Can ectopic pregnancy be reimbursed by medical insurance?

Ectopic pregnancy belongs to the scope of medical insurance reimbursement, and can be reimbursed through medical insurance after treatment in regular public hospitals. Generally, it can be reimbursed when going through the discharge formalities. If maternity insurance is insured, medical expenses can also be reimbursed through maternity insurance.

Ectopic pregnancy is generally not covered by commercial insurance reimbursement (even hospitalization or hospitalization allowance insurance cannot be reimbursed). If you want to reimburse the risk of ectopic pregnancy, you generally need to apply for special insurance or special additional insurance when you apply for insurance.

One of the underwriting conditions of commercial insurance is that the risk should meet the requirements of unforeseen risks in insurance, but pregnancy is generally a planned behavior, and ectopic pregnancy does not meet the real disease to a certain extent, and it is a replacement pregnancy. From the insurance principle, claims cannot be settled unless there is a special agreement in the insurance contract.

The reimbursement process of medical insurance is as follows:

1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;

2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day;

3. After the social security agency reviews the materials and approves the application, the applicant receives the reimbursement form of social medical insurance medical expenses and submits it for reimbursement.

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations. 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.

To sum up, the operation of ectopic pregnancy belongs to the scope of medical insurance and can be reimbursed by medical insurance. As long as the relevant documents are provided before admission, they can be settled when they leave the hospital. The operation of ectopic pregnancy, mostly tubal pregnancy, is not a simple operation, because ectopic pregnancy is likely to cause massive bleeding due to tubal rupture, so it needs to be operated in a regular hospital. Now many diseases can be covered by medical insurance.

Legal basis:

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

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.