Legal analysis: 1. Inpatient medical insurance benefits, basic medical expenses above the minimum standard shall be paid from the overall fund according to the following proportions: (1) Minors and school students shall pay 85% for first-level medical institutions and 75% for second-level medical institutions.

, tertiary medical institutions pay a proportion of 65%.

(2) Other urban and rural residents shall pay 85% for first-level medical institutions, 70% for second-level medical institutions, and 55% for third-level medical institutions.

2. For outpatient chronic disease benefits, the insured person’s outpatient treatment for designated chronic disease outpatient specialty drugs shall be paid by the overall fund at the proportion of 70% for primary medical and health institutions and 50% for other designated medical institutions.

The overall fund can pay a maximum of 50 yuan per person per disease per month, and the excess will be paid by the insured.

3. Outpatient medical insurance benefits. The general outpatient drug expenses incurred by insured persons for medical treatment according to regulations shall be paid by the overall fund in accordance with the following regulations: (1) Minors and school students shall be paid at a rate of 80% for outpatient treatment at selected grass-roots medical institutions.

Payment; 50% payment for medical treatment at other selected medical institutions and designated specialist medical institutions within 30 days after being referred by the grassroots selected medical institution; directly going to other selected medical institutions and designated specialists without referral from the grassroots selected medical institution

Medical treatment in medical institutions is paid at a rate of 40%.

(2) Other residents who receive outpatient treatment at selected grassroots medical institutions are paid at a rate of 60%.

(3) When insured persons seek outpatient treatment at designated medical institutions approved by the health department to implement the essential drug system and implement zero-margin sales of essential drugs, 70% of the general diagnosis and treatment fees will be paid.

(4) The general outpatient drug expenses paid by the unified fund shall not exceed 1,000 yuan per person per year for minors and school students, and shall not exceed 600 yuan per person per year for other urban and rural residents.

Legal basis: Article 28 of the "Regulations of the People's Republic of China on the Basic Medical Insurance for Urban Employees" Personal accounts are used to pay medical expenses beyond the scope of payment by the overall fund; if the personal account is insufficient to pay, it is the responsibility of the individual.

Article 29 Medical expenses for hospitalization for serious diseases shall be paid according to the following methods: (1) The minimum payment standard is in principle controlled at 9% to 11% of the average social salary of employees in cities, counties, and autonomous counties in the previous year.

(2) In principle, the maximum payment limit is controlled at 3-5 times the average annual social salary of employees in cities, counties, and autonomous counties in the previous year.

(3) Medical expenses above the minimum payment standard and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion.

Appropriate care will be given to the proportion of retirees paying medical expenses.

The scope of serious diseases, specific standards for deductibles and maximum payment limits, and the sharing ratio of medical expenses above the deductible standard and below the maximum payment limit shall be determined by the Provincial People's Government.

Article 30 The overall fund will not pay for medical expenses that are below the minimum payment standard and above the maximum payment limit.