Legal analysis: 1. Among the basic medical expenses incurred by the insured for hospitalization or special treatment, the individual pays the medical expenses below the maximum payment limit of the urban and rural residents' medical insurance pooling fund, and 5% of the part accumulated over 18, yuan in the whole year is paid by the serious illness insurance fund.

2. if the basic medical expenses incurred by the insured for hospitalization or special treatment exceed the maximum payment limit of the urban and rural residents' medical insurance pooling fund for the whole year, 7% will be paid by the serious illness insurance fund.

3. If the insured person has been insured for less than 2 years continuously, the annual maximum amount is 12, yuan; For those who have been insured for more than 2 years and less than 5 years, the annual maximum payment limit is 15, yuan; For those who have been insured continuously for 5 years, the annual maximum payment limit is 18, yuan (the calculation time for the first year of continuous insurance is.

legal basis: social insurance law of the people's Republic of China

article 2 the state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in case of old age, illness, industrial injury, unemployment and maternity.

article 3 the social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be commensurate with the level of economic and social development.

article 4 the people's Republic of China * * * and employers and individuals within the territory of China have the right to inquire about the payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.