Legal analysis: At present, our basic medical insurance can only report the expenses in the basic medical catalogue, and only drugs, medical items and medical materials that meet this catalogue can be reimbursed by the basic medical insurance. After the expenses in the basic medical insurance catalogue are reimbursed by the basic medical insurance, they reach the deductible line of serious illness insurance (20,000 yuan in 2020), and after being reimbursed by the serious illness insurance, the remaining personal expenses are reimbursed by Zhelibao. In addition, self-funded drugs, diagnosis and treatment items and medical materials that cannot be covered by basic medical insurance are included in the scope of "Zhelibao" according to the deductible line10.8 million yuan. In addition, "Zhelibao" has established two lists: one is the access list, which includes medical services outside the catalogue that are not included in the scope of basic medical insurance and major illness insurance but have obvious curative effect, reasonable price and clear application scope; Second, the negative list, including drugs, diagnosis and treatment services and medical materials with abuse tendency and unclear curative effect, is mainly used for nourishing health care and plastic surgery, and the expenses of the negative list are not included in the protection scope of Zhelibao. Therapeutic drugs and medical materials not included in the negative list can be included in the protection scope of Zhelibao.

Legal basis: According to the provisions of Article 28 of the Social Insurance Law, 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. According to the provisions of Article 29 of the Social Insurance Law, the part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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. According to the provisions of Article 30 of the Social Insurance Law, the following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) those that should 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.