Seven kinds of accidental injuries are not covered by medical insurance reimbursement.

Seven kinds of accidental injuries that are not reimbursed include:

1, concealment and fraud, including providing false trauma time and place, accident cause, treatment process, false certification materials and forging trauma medical documents;

2, the implementation of drug abuse, the use of controlled drugs, fighting, drinking and other illegal acts;

3, in addition to the third and fourth provisions of these measures, shall be borne by the responsible person;

4. Motor vehicle road traffic accidents;

5, should be paid from the industrial injury insurance fund or maternity insurance fund;

6, should be borne by public health;

7. Medical expenses incurred overseas.

Medical insurance First of all, the difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level. Generally, Class A drugs can enjoy full coverage, while Class C needs all out-of-pocket expenses, with Class B reporting 80% and paying 20%. Medical reimbursement mainly refers to medical treatment, medication, hospitalization and surgery. And medical expenses can be reimbursed by medical insurance card according to relevant regulations, but the compensation for major diseases or accidents is limited. At this time, it is suggested that the insured can purchase commercial medical supplementary insurance and social security to reduce their economic losses.

legal ground

Measures of the Human Resources and Social Security Bureau for the Administration of Social Medical Insurance Accidental Injury Protection Article 4 The medical expenses incurred by the insured due to the following circumstances may be included in the payment scope of the social medical insurance fund:

(1) Accidental injury of the insured without liability;

(2) Accidental injury that the insured bears part of the responsibility as determined by the relevant departments;

(3) In a criminal or public security case in which the insured was injured due to another person's illegal act, after the judgment or ruling of the people's court, the responsible person failed to make full compensation, or the case was not solved within six months from the date of the injury, and the responsible person could not be determined;

(four) after the judgment or ruling of the people's court, the responsible person fails to make full compensation.