Legal subjectivity:

The calculation method of medical expenses paid by the basic medical insurance fund is: the medical expenses of employees and retirees for outpatient treatment of some serious diseases that meet the regulations shall be calculated by the overall fund Proportional payments are made, but individuals also have to pay a certain proportion. However, if the required medical expenses exceed the "ceiling line" of the overall pool fund, the commercial insurance company will be responsible for settling the claim based on segment calculation and cumulative payment, but the individual must also bear a certain proportion of the expenses. The law is objective:

Article 23 of the "Social Insurance Law"

Employees shall participate in employee basic medical insurance, and the employer and employees shall jointly pay for basic medical insurance in accordance with national regulations fee.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.