While there is a repeated emphasis on “31 provinces being covered by medical insurance”, there is another equally important aspect that is often overlooked:The positioning of medical insurance for assisted reproduction is “to cover basic needs and benefit the people”.This means that efforts should be focused on those core projects that are truly necessary, rather than trying to cover every possible expense. This article helps you understand which items are likely not to be included in the plan, so that you can manage your expectations effectively and avoid any disappointments.

1. What exactly does “ensuring basic services” mean?

From the five major procedures listed by the National Healthcare Administration, namely egg retrieval, sperm selection, embryo culture, embryo transfer, and intracytoplasmic sperm injection, it can be seen that the focus of protection lies in these procedures.An indispensable and irreplaceable component of the treatment chainThis determination defines the “basic scope” of reimbursement procedures.

II. Which items are usually “not covered” or “not necessarily included” in the reimbursement scope

1. Some types of embryonic genetic screening, such as PGT

The coverage of PGT (Pre-Implantation Genetic Testing) varies from province to province. In some areas, it is limited to specific medical circumstances, and not all cases are covered. Whether the costs will be reimbursed, and how much will be covered, depends on the local regulations.

2. Non-essential medications

Ovulation-stimulating medications and progesterone support treatments may be covered through outpatient programs or local policies. However, there are significant differences among these options, and it cannot be assumed that all of them are covered by these systems.

3. Value-added services and optional offerings

Some advanced embryo observation techniques, unnecessary additional tests, and specialized services are not included in the basic list of services.

4. Items that exceed the specified criteria

Projects that do not meet clinical criteria or are requested by the participants themselves are generally not eligible for reimbursement.

三、为什么这样设计

The medical insurance fund is the “common resource” of all insured individuals. It is essential to prioritize funding for those services that are widely needed and affordable. This is the foundation for sustainable healthcare systems. Only by allocating limited resources to the most critical areas can we ensure that the benefits reach the widest possible audience.

IV. How to Manage Patients’ Expectations

• Check the directory before visiting the doctor.: Please contact the local medical insurance department or the hospital’s medical insurance office to confirm whether the target project is included in their list.
• Confirm the self-payment ratioEven in the catalog, there are sections that require self-payment;
• Phrases to use when declining "package deals"Any offer to provide “full coverage” should be taken with caution.

五、Lelaiwa建议

It’s important to treat both “what doesn’t need to be reported” and “what needs to be reported” as equally important. Clear expectations can help reduce financial anxiety during treatment. The Lelaiwa Q&A sessions will guide you in reviewing the official guidelines.Ultimately, it shall be subject to the regulations of the region where the insurance is purchased.。