Shanxi province health insurance reimbursement regulations are as follows: urban residents reimbursement ratio: first-class hospitals: 85%; second-class hospitals: 70%; third-class hospitals: 60%; emergency hospitalization: 50%; referral to foreign third-class hospitals: 55%. General outpatient reimbursement rate: medical expenses above the starting standard that are within the scope of outpatient coordinated payment, the outpatient coordinated fund pays 50%. Reimbursement ratio for urban workers: within 5,000 yuan (including 5,000 yuan), individuals pay 15% for first-level hospitals, 17% for second-level hospitals, and 19% for third-level hospitals; within 5,000 yuan to 15,000 yuan (including 15,000 yuan), individuals pay 13% for first-level hospitals, 15% for second-level hospitals, and 17% for third-level hospitals; individuals pay 11% for first-level hospitals, 13% for second-level hospitals, and 15% for third-level hospitals for medical expenses above 15,000 yuan. 13% for level 1 hospitals, 15% for level 2 hospitals, and 15% for level 3 hospitals.
Legal Objective:Article 28 of the Social Insurance Law, medical expenses that conform to the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations. Article 29 of the Social Insurance Law: The portion of a participant's medical expenses that should be paid out of the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses incurred in other places to facilitate the enjoyment of basic medical insurance by insured persons.