Can children's dental insurance be reimbursed

Children's medical insurance may not reimburse dental care. Children's medical insurance depends on whether the teeth can be reimbursed. Generally speaking, it depends on the situation, some can be reimbursed, and some cannot be reimbursed. Only therapeutic dental treatment belongs to the scope of medical insurance reimbursement, such as the cost of dental diseases such as tooth filling, tooth extraction, periodontal disease and gingivitis. In the case of dental restoration and high-priced dental implants, medical insurance cards cannot be used for reimbursement.

Whether children's dental insurance is reimbursed generally depends on the situation:

1. If it is social medical insurance, medical insurance can be used to reimburse the treatment expenses of tooth filling, tooth extraction, periodontal treatment and gingivitis-related dental diseases. In the designated medical insurance dental clinic treatment, which belongs to the scope of medical insurance, can be reimbursed; The overall account is managed by the medical insurance center, and the expenses of the insured who meet the local medical insurance reimbursement are reimbursed by them. When seeking medical treatment, show the medical insurance card to prove the identity of the insured. At the time of checkout, the part that should be paid by the individual can be paid directly by the medical insurance card. If hospitalization needs to be reimbursed, it will be reimbursed only after reaching the local deductible line.

2. If the expenses involve tooth cleaning, tooth planting, tooth planting, orthodontics and tooth beauty, they cannot be reimbursed through overall medical insurance.

3. If it is employee medical insurance, it can be paid with the money in personal account. The personal account of medical insurance is embodied in the medical insurance card, which can be used to buy medicines at designated pharmacies, pay the outpatient expenses of designated medical institutions by credit card, and pay the out-of-pocket part of hospitalization expenses.

4. If it is commercial medical insurance, oral medical expenses are generally not reimbursed, including dental expenses such as tooth extraction, tooth cleaning, tooth filling and tooth implantation. Moreover, in the exemption clause of commercial medical insurance, you can actually see the relevant content. However, if commercial medical insurance needs to treat accidental tooth loss caused by accidents, it can still reimburse some medical expenses;

The proportion of children's dental reimbursement and the amount of accidental injury insurance reimbursement depend on the compensation rules of the product. According to the accidental injury insurance for children on the market, the accidental injury medical insurance amount of this product can reach up to 60,000 yuan, and the medical expenses in the medical insurance can be reimbursed. There is no limit to the deductible, and expenses within the scope of responsibility can be reimbursed 100%. If the child loses more than 8 teeth due to accident, it can be classified as 10 disability and can compensate 10% of the insurance amount.

legal ground

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

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Interim Measures for the Administration of Medication in Basic Medical Insurance

Twenty-third insured use of drugs in the drug list costs, meet the following conditions, the basic medical insurance fund can pay:

(a) For the purpose of disease diagnosis or treatment;

(two) diagnosis and treatment in line with the condition, in line with the legal indications of drugs and medical insurance to limit the scope of payment;

(three) provided by designated medical institutions that meet the requirements, except for first aid and rescue;

(four) the drug expenses paid by the overall fund shall be based on the doctor's prescription or hospitalization order;

(five) in accordance with the prescribed procedures by pharmacists or licensed pharmacists.