Legal analysis: If there is no third party responsible for the trauma, medical insurance can reimburse it. Legal basis: Article 30 of the "Social Insurance Law of the People's Republic of China" The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) should be paid from the work-related injury insurance fund; (2) should be paid by a third party (3) Should be borne by the public health department; (4) Seek medical treatment abroad. Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or cannot confirm"

According to relevant regulations, the following medical expenses are not included in the payment scope of the basic medical insurance fund:

1 . Should be paid from the work-related injury insurance fund

2. Should be borne by a third party

3. Should be borne by the public health department

4. Medical treatment abroad.

5. Sports and fitness, health care consumption, and physical examinations

6. Others that are not covered by the basic medical insurance fund prescribed by the state. Expenses.

According to the relevant provisions of the country’s medical insurance:

Reimbursement cannot be made if you seek medical treatment on your own (without a designated hospital or without a referral form), self-purchased medicines, and public-funded medical treatment. Drugs and medical expenses that are not in compliance with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, accompanying guests, nutrition fees, blood transfusion fees (except for those with family blood banks, which will be reimbursed according to relevant regulations), air conditioning and heating fees, and first aid expenses, special care expenses and other expenses; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents and medical accidents; reimbursement of orthopedics, plastic surgery, dental implants, prostheses, organ transplants, named surgery fees, consultation fees, etc., within the scope of reimbursement, with a limit Other parts are not within the scope of medical insurance reimbursement.

Therefore, it cannot be said that trauma cannot be reimbursed, but it can be reimbursed if it meets the prescribed conditions.

Medical insurance reimbursement and subsidy scope:

1. Outpatient and emergency medical expenses: The cumulative medical expenses of active employees that meet the provisions of basic medical insurance exceed the prescribed amount of 2,000 yuan.

2. Settlement ratio: During the contract period, 50% of the dispatched personnel’s expenses exceeding 2,000 yuan will be reimbursed, and the individual will pay 50%; the maximum amount of outpatient and emergency reimbursement for dispatched personnel in one year is 20,000 yuan.

3. Insured persons must properly keep the outpatient medical receipts for treatment at designated hospitals (including receipts for large amounts and below, the bottom of prescriptions, etc.) as proof of medical expense reimbursement.

4. Three special cases. Outpatient medical treatment for diseases: When the insured person needs to seek medical treatment in an outpatient clinic after taking anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, renal dialysis, and kidney transplantation, the second or designated hospital where the insured person seeks medical treatment will issue a "disease diagnosis certificate" ", and fill out the "Medical Insurance Special Disease Application Approval Form" and submit it to the district medical insurance center for approval and filing. Outpatient treatment and medicine collection for these three special diseases are only available in designated hospitals that have been approved for treatment, and cannot be purchased at designated retail pharmacies. Occurrences If the medical expenses are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.

5. Inpatient medical treatment.