The hospitalization expenses of special wards can be reimbursed within the scope of diagnosis and treatment projects, medical service facilities standards and emergency rescue; The part beyond the scope of reimbursement, such as the part of the special needs ward that is higher than the bed fee paid by medical insurance, cannot apply for reimbursement, and the parties must pay their own expenses. Special outpatient service does not belong to the scope of reimbursement of basic medical insurance, so the operation after special outpatient service generally cannot be reimbursed. In addition, if the drugs prescribed by special needs clinics are not covered by medical insurance reimbursement, they cannot be reimbursed by medical insurance cards. Special medical services are limited to analgesia delivery, doula delivery, LDR home delivery, plastic surgery and special outpatient service, and other non-profit medical institutions are not allowed to increase special medical services without authorization.

Reimbursement scope of medical insurance:

1. Basic medical insurance reimbursement items: including drugs, diagnosis and treatment items and medical service facilities that meet the requirements;

2. Expenses that are not reimbursed by medical insurance: such as special medical service fees, price difference of advanced wards, cosmetic fees, etc.

3. Medical insurance drug list: the designated drug types and scope, and drugs that are not in the list are usually not reimbursed;

4. The difference between outpatient reimbursement and hospitalization reimbursement: outpatient reimbursement is usually low and hospitalization reimbursement is high;

5. Impact of regional differences: There may be differences in medical insurance policies and reimbursement rates in different regions.

To sum up, the hospitalization medical insurance for special needs cannot be reimbursed, and part of the expenses of special needs wards can be reimbursed, but the part beyond the scope of reimbursement must be paid at its own expense. Special clinics and operations are generally not reimbursed, and drugs prescribed by special clinics cannot be reimbursed by medical insurance cards if they are not covered by medical insurance. Special medical services are limited to a specific scope, and non-profit medical institutions are not allowed to increase special medical services without authorization.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.