How does medical insurance reimburse dental expenses?

After the insured person submits all the documents and certificates required for reimbursement to the local authorities, it is good to wait for the social security agency to handle it, or it can be reimbursed directly in the hospital, that is, when going through the hospitalization procedures, he can directly participate in reimbursement with the new rural cooperative medical system certificate issued by the hospital. It should be noted that the documents and materials you carry must be complete. Generally, it is necessary to prepare relevant consumption vouchers, expense vouchers and personal documents. If you don't know what to prepare, you can consult the relevant departments in advance.

The reimbursement scope of oral medical insurance can generally reimburse the insured for medical expenses caused by dental diseases. For example, tooth extraction is an outpatient operation to treat dental diseases, which belongs to the scope of reimbursement. For example, accidental tooth loss caused by accidents must be treated, so it is also within the scope of reimbursement. However, dental restoration and cosmetic medical projects, such as porcelain restoration, orthodontics, tooth implantation, tooth whitening and so on. All of them belong to medical cosmetic repair, and the charging standard is subject to market adjustment price, which is not within the scope of medical insurance reimbursement.

When reimbursing medical insurance, the drugs in the drug list are divided into three categories: A, B and C. Among them, all drugs in category A can be included in the scope of medical insurance reimbursement according to the medical insurance reimbursement standards for outpatient co-ordination, chronic diseases or hospitalization, while drugs in category B need to pay 5% in advance, and the rest are reimbursed according to the medical insurance reimbursement standards, while drugs in category C in the medical insurance list need to be fully reimbursed at their own expense; Diagnosis and treatment items include examination fees, inspection fees, treatment fees, operation fees, etc. , also divided into Class A, Class B, and Class C. According to the price difference of consumables involved in some medical treatment projects, the insured enjoys different reimbursement treatment according to the corresponding payment ratio.

According to the policy, at present, dental diagnosis and treatment projects within the scope of medical insurance mainly focus on examination and treatment projects, such as tooth filling (including basic materials and treatment fees), root canal treatment, tooth extraction and treatment of periodontal disease and gingivitis. The expenses incurred in oral diagnosis and treatment can be reimbursed by medical insurance, while dental restoration and cosmetic medical projects, such as porcelain restoration, orthodontics, tooth implantation and tooth whitening, belong to medical cosmetic repair, and the charging standard is market-oriented.

I hope the above content can help you. If in doubt, please consult a professional lawyer.

Legal basis:

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

Article 28

In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, medical insurance can be reimbursed. Toothache, tooth extraction, tooth filling, etc. (excluding imported materials) can be covered by medical insurance; Dental implants and tooth washing are not in medical insurance coverage.

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.