First, the cost of drugs and services in the non-medical insurance catalogue; Second, medical expenses that should be paid by industrial injury insurance; Third, the medical expenses that should be borne by the third party; The fourth is the medical expenses for going abroad for medical treatment; Fifth, fitness, health care consumption, health check-up and other expenses. Sixth, other expenses that are not paid by the basic medical insurance fund stipulated by the state.

First, the cost of drugs and services in the non-medical insurance catalogue.

The scope of medical insurance payment is limited, mainly paying for drugs, diagnosis and treatment projects, medical service facilities and other expenses that meet the requirements. If the drug or service used is not in the medical insurance catalogue, then this part of the cost needs to be borne by the individual.

Two, medical expenses should be paid by work-related injury insurance.

Work-related injury insurance is a security system that provides medical and economic compensation for employees who suffer from accidents or occupational diseases at work. Therefore, the medical expenses that should be paid by industrial injury insurance will not be paid by the medical insurance fund.

Third, the medical expenses that should be borne by the third party.

When the patient's medical expenses are caused by a third person (such as an offender), this part of the expenses should be borne by the third person. In this case, the medical insurance fund will not pay.

IV. Medical expenses for going abroad for medical treatment

As medical insurance is China's social security system, its payment scope is mainly limited to China. Therefore, the medical expenses incurred by overseas medical treatment will not be paid by the medical insurance fund.

Five, physical fitness, health care consumption, health examination and other expenses.

These expenses belong to personal health consumption expenditure, not to disease treatment. Therefore, the medical insurance fund does not pay these expenses.

Six, the provisions of the state basic medical insurance fund will not pay other expenses.

In addition to the above, there are other expenses that the medical insurance fund will not pay, which are usually stipulated and clearly listed by the state.

To sum up:

The six situations in which medical insurance does not pay mainly include the expenses of drugs and services in the non-medical insurance catalogue, medical expenses that should be paid by industrial injury insurance, medical expenses that should be borne by a third party, medical expenses for overseas medical treatment, fitness, health care consumption, physical examination and other expenses that are not paid by the basic medical insurance fund stipulated by the state. These regulations aim to ensure that the medical insurance fund can be used reasonably and effectively, and provide necessary medical protection for patients who really need it.

Legal basis:

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

Article 28 provides that:

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.

Article 30 provides that:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) 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.