Legal analysis: medical expenses exceeding the minimum deductible and within the scope of the basic medical insurance fund shall be paid by social pooling funds and individuals in proportion. (1) The outpatient medical expenses are paid by the overall fund according to the proportion of 65% in tertiary hospitals, 70% in secondary hospitals, 75% in primary hospitals and other designated medical institutions, and the remaining 35%, 30% and 25% are paid by individuals. The proportion of retirees' outpatient co-ordination payment is 5% higher than that of on-the-job personnel. (2) The hospitalization expenses increase in three stages. Medical expenses for medical treatment in secondary and above medical institutions in this city, where the employees are within 6.5438+0 million yuan (including 6.5438+0 million yuan), the part of 6.5438+0 million yuan to 30,000 yuan (including 30,000 yuan) and the part of 30,000 yuan to the annual maximum limit of 80,000 yuan are paid by the social pooling fund respectively. The medical expenses for medical treatment in designated medical institutions below Grade II are within the maximum limits of 6,543.8+0,000 yuan (including 6,543.8+0,000 yuan), 6,543.8+0,000 yuan to 30,000 yuan (including 30,000 yuan) and 30,000 yuan to the year, and 80%, 90% and 95% are paid by social pooling funds respectively. The proportion of retirees' hospitalization medical expenses paid by individuals above the deductible line is half that of working individuals.

Legal basis: Article 2 of the Social Insurance Law of People's Republic of China (PRC) The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., to guarantee citizens' right to receive material assistance from the state and society in case of old age, illness, industrial injury, unemployment and maternity.