Can wisdom tooth medical insurance be reimbursed?

Wisdom teeth medical insurance can be reimbursed.

The removal of wisdom teeth belongs to the scope of tooth extraction and is one of the oral treatment projects, so it is in line with the medical insurance reimbursement policy. However, according to the medical insurance regulations, the reimbursement ratio of employees and retirees is different, so the specific reimbursement ratio must be in accordance with the relevant medical insurance regulations. When wisdom teeth need to be extracted, you can consult the medical insurance office of the local hospital.

In addition, if the teeth are ambushed and need to be hospitalized, the teeth can be extracted under general anesthesia, and you can go to medical insurance for reimbursement. The reimbursement rate is directly related to the level of the hospital. Secondary hospitals are relatively high, probably around 70%, and tertiary hospitals are around 50%.

Medical insurance reimbursement process of dental clinic:

1, the insured submits all the documents and vouchers required for reimbursement to the relevant local authorities;

2. Just wait for the social security agency to handle it, or you can directly reimburse it in the hospital, that is, when you go through the hospitalization procedures, you can directly participate in the reimbursement by issuing a new rural cooperative medical certificate to the hospital.

Proportion of reimbursement for dental medical insurance:

Dental medical insurance reimbursement can only be partial, not all. In case of hospitalization expenses, the minimum payment standard for employees and retired employees to use for the first time within one year is 1300. If it is the second hospitalization, according to 50% of the minimum payment standard, the maximum treatment cost that medical insurance can pay within one year is 70,000 yuan.

The reimbursement rate of township hospitals and community health service institutions is not less than 80%, the institutions above the county level are not less than 70%, and the municipal hospitals are not less than 60%.

To sum up, the removal of wisdom teeth belongs to the scope of medical insurance, and the documents and materials needed for reimbursement must be complete. Generally, it is necessary to prepare relevant consumption vouchers, expense vouchers and personal documents.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.