Legal analysis: Kidney transplants are covered by health insurance. Other organ transplants are not covered by medical insurance.
The scope of treatment items for which the basic insurance does not cover the cost is as follows:
(I) Service item category
1, registration fee, out-of-hospital consultation fee, and cost of medical records;
2, consultation fee, expedited fee for checkups and treatments (except for emergencies), surcharge on named surgeries, high quality and excellent price, and fee for special nurses for special needs medical services, etc.
This category is not covered by the basic insurance.
(B) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness programs and messy non-functional cosmetic surgery, orthopedic surgery, etc.
2, a variety of weight loss, weight gain, height projects;
3, a variety of health checkups;
4, a variety of preventive, health care treatment programs;
(C) non-disease treatment program category
1, a variety of beauty (cosmetic life, medical cosmetology) fitness program as well as non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, weight gain, height projects;
3, a variety of health checkups;
4, a variety of preventive, health-care clinic projects;
5, dental orthodontics, Dental porcelain;
6, a variety of medical consultation (excluding psychiatric consultation), medical appraisal.
(D) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the examination and treatment of the project;
2, eyeglasses, dental prostheses, eye prostheses, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, a variety of self-help health care, massage, examination, rehabilitation and treatment equipment.
(E) therapeutic program category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, except for kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation of organs or tissues;
3, myopic eye orthopaedics;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary therapies therapy, magnetic therapy and other complementary treatment programs.
(F) Other
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, a variety of scientific research, clinical verification of the diagnosis and treatment programs.
Legal basis: The Social Insurance Law of the People's Republic of China
Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with state regulations.
Article 27 Individuals who have participated in basic medical insurance for employees and whose accumulated contributions have reached the number of years prescribed by the State by the time they reach the legal retirement age shall not pay any more basic medical insurance premiums after their retirement and shall enjoy basic medical insurance benefits in accordance with the State's stipulations; and those who have not yet reached the number of years prescribed by the State may pay contributions up to the number of years prescribed by the State.
Article 28 Medical expenses that conform to the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public ****health;
(4) those that seek medical treatment outside China.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.