Legal analysis: In the case of outpatient service, the total amount of the second-and third-class insured in the basic medical insurance in one medical insurance year does not exceed 1 000 yuan, 80% for class A drugs, 60% for class B drugs, and 90% for medical treatment items (the single reimbursement does not exceed 1, 20 yuan; Outpatient serious illness reimbursement, continuous insurance time is less than 12 months, the corresponding specialist treatment costs paid by the overall fund 60%; If the continuous insured time is over 65438+2 months and less than 36 months, 75% will be paid; If the insurance period exceeds 36 months, 90% will be paid; In the case of hospitalization, the longer the continuous insurance period, the higher the hospitalization reimbursement cost.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.