줄 수 있을것같습니다.

 

진료비와 직결하는 부분이니까요...

해당 자료를 참고해보시면 도움이 될 거라 생각됩니다.

 

 

산 업 재 해 보 상 보 험 요 양 급 여 산 정 기 준 ······························· 3
[별표 1] 국민건강보험과 달리 적용하는
요양급여의 범위 및 비용산정기준 ········································ 1 1
[별표 2] 산재보험에서 추가로 인정하는
요양급여의 범위 및 비용산정기준 ········································ 1 5
제 1 절 치 과 보 철 ····················································································· 1 5
제 2 절 재 활 보 조 기 구 ·············································································· 1 8
제 3 절 보 험 급 여 청 구 서 확 인 및 진 단 서 발 급 수 수 료 ···························· 3 0
제 4 절 화 상 환 자 에 게 인 정 하 는 약 제 및 치 료 재 료 등 ·························· 3 3
제 5 절 재 활 보 조 기 구 처 방 및 검 수 료 ··················································· 3 4
제 6 절 이 송 료 ························································································ 3 5
제 7 절 치 료 보 조 기 구 ·············································································· 3 7
제 8 절 한 방 첩 약 및 탕 전 료 ································································· 3 9
제 9 절 전 신 해 부 에 따 른 비 용 ······························································· 4 0
제 1 0 절 재 활 치 료 료 ················································································· 4 1
제 1 1 절 냉 각 부 하 검 사 료 ·········································································· 4 8
제 1 2 절 처 치 료 ························································································ 4 9
제 1 3 절 예 방 접 종 비 용 ············································································· 5 0
별 지 서 식 ( 제 1 호 ~ 제 9 호 ) ········································································· 5 1

2 부 록······················································································· 6 1
산업재해보상보험 관련
▸산업재해보상보험 요양급여 산정기준(고시 제2019-80호) ················ 6 5
▸산업재해보상보험 진료비･약 제 비 청 구 서 등 서 식 작 성 요 령 ··············· 1 1 5
▸산 재 보 험 요 양 급 여 산 정 기 준 관 련 진 료 항 목 별 청 구 코 드 ·················· 1 6 0
국민건강보험 관련
▸국민건강보험 요양급여의 기준에 관한 규칙(제5조, 제8조, 제9조) ········· 1 8 3
▸국 민 건 강 보 험 법 시 행 규 칙 ( 제 2 3 조 , 제 2 6 조 ) ······································· 198
▸요 양 비 의 보 험 급 여 기 준 및 방 법 ······················································· 2 0 4
▸장 애 인 전 동 보 장 구 급 여 품 목 및 결 정 가 격 고 시 ································ 2 5 6
▸장 애 인 자 세 보 조 용 구 급 여 품 목 및 결 정 가 격 고 시 ···························· 2 5 9
▸장 애 인 보 조 기 기 보 험 급 여 기 준 등 세 부 사 항 ··································· 2 6 2
기타
▸응 급 의 료 에 관 한 법 률 시 행 규 칙 ( 제 2 조 , 제 1 1 조 ) ······························ 2 9 3
▸응 급 의 료 수 가 기 준 ················································································ 2 9 7
▸의 료 관 계 행 정 처 분 규 칙 ····································································· 3 0 1
참고자료
▸간 병 대 상 ······························································································ 3 2 1
▸보 상 관 련 고 시 내 용 ·············································································· 3 2 4
▸근 로 복 지 공 단 소 속 기 관 주 소 ······························································ 3 3 0

 

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