Current location - Plastic Surgery and Aesthetics Network - Plastic surgery and medical aesthetics - Can commercial insurance for orthognathic surgery be reimbursed?
Can commercial insurance for orthognathic surgery be reimbursed?
No, this is cosmetic surgery, not a disease. The reimbursement scope of commercial medical insurance only reimburses the medical expenses actually incurred by the insured, but different commercial medical insurance has different reimbursement scope. Expense reimbursement insurance can reimburse hospitalization medical expenses, but different products have different provisions on the scope of reimbursement. Some commercial medical insurance contracts stipulate that the actual medical expenses must be reimbursed within the scope of social security reimbursement.

First, the scope of reimbursement of commercial medical insurance

1, the difference between medical insurance drugs and non-medical insurance drugs, and the reimbursement deductible line are also different according to the hospital level.

Generally, Class A drugs can enjoy full coverage, while Class C drugs need to bear all the expenses, while Class B drugs will be charged 80% and bear 20% of the expenses.

A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.

2. Medical insurance also has exclusions, and the following ten items are not within the scope of medical insurance reimbursement.

(1) Among the special medical expenses, the expenses for organ and tissue transplantation due to illness, organ and tissue purchase, and the expenses for using anti-rejection drugs and immunomodulatory drugs beyond the scope of medical insurance reimbursement for employees in Zhenjiang;

(2) Work-related injuries and occupational diseases;

(3) Maternity of female employees;

(4) hooliganism;

(5) Harm caused by alcoholism;

(6) Traffic accidents;

(7) intentional injury by others;

(8) Medical accidents;

(9) beauty and health examination;

(10) Other expenses not paid by the social medical insurance fund.

Test your anti-risk index, and experts will interpret it for you for free!