Are employees in Vietnam entitled to health insurance benefits for giving birth at off-route facilities?

Are employees in Vietnam entitled to health insurance benefits for giving birth at off-route facilities? (Internet image)

According to the regulations in Clause 15, Article 1 of the 2014 Amended Law on Health Insurance, amending and supplementing Article 22 of the 2008 Law on Health Insurance, in cases where female laborers give birth out of district, they will be covered by health insurance in Vietnam as follows:

- At central-level hospitals, 40% of inpatient treatment costs;

- At provincial-level hospitals, 60% of inpatient treatment costs until December 31, 2020; 100% of inpatient treatment costs from January 01, 2021, nationwide;

- At district-level hospitals, 100% of medical examination and treatment costs.

Thus, female laborers who choose to give birth at out-of-district medical facilities can still be covered by health insurance. The coverage rate will depend on whether the selected medical facility belongs to the district, provincial, or central level, which may provide complete coverage for childbirth costs.

So, in which cases is giving birth out of district identified? Currently, the law only stipulates cases of in-network medical examination and treatment, including:

- Persons holding health insurance cards who register for initial medical examination and treatment at commune-level medical facilities or polyclinics or district-level hospitals are entitled to receive medical examination and treatment covered by health insurance at commune-level medical stations, polyclinics, or district-level hospitals within the same province.

- Persons holding health insurance cards who register for initial medical examination and treatment at commune-level medical facilities are referred to district hospitals, including first-class and second-class district hospitals and provincial traditional medicine hospitals (in cases where district hospitals do not have a traditional medicine department).

- Persons holding health insurance cards referred by district-level hospitals, including first-class, second-class district hospitals, general hospitals, specialized hospitals, specialized institutes, and specialized centers at the provincial level, are referred to specialized centers at the provincial level, or general hospitals, specialized hospitals, specialized institutes at the same level or lower.

- Emergency cases;- Cases where patients are referred for medical examination and treatment have other accompanying diseases, diseases detected, or arisen outside the diseases listed on the referral paper. The receiving medical facility will perform medical examination and treatment for those diseases within their professional scope.

- Persons participating in health insurance who are on business trips, studying, working, or temporarily residing for less than 12 months in another locality are entitled to receive medical examination and treatment at medical facilities in that locality equivalent to the initial medical examination and treatment facility recorded on their health insurance cards. In cases where the locality does not have an equivalent medical facility, health insurance participants can choose another medical facility that offers initial health insurance medical examination and treatment services.

Female laborers who choose to give birth at medical facilities not included in the above-mentioned ones will be considered as giving birth out of district. Laborers need to be aware of this regulation to maximize their entitled benefits when giving birth.

Legal Basis: 2008 Law on Health Insurance, 2014 Amended Law on Health Insurance; Article 11 Circular 40/2015/TT-BYT.

Thuy Tram

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