There are some cases in which illnesses cannot be reimbursed by health insurance. The following are some common cases:
1. Diseases not covered by medical insurance: Medical insurance usually only covers a specific range of diseases, such as certain chronic diseases and infectious diseases. If your illness is not covered by health insurance, you will not be able to get reimbursed by your health insurance.
2. Out-of-pocket expenses: Certain medical items or medications may not be covered by medical insurance and are considered out-of-pocket expenses. These items include cosmetic surgery, unnecessary medical checkups, and certain high-end medications. If you choose to receive these items, you will need to pay for them yourself and will not be reimbursed by your medical insurance.
3. Exceeding the limit: Medical insurance usually has a certain limit, such as a maximum amount of reimbursement per year or per visit. If medical expenses exceed this limit, the excess will not be reimbursed by your health insurance.
4. Failure to follow the rules: Medical insurance requires patients to go to a designated medical institution and follow the prescribed procedures. Failure to follow the prescribed procedures, such as choosing a non-Medicare designated medical institution or not being referred by a doctor, will result in no reimbursement from MediShield.
How to get reimbursed for medical treatment abroad:
1, referral certificate. If you want to use your health insurance card to reimburse you for a visit to a foreign country, you should first open a referral certificate at a local hospital, which needs to be at a slightly larger local hospital, at least if it's a county hospital or above;
2, the hospital seal. In the county hospital after the referral certificate needs to be stamped, this stamp is not just any hospital chapter can be, must be open referral certificate of the hospital's social security window stamp;
3, the social security bureau registration. After opening the referral certificate and hospital seal, with the relevant information to the local equipment bureau for registration, this registration is mainly for the record in the Social Security Administration, to facilitate the future reimbursement of foreign health insurance;
4, hospital invoices. In a different place to see the reimbursement of hospitalization is still the main reimbursement, after seeing the hospital to let the hospital to open an invoice, be sure to keep the invoice, which is the basis for reimbursement;
5, the social security bureau reimbursement. After seeing the doctor back to the local social security bureau for reimbursement, bring the relevant materials, including: invoices, ID cards, household registration and social security cards and other materials;
6, outpatient reimbursement. General reimbursement of the trouble is a little bit of hospitalization costs, but if the reimbursement of outpatient costs in a different place, do not have to be so troublesome, just need to bring back the invoice to the social security bureau for reimbursement.
In summary, diseases outside the scope of reimbursement of health insurance mainly refer to those diseases or medical programs that do not comply with the provisions of the health insurance policy, so you need to be careful when choosing treatment and programs, and consult with the health insurance agency to confirm.
Legal basis:
The People's Republic of China*** and the State Social Insurance Law
Article 28
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.