I have a general understanding of your question. The medical insurance benefits for retired workers are as follows: basic medical insurance benefits for employees and retirees in urban units (including individual owners and employees, freelancers and migrant workers with household registration in this city). All urban employers, including enterprises, institutions, social organizations, private non-enterprise units and individual economic organizations, should handle medical insurance for migrant workers who have formed labor relations with them according to regulations. Urban workers and retirees: all employers in cities and towns, including enterprises (state-owned enterprises, collective enterprises, joint-stock enterprises, foreign-invested enterprises and private enterprises), organs, institutions, social organizations, private non-enterprise units and their employees; If the insured person is sick, he should go to the outpatient clinic for treatment first. Medical expenses incurred in outpatient treatment in local designated hospitals are directly settled by medical insurance and IC cards in designated hospitals, and the insufficient part is paid by individuals in cash. Medical expenses incurred in non-designated hospitals or outpatient treatment in different places shall be paid in advance by the insured. The outpatient medical expenses and drug purchase expenses of the insured, whether incurred locally or in other places, are not included in the payment scope of the overall fund. Outpatient treatment is ineffective, or serious illness requires direct hospitalization, and hospitalization registration procedures should be handled in time.

Legal objectivity:

I. Medical Insurance Policy for Retired Employees Article 27 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement, and will enjoy the basic medical insurance benefits in accordance with state regulations when they reach the statutory retirement age; If it is not reached, it can be paid to the prescribed time limit. " The core spirit of this regulation is: "After retirement, employees will no longer pay basic medical insurance premiums and enjoy basic medical insurance benefits in accordance with state regulations; The flexible prerequisite of this clause is: "the accumulated payment has reached the fixed number of years stipulated by the state". It is precisely because the country has no unified regulations that all localities have their own needs and do their own things, which infringes on the legitimate rights and interests of laid-off workers and retired workers in social vulnerable groups. II. Measures to Solve the Medical Insurance Problem of Retired Workers It is not easy to solve the medical insurance problem of laid-off workers and retired workers according to law, so the following measures are suggested: 1. It is suggested that the National People's Congress instruct the Supreme People's Court to issue and implement the relevant judicial interpretation of the Social Insurance Law of People's Republic of China (PRC) as soon as possible, clearly stipulate the payment period of medical insurance for laid-off workers and retired workers (including 20 years as deemed payment period), and safeguard the legitimate rights and interests of medical insurance for laid-off workers and retired workers in the form of legal system. 2. It is suggested that the State Council instruct Ministry of Human Resources and Social Security to formulate and implement the implementation opinions of the Social Insurance Law of People's Republic of China (PRC) as soon as possible, clearly stipulating that "employees who have paid for 20 years (including the deemed payment period) after retirement will no longer pay the basic medical insurance premium and enjoy the basic medical insurance benefits according to state regulations." The overall management committee of the retirement pension fund has a medical management office. Before the establishment of the institution, the social insurance company temporarily fails to perform its duties; All townships, towns and fields should set up a trinity medical insurance management team of party committees and governments, medical units and medical insurance institutions. Responsible for the management, service, supervision, approval and coordination of medical expenses, and ensure the rational use of medical insurance expenses. Retired workers who enjoy social medical insurance as a whole shall seek medical treatment in the outpatient department of the hospital stipulated by the medical insurance institution. After being diagnosed as being hospitalized by a doctor, you must hold the disease certificate, inspection report, medical record and hospitalization notice issued by the doctor and go to the local medical insurance institution for inspection before you can be hospitalized.