If you choose corneal laser surgery to treat myopia, whether it is LASIK, semi-femtosecond laser or full femtosecond laser surgery, it is a self-funded project and you can't enjoy medical insurance reimbursement. However, if you choose endoscopic surgery, the operation fee: intraocular lens implantation with lens can be reimbursed in proportion, but the implanted intraocular lens is at your own expense.
The scope of medical insurance reimbursement is limited, and it can only be reimbursed if you seek medical treatment and buy medicine in medical institutions and pharmacies stipulated by medical insurance. Moreover, only drugs, treatments and operations in the basic medical insurance catalogue can be reimbursed. Class A can be reimbursed, class B drugs can be reimbursed, and class C cannot be reimbursed. If you want full reimbursement, you can only get it if it meets the scope of basic medical insurance diagnosis and treatment projects. If it is partial reimbursement, the expenses outside the scope of medical insurance refer to those expenses that are not reimbursed by medical insurance. If the medical expenses do not exceed the deductible, they must be borne by individuals; There are also some drugs and projects that are partly at their own expense and should be borne by patients. The lower the reimbursement rate, the higher the individual rate.
Details are as follows:
1. Commercial medical insurance does not reimburse medical expenses for myopia surgery. Because myopia surgery belongs to corrective surgery in a strict sense, it is stated in the exemption clause of commercial medical insurance that the insurance company will not bear the responsibility for medical expenses such as corrective surgery and plastic surgery, and the related expenses arising therefrom will be borne by the insured. Moreover, myopia surgery is actually not a necessary and reasonable medical expense caused by illness or accident, and it is not within the reimbursement scope of commercial medical insurance;
2. The basic medical insurance does not reimburse the medical expenses of myopia surgery, because myopia is not a treatment plan recognized by the medical and health system as necessary for surgery, so it is not included in the scope of medical insurance reimbursement. However, if the insured suffers from myopia due to cataract, the basic medical insurance can reimburse the related treatment expenses.
At present, there are five main categories of diagnosis and treatment projects that are not included in the basic medical insurance in China. They are:
(1) service item classification. Registration fee, out-of-hospital consultation fee, medical record fee, etc. ; Special medical services, such as visiting fees, expedited fees for examination and treatment.
(2) Non-disease treatment projects. Beauty, plastic surgery, etc. ; Weight loss, weight gain and height increase projects; Physical examination; All kinds of medical consultation and medical appraisal.
(3) Diagnostic equipment and medical materials. Inspection and treatment projects carried out by large medical equipment such as ophthalmic excimer laser therapeutic apparatus; Rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS; All kinds of self-use health care, massage, examination and treatment equipment; Disposable medical materials that cannot be charged separately as stipulated by the price department.
(4) Treatment items. The organ source or tissue source of various organ or tissue transplants; Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow; Orthopedic surgery for myopia; Adjuvant treatment projects such as health nutrition therapy.
(5) others. Various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects; Various scientific research and clinical verification diagnosis and treatment projects.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
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.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.