{"id":3095,"date":"2013-12-04T23:42:12","date_gmt":"2013-12-04T21:42:12","guid":{"rendered":"http:\/\/www.ced.org.tr\/?p=3095"},"modified":"2013-12-04T23:42:12","modified_gmt":"2013-12-04T21:42:12","slug":"tamamlayici-saglik-sigortasi-tss","status":"publish","type":"post","link":"http:\/\/www.ced.org.tr\/?p=3095","title":{"rendered":"Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131 (TSS)"},"content":{"rendered":"

Tamamlay\u0131c\u0131 Sigorta’ya en fazla ihtiya\u00e7 duyan\u00a0\u00a0Kronik hastal\u0131k sahipleri ve 60 ya\u015f \u00fcst\u00fc yurtta\u015flar, tamamlay\u0131c\u0131 sigorta uygulamas\u0131n\u0131n kapsam\u0131 d\u0131\u015f\u0131nda tutuluyorlar.<\/span><\/h1>\n

Neredeyse hi\u00e7 bir hastal\u0131\u011f\u0131 sigorta teminat paketi i\u00e7erisinde kabul etmiyor.
Ayakta tedavi s\u0131ras\u0131ndaki ila\u00e7, tetkik ve malzeme masraflar\u0131 poli\u00e7e d\u0131\u015f\u0131nda b\u0131rak\u0131l\u0131yor.<\/span><\/h1>\n

Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131, Her Derde Veba!<\/span><\/strong> <\/span><\/p>\n

Burcu Cansu\/Ankara<\/span><\/em> <\/span><\/em><\/span>4 Aral\u0131k 2013 \u00c7ar\u015famba <\/span><\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

Ya\u015fl\u0131lar\u0131n, hamilelerin, kronik hastal\u0131k sahiplerinin, salg\u0131n hastal\u0131klara yakalananlar\u0131n ve acil tedaviye ihtiyac\u0131 olanlar\u0131n kapsam d\u0131\u015f\u0131nda kald\u0131\u011f\u0131 Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131, sa\u011fl\u0131k hizmetinin \u00f6n \u015fart\u0131 haline geliyor.<\/span><\/p>\n

http:\/\/www.muhalefet.org\/haber-tamamlayici-saglik-sigortasi-her-derde-veba-12-8787.aspx<\/span><\/a><\/span><\/p>\n

\u201cSa\u011fl\u0131k hizmeti almayan kalmayacak\u201d \u015fiar\u0131 ile ba\u015flayan Genel Sa\u011fl\u0131k Sigortas\u0131\u2019n\u0131n (GSS) kapsamad\u0131\u011f\u0131 hizmetleri kar\u015f\u0131lanmas\u0131 planlanan Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131 (TSS) ile ilgili Tebli\u011f ge\u00e7ti\u011fimiz Eyl\u00fcl ay\u0131nda y\u00fcr\u00fcrl\u00fc\u011fe girdi. Tebli\u011f ile birlikte, yurtta\u015flar\u0131n t\u0131pk\u0131 kasko yapt\u0131r\u0131r gibi, sa\u011fl\u0131k hizmetlerinden yararlanabilmeleri i\u00e7i TSS yapt\u0131r\u0131p, primlerini d\u00fczenli \u00f6demeleri gerekecek. <\/span><\/p>\n

Sigorta \u015eirketi Tek!<\/span><\/strong>
TSS’den istifade edebilmek i\u00e7in sigorta \u015firketlerinin Sosyal G\u00fcvenlik Kurulu (SGK) ile s\u00f6zle\u015fme imzalam\u0131\u015f olmas\u0131 gerekiyor. Mevcut sistemde sadece Medical Park ile anla\u015fmas\u0131 olan Mapfre Genel Sigorta bu hizmeti veriyor. SGK’n\u0131n resmi internet sitesinde de reklam\u0131 yer alan Mapfre Genel Sigorta’n\u0131n \u201cFark Yok Sigortas\u0131\u201d, neredeyse hi\u00e7 bir hastal\u0131\u011f\u0131 sigorta teminat paketi i\u00e7erisinde kabul etmiyor.<\/p>\n

60 Ya\u015f \u00dcst\u00fcne Poli\u00e7e Yok<\/span><\/strong>
Fark Yok Sigortas\u0131’n\u0131n i\u00e7eri\u011fi en \u00e7ok yoksul kesimleri ve kronik hastal\u0131k sahiplerini olumsuz etkileyecek. Tamamlay\u0131c\u0131 Sigorta’ya en fazla ihtiya\u00e7 duyan kronik hastal\u0131k sahipleri ve 60 ya\u015f \u00fcst\u00fc yurtta\u015flar, tamamlay\u0131c\u0131 sigorta uygulamas\u0131n\u0131n kapsam\u0131 d\u0131\u015f\u0131nda tutuluyorlar. Sigorta \u015firketi yetkilileri, gebelerin, kronik hastalar\u0131n, salg\u0131n hastal\u0131klara yakalanan yurtta\u015flar\u0131n poli\u00e7e d\u0131\u015f\u0131 oldu\u011funu a\u00e7\u0131k\u00e7a belirtiyor. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 veya D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc taraf\u0131ndan ilan edilen salg\u0131n hastal\u0131klar poli\u00e7e kapsam\u0131ndan \u00e7\u0131kart\u0131l\u0131rken, ayakta tedavi s\u0131ras\u0131ndaki ila\u00e7, tetkik ve malzeme masraflar\u0131, gebelikle ilgili yap\u0131lacak t\u00fcm masraflar ve do\u011fum giderleri, anla\u015fmal\u0131 kurumlar d\u0131\u015f\u0131nda yap\u0131lacak t\u00fcm tedavi, ambulans, yol, refakat\u00e7i ve \u00f6zel harcama giderleri poli\u00e7e d\u0131\u015f\u0131nda b\u0131rak\u0131l\u0131yor.<\/p>\n

Primler Cep Yak\u0131yor<\/span><\/strong>
Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131 kapsam\u0131nda \u201cyatarak ayaktan tedavi\u201d olarak tan\u0131mlanan hizmet s\u00f6z konusu oldu\u011funda, 18-35 ya\u015f aras\u0131 hastalar 625 TL, 35-50 ya\u015f aras\u0131 hastalar 780 TL, 51-60 ya\u015f aras\u0131ndaki hastalar ise 925 TL \u00f6demek zorunda kalacak. \u00c7al\u0131\u015fan anne baba i\u00e7in ise durum daha da zor. 0-6 ya\u015f aras\u0131 \u00e7ocuklar\u0131 i\u00e7in 950 TL, 7-17 ya\u015f i\u00e7in 740 TL, bakmakla y\u00fck\u00fcml\u00fc olduklar\u0131 51-60 ki\u015filer i\u00e7inse 1,156 TL \u00f6deme yapacaklar.<\/p>\n

Neyde Fark Yok?<\/span><\/strong>
\u015eirketin kapsam d\u0131\u015f\u0131 b\u0131rakt\u0131\u011f\u0131 durumlar:
\u201c*Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan resmen ilan edilmi\u015f salg\u0131n hastal\u0131klar veya D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc taraf\u0131ndan d\u00fcnyan\u0131n herhangi bir yerinde ilan edilen salg\u0131n hastal\u0131klara ait her t\u00fcrl\u00fc sa\u011fl\u0131k giderleri poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.
*Poli\u00e7e \u00fczerinde yaz\u0131l\u0131 kullan\u0131m (6) limitini a\u015fan ayakta tedavi giderleri poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.
*Ayakta tedavi teminat\u0131ndaki her t\u00fcrl\u00fc ila\u00e7, tetkikler i\u00e7in kullan\u0131lan malzeme ve kontrast maddeler, malzeme masraflar\u0131 ve a\u015f\u0131 giderleri poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.
*Acil durumlar da d\u00e2hil olmak \u00fczere Poli\u00e7e \u00fczerinde yaz\u0131l\u0131 Anla\u015fmal\u0131 Kurum ve \/ veya Kurumlar d\u0131\u015f\u0131nda yap\u0131lacak tedavilere ili\u015fkin sa\u011fl\u0131k giderleri poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.
*Gebelikle ilgili yap\u0131lacak t\u00fcm masraflar ve do\u011fum giderleri poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.
*Anla\u015fmas\u0131z \u015eehir i\u00e7i ve d\u0131\u015f\u0131 her t\u00fcrl\u00fc ambulans \u00fccretleri, yol, g\u00fcndelik, 2. refakat\u00e7i giderleri, suit oda farklar\u0131 ve \u00f6zel harcamalar poli\u00e7e teminat kapsam\u0131 d\u0131\u015f\u0131ndad\u0131r.\u201d
Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131
\u201cSGK \u201cTamamlay\u0131c\u0131 veya Destekleyici Sa\u011fl\u0131k Sigortas\u0131 Uygulamalar\u0131\u201dna dair Genelgeyi 28 Haziran 2012 tarihinde yay\u0131nland\u0131. Genelgede, \u201c\u00d6zel sa\u011fl\u0131k sigortas\u0131n\u0131n bir t\u00fcr\u00fc olan ‘Tamamlay\u0131c\u0131 veya Destekleyici Sa\u011fl\u0131k Sigortas\u0131’ genel sa\u011fl\u0131k sigortas\u0131n\u0131n temel teminat paketi i\u00e7erisinde yer almayan, k\u0131smen kar\u015f\u0131lanan, yani cepten \u00f6deme yap\u0131lan ya da bireylerin daha y\u00fcksek standartlarda sa\u011fl\u0131k hizmeti talep etti\u011fi durumlarda devreye giren \u00f6zel sa\u011fl\u0131k sigortas\u0131 t\u00fcr\u00fcd\u00fcr\u201d tan\u0131mlamas\u0131 yap\u0131ld\u0131.<\/p>\n

Tamamlay\u0131c\u0131 Sigorta Te\u015fvik Tebli\u011fi<\/span><\/strong>
Genel Sa\u011fl\u0131k Sigortas\u0131 uygulamas\u0131 ile herkesin sigortal\u0131 olarak sa\u011fl\u0131k hizmeti alabilece\u011fi s\u00f6ylense de, 23 Ekim\u2019de Tamamlay\u0131c\u0131 Sa\u011fl\u0131k Sigortas\u0131na te\u015fvik i\u00e7in tebli\u011f yay\u0131nland\u0131. \u00d6nce 12 Ekim’de \u00f6zel hastane primlerine gelen y\u00fczde 200’l\u00fck zam a\u00e7\u0131kland\u0131. Hemen ard\u0131ndan da, \u00f6zel sa\u011fl\u0131k sigortas\u0131 yapan \u015firketlerden tamamlay\u0131c\u0131 sa\u011fl\u0131k sigortas\u0131 yapt\u0131ran yurtta\u015f\u0131n \u00f6zel hastanelerde uygulamaya ge\u00e7en y\u00fczde 200’l\u00fck zamdan etkilenmeyecekleri karar\u0131 Resmi Gazete’de yay\u0131nland\u0131.<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

TAMAMLAYICI SA\u011eLIK S\u0130GORTASI PR\u0130M TABLOSU<\/span><\/strong> <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

<\/span><\/p>\n<\/td>\n

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<\/span><\/p>\n<\/td>\n

\n

<\/span><\/p>\n<\/td>\n

\n

<\/span><\/p>\n<\/td>\n

\n

<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

YA\u015e ARALI\u011eI<\/span><\/strong> <\/span><\/p>\n<\/td>\n

\n

\u00c7ALI\u015eAN<\/span><\/strong> <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

\u0130STANBUL<\/span><\/strong> <\/span><\/p>\n<\/td>\n

\n

\u0130STANBUL DI\u015eI<\/span><\/strong> <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

YATARAK TEDAV\u0130<\/span><\/strong> <\/span><\/p>\n<\/td>\n

\n

YATARAK AYAKTA TEDAV\u0130<\/span><\/strong> <\/span><\/p>\n<\/td>\n

\n

YATARAK TEDAV\u0130<\/span><\/strong> <\/span><\/p>\n<\/td>\n

\n

YATARAK AYAKTA TEDAV\u0130<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

18-35 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

250,00<\/span><\/p>\n<\/td>\n

\n

625,00<\/span><\/p>\n<\/td>\n

\n

168,00<\/span><\/p>\n<\/td>\n

\n

420,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

36-50 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

312,00<\/span><\/p>\n<\/td>\n

\n

780,00<\/span><\/p>\n<\/td>\n

\n

210,00<\/span><\/p>\n<\/td>\n

\n

525,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

51-60 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

370,00<\/span><\/p>\n<\/td>\n

\n

925,00<\/span><\/p>\n<\/td>\n

\n

248,00<\/span><\/p>\n<\/td>\n

\n

620,00<\/span><\/p>\n<\/td>\n<\/tr>\n

<\/p>\n

<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n


\n<\/tbody>\n<\/table>\n

<\/span><\/em><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

YA\u015e ARALI\u011eI<\/span><\/strong><\/p>\n<\/td>\n

\n

\u00c7ALI\u015eANIN BAKMAKLA Y\u00dcK\u00dcML\u00dc OLDU\u011eU K\u0130\u015e\u0130LER<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

\u0130STANBUL<\/span><\/strong><\/p>\n<\/td>\n

\n

\u0130STANBUL DI\u015eI<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

YATARAK TEDAV\u0130<\/span><\/strong><\/p>\n<\/td>\n

\n

YATARAK AYAKTA TEDAV\u0130<\/span><\/strong><\/p>\n<\/td>\n

\n

YATARAK TEDAV\u0130<\/span><\/strong><\/p>\n<\/td>\n

\n

YATARAK AYAKTA TEDAV\u0130<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

0-6 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

380,00<\/span><\/p>\n<\/td>\n

\n

950,00<\/span><\/p>\n<\/td>\n

\n

220,00<\/span><\/p>\n<\/td>\n

\n

550,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

7-17 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

296,00<\/span><\/p>\n<\/td>\n

\n

740,00<\/span><\/p>\n<\/td>\n

\n

198,00<\/span><\/p>\n<\/td>\n

\n

495,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

18-35 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

312,00<\/span><\/p>\n<\/td>\n

\n

781,00<\/span><\/p>\n<\/td>\n

\n

210,00<\/span><\/p>\n<\/td>\n

\n

525,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

36-50 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

390,00<\/span><\/p>\n<\/td>\n

\n

975,00<\/span><\/p>\n<\/td>\n

\n

262,00<\/span><\/p>\n<\/td>\n

\n

656,00<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

51-60 YA\u015e<\/span><\/strong><\/p>\n<\/td>\n

\n

462,00<\/span><\/p>\n<\/td>\n

\n

1.156,00<\/span><\/p>\n<\/td>\n

\n

310,00<\/span><\/p>\n<\/td>\n

\n

775,00<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Haber: Burcu Cansu\/Ankara<\/span><\/em><\/p>\n

<\/span><\/p>\n

<\/p>\n

<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Tamamlay\u0131c\u0131 Sigorta’ya en fazla ihtiya\u00e7 duyan\u00a0\u00a0Kronik hastal\u0131k sahipleri ve 60 ya\u015f \u00fcst\u00fc yurtta\u015flar, tamamlay\u0131c\u0131 sigorta uygulamas\u0131n\u0131n kapsam\u0131 d\u0131\u015f\u0131nda tutuluyorlar. Neredeyse...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[62],"tags":[],"class_list":["post-3095","post","type-post","status-publish","format-standard","hentry","category-sagliktan-haberler"],"aioseo_notices":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/3095","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3095"}],"version-history":[{"count":0,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/3095\/revisions"}],"wp:attachment":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3095"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3095"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3095"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}