The payment scope of the basic medical insurance fund shall be formulated by the competent department of medical security in the State Council, and the opinions of the competent department of health and health, the competent department of traditional Chinese medicine, the drug supervision and administration department and the financial department in the State Council shall be listened to. The people's governments of provinces, autonomous regions and municipalities directly under the Central Government may, in accordance with the relevant provisions of the state, supplement and determine the specific items and standards paid by the basic medical insurance fund within their respective administrative areas, and report them to the competent medical security department of the State Council for the record.

The competent department of medical security in the State Council should carry out evidence-based medicine and economic evaluation on the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and other organizations that are included in the scope of payment, and should listen to the opinions of the health authorities in the State Council, the competent department of traditional Chinese medicine, the drug supervision and administration department, the financial department and other relevant parties. The evaluation results should be used as the basis for adjusting the payment scope of the basic medical insurance fund. At the same time, individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Legal basis:

According to the Social Insurance Law of People's Republic of China (PRC)

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.