The first is the cost of drugs and services that are not included in the medical insurance catalog; the second is the medical expenses that should be paid by work-related injury insurance; the third is the medical expenses that should be borne by a third party; the fourth is the medical expenses for medical treatment abroad; the fifth is sports fitness, health care

Consumption, health examination and other expenses; sixth, other expenses that are not covered by the basic medical insurance fund stipulated by the state.

1. The scope of medical insurance payment for drugs and services not included in the medical insurance catalog is limited. It mainly pays for drugs, diagnosis and treatment items, medical service facilities, etc. that comply with regulations.

If the medicines or services used are not included in the medical insurance catalog, the cost will need to be borne by the individual.

2. Medical expenses that should be paid by work-related injury insurance Work-related injury insurance is a security system that provides medical treatment and economic compensation for employees who are injured in accidents or suffer from occupational diseases due to work.

Therefore, the medical insurance fund will not pay for medical expenses that should be paid by work-related injury insurance.

3. Medical expenses that should be borne by a third party When the patient’s medical expenses are caused by a third party (such as the perpetrator), this part of the expenses should be borne by the third party.

The medical insurance fund will not pay in this case.

4. Medical expenses for medical treatment abroad. Since medical insurance is my country’s social security system, its payment scope is mainly limited to the country.

Therefore, the medical insurance fund will not cover the medical expenses incurred for medical treatment abroad.

5. Expenses for sports and fitness, health care consumption, health examinations, etc. These expenses are personal health consumption expenditures and are not required for disease treatment.

Therefore, the medical insurance fund does not pay these costs.

6. Other expenses that are not covered by the basic medical insurance fund stipulated by the state. In addition to the above situations, there are other expenses that are not covered by the medical insurance fund. These expenses are usually stipulated and clearly listed by the state.

To sum up: the six situations in which medical insurance will not pay mainly include the cost of drugs and services not included in the medical insurance catalog, medical expenses that should be paid by work-related injury insurance, medical expenses that should be borne by a third party, and medical expenses for medical treatment abroad.

, sports and fitness, health care consumption, health examinations and other expenses that are not covered by the basic medical insurance fund stipulated by the state.

These regulations are designed to ensure that medical insurance funds can be used reasonably and effectively to provide necessary medical protection for patients who really need it.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" stipulates: Medical expenses that meet the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be covered by the basic medical insurance in accordance with national regulations.

Paid from the fund.

Article 30 stipulates: The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid from the work-related injury insurance fund; (2) Those that should be borne by a third party; (3) Those that should be paid by the public ***

Those who bear health burden; (4) Those who seek medical treatment abroad.

Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first.

After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.