Legal analysis: (1) For employees and retirees who meet the conditions for outpatient treatment of serious and serious diseases, part of medical expenses shall be paid by the pooling fund according to the following proportion, but individuals shall also bear a certain proportion: 1, 80% of employees' medical treatment shall be paid by the pooling fund and 20% by individuals; 2. 85% of retirees treated by the overall fund, individual 15%. (2) When the medical expenses of employees and retirees for hospitalization, outpatient emergency rescue or outpatient treatment of some serious and serious diseases exceed the "top line" of the overall fund within an insurance year, the commercial insurance company shall be responsible for the claims according to the method of subsection calculation and cumulative compensation, but individuals shall also bear a certain proportion of the expenses, specifically: 65,438 yuan+0,30,000 yuan to 65,438 yuan+00,000 yuan (inclusive) for medical expenses. 6% for individuals to pay 1 yuan to 200,000 yuan (inclusive) for medical expenses, 96% for large medical insurance premiums, and 4% for individuals to pay 200,000 yuan or more for medical expenses. In a year, the highest proportion of large medical insurance premiums is 300,000 yuan per person. In addition, in an insurance year, if the medical expenses paid by individuals (excluding the medical expenses with the minimum threshold and the medical expenses that do not meet the requirements of basic medical insurance) are less than 30,000 yuan and more than 4,000 yuan, the commercial insurance company will give a one-time subsidy of 1 10,000 yuan.

Legal basis: Article 29 of the Regulations on Work-related Injury Insurance, employees who suffer from accidents or occupational diseases due to work shall be treated and enjoy medical treatment for work-related injuries. If the expenses required for work-related injury treatment meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, they shall be paid from the work-related injury insurance fund.