Can the special outpatient examination fee be covered by medical insurance?

Medical insurance is not allowed for special outpatient examination fees.

Because it does not belong to the reimbursement scope of basic medical insurance. China's labor and social security departments also expressly stipulate that special needs clinics belong to the scope of medical treatment projects that are not paid by basic medical insurance.

Medical insurance refers to social medical insurance. It is a social insurance system that meets the basic medical needs of the state and society according to laws and regulations when workers are sick.

Medical insurance has the characteristics of "low level and wide coverage". The payment is based on the expenses that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees in different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "the burden of both parties and the combination of unified accounts"; Based on the principle of "balance of payments".

Personal account of medical insurance is a special account established according to the basic medical insurance policy, which is specially used to store the medical insurance premiums paid by the insured and the funds allocated by the employer according to a certain proportion, and record the medical consumption. The funds in the personal account are used to pay for the out-of-pocket part of medical treatment and medicine purchase.

Advantages of medical insurance: enjoy treatment according to unified standards. The same access conditions, the same fees, the same treatment, there is no difference between high and low. The employee's outpatient expenses can be deducted from his personal account and paid by the employee after deduction.

People's Republic of China (PRC) Social Insurance Law Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.

Twenty-third employees should participate in the basic medical insurance for employees, and the employer and employees should jointly 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.