Is there any medical insurance reimbursement for the operation expenses?

Whether the operation expenses can be reimbursed by medical insurance depends on the type of operation, medical insurance policy and personal medical insurance.

First, the type of surgery and medical insurance reimbursement

The scope of medical insurance reimbursement for surgical expenses depends first on the type of surgery. Some common and necessary operations, such as emergency treatment due to illness or accidental injury, are often included in the scope of medical insurance reimbursement. But for some unnecessary cosmetic surgery, medical insurance is usually not reimbursed.

Second, the medical insurance policy and reimbursement ratio

The specific proportion of medical insurance reimbursement for surgical expenses will be affected by the medical insurance policy. The medical insurance policies in different regions may be different, so the reimbursement ratio will be different. In addition, the medical insurance policy will be adjusted according to the level of the hospital and the complexity of the operation.

Three, personal medical insurance and reimbursement restrictions

Personal medical insurance will also affect the reimbursement of surgical expenses. For example, the payment of individual medical insurance and the types of medical insurance (such as employee medical insurance and resident medical insurance). ) and the balance of medical insurance account will affect the amount and proportion of reimbursement. In addition, some specific surgical items or drugs may not be in the medical insurance catalogue and cannot be reimbursed.

To sum up:

Whether the operation expenses can be reimbursed by medical insurance depends on the type of operation, medical insurance policy and personal medical insurance. For the operation expenses that meet the requirements of medical insurance policy, part or all of the expenses can be reimbursed through medical insurance. However, medical insurance may not reimburse unnecessary surgery or surgical items that are not in the medical insurance catalogue. Therefore, when deciding to have surgery, it is recommended to know the local medical insurance policy and personal medical insurance in advance so as to make a reasonable decision.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28 provides that:

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

People's Republic of China (PRC) social insurance law

Article 30 provides that:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.