1, orthodontics is a non-disease treatment project, which is not covered by the medical insurance fund. At present, there are five types of diagnosis and treatment items that are not listed in the catalogue of urban basic medical insurance diagnosis and treatment items, including service items, non-disease diagnosis and treatment items, diagnosis and treatment equipment and medical materials, and diagnosis and treatment items.
2. However, because most of the tooth deformities in China are tooth damage and tooth crowding, it is necessary to extract teeth to make room for tooth crowding, and tooth extraction is within the scope of medical insurance reimbursement. Therefore, only tooth extraction can reimburse orthodontics.
Medical insurance cannot be reimbursed:
1. Medical expenses incurred by a third party. If there is a third-party responsible person, the medical expenses arising from the accidental injury paid to Sakura Fortis shall be borne by the third-party responsible person. If the third-party responsible person does not pay the medical expenses, or if the third-party responsible person cannot be determined in the hit-and-run accident, the medical insurance fund can usually pay the medical expenses first and then recover.
2, non designated hospital treatment costs. Medical expenses incurred in designated hospitals with medical insurance can only be reimbursed. If you are treated in a non-medical insurance designated hospital, it cannot be reimbursed, but emergency treatment can usually be reimbursed.
3. Expenses outside the medical insurance catalogue. Only the items in the medical insurance catalogue can be reimbursed, and the items outside the medical insurance catalogue cannot be reimbursed.
4, did not reach the deductible. There are deductible requirements for medical insurance reimbursement. Medical expenses can only be reimbursed if they meet the deductible standard of medical insurance reimbursement. If the medical expenses do not meet the deductible line, then the medical expenses incurred can only be borne by themselves.
5. Exceeding the reimbursement limit. If it exceeds the upper limit of reimbursement, then the excess cannot be reimbursed.
6, industrial injury insurance, maternity insurance within the scope of medical expenses. If the medical expenses are within the scope of work-related injury insurance, they need to be paid by the work-related injury insurance fund, but they cannot be reimbursed by medical insurance. Similarly, if the medical expenses are within the scope of maternity insurance, they can only be paid by maternity insurance fund, not by medical insurance.
7. Special medical care. The reimbursement scope of medical insurance is usually in some routine items such as registration, consultation and operation fees. If the medical expenses are caused by plastic surgery and other reasons, then medical insurance cannot be reimbursed.