Legal analysis: for the insured employees, the part within the policy scope of uremia dialysis, anti-rejection drug treatment after organ transplantation, radiotherapy and chemotherapy for malignant tumors and the treatment expenses accumulated within 40,000 yuan (including 40,000 yuan) will be paid by the basic medical insurance pooling fund at a rate of 90%; 40,000 yuan to 654.38+10,000 yuan (including 654.38+10,000 yuan), and the basic medical insurance pooling fund pays 95%.

Insured workers in the settlement year in accordance with the provisions of the specific project of hospitalization and outpatient medical expenses, accumulated more than 6.5438+ten thousand yuan, by large medical expenses social * * * fund to pay 95%, individuals pay 5%. For urban and rural medical insurance participants, if the cost of uremia dialysis, radiotherapy and chemotherapy for malignant tumors and anti-rejection drugs after organ transplantation within the policy scope is less than 654.38+10,000 yuan, it will be paid by the residents' medical insurance fund according to the proportion of 90%.

Legal basis: Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers.

Twenty-eighth personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.

Twenty-ninth serious illness hospitalization medical expenses, according to the following methods to pay:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

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

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.

Thirtieth medical expenses below Qifubiaozhun and above the maximum payment limit shall not be paid by the overall fund.