免费疫苗接种

Search documents
在西安,医保哪些情况不予报销?
Sou Hu Cai Jing· 2025-08-06 14:20
Core Points - The article discusses situations where medical insurance (医保) does not provide reimbursement for medical expenses, highlighting six specific scenarios [2][4][5][7]. Group 1: Situations Where Medical Insurance Does Not Cover Expenses - Work-related injuries are covered by work injury insurance, not medical insurance [2]. - Medical expenses from accidents caused by third parties, such as traffic accidents or fights, are not covered unless the responsible party is identified [2]. - Public health services funded by the government, such as free vaccinations and disease prevention, are not reimbursed by medical insurance [2][4]. - Medical expenses incurred while receiving treatment abroad are not covered by medical insurance [4]. - Preventive health measures, such as routine check-ups and wellness treatments, are not included in the coverage [4]. - Only expenses listed in the three major directories (medical insurance drug directory, medical treatment project directory, and medical service facility directory) are eligible for reimbursement [5][7]. Group 2: The Three Major Directories of Medical Insurance - The drug directory includes: - Class A drugs, which are fully reimbursed [8]. - Class B drugs, which require a personal contribution of 10% or 14% [8]. - Non-reimbursable drugs, often expensive or for rare diseases, are excluded from coverage [8]. - The medical treatment project directory includes necessary and effective clinical treatment projects, but excludes cosmetic procedures and certain fees [9]. - The medical service facility directory covers essential services provided by designated medical institutions, but excludes non-essential services like entertainment fees [9].