According to the Draft Law on Health Insurance of Vietnam, how much is the health insurance benefits for medical examination and treatment?
Definition of health insurance according to the Law on Health insurance 2008
Pursuant to Clause 1 Article 2 of the Law on Health Insurance 2008 of Vietnam (This Clause is amended by Clause 1 Article 1 of the Amendment to the Law on Health Insurance 2014 of Vietnam) stipulating:
“Article 2. Interpretation of terms
In this Law, the terms below are construed as follows:
Health insurance is a form of compulsory insurance which is implemented by the State to look after the health of the insured according to this Law for non-profit purposes.”
Definition of health insurance according to the Draft Law on Health Insurance dated February 15, 2022
Pursuant to Clause 1 Article 2 of the Draft Law on Health Insurance of Vietnam (Draft dated February 15, 2022), the concept of health insurance is as follows:
"Article 2. Interpretation of words
In this Law, the following terms are construed as follows:
1. Health insurance is a form of insurance in health care, not for profit, including:
a) Social health insurance (hereinafter referred to as health insurance for short) is the basic health insurance compulsory for the subjects specified in Article 11 of this Law and organized by the State.
b) Complementary health insurance is a type of voluntary health insurance used by a person participating in health insurance to pay for medical expenses that are outside the coverage of basic health insurance according to the agreements of law in the insurance contract. Complementary health insurance may be provided by a health insurance organization under the Vietnam Social Insurance and accounted for independently of basic health insurance or by insurance enterprises."
Health insurance benefits
Health insurance benefits according to the Draft Law on Health Insurance dated February 15, 2022
According to Article 27 of the Draft Law on Health Insurance of Vietnam (Draft dated February 15, 2022), the specific health insurance benefits are as follows:
1. Health insurance participants who go for medical examination and treatment according to the provisions of Articles 32 and 33 of this Law shall be entitled to payment of medical examination and treatment expenses by the health insurance fund within the scope of its benefits as follows:
- 95% of medical examination and treatment expenses for the subjects specified at Points d, e, g, h and i, Clause 3, Article 10 of this Law.
- 100% of medical examination and treatment expenses of the subjects specified at Point a, Clause 3, Article 10 of this Law, expenses outside the scope of health insurance coverage guaranteed by the state budget;
- 100% of medical examination and treatment expenses for elderly people aged 80 years or older;
- 100% of medical examination and treatment costs for medical examination and treatment at the commune level;
-100% of medical examination and treatment expenses for cases where the cost of a medical examination and treatment is lower than the level prescribed by the Government;
-100% of medical examination and treatment expenses when the patient has participated in health insurance for 5 consecutive years or more and the amount of money jointly paid for medical examination and treatment expenses in the year is greater than 6 months' basic salary, except for the case of self-diagnosis and medical treatment at the wrong line;
- 95% of medical examination and treatment expenses for all subjects specified at Point a, Clause 2, Point k, Clause 3 and Point a, Clause 4, Article 10 of this Law;
- 80% of medical examination and treatment expenses for other subjects.
2. In case a person belongs to many subjects participating in health insurance, he/she is entitled to health insurance benefits according to the subject with the highest benefits.
3. In case the holder of the health insurance card goes to a medical facility that is not the place where the initial medical examination and treatment is registered, except for the case specified in Clause 4 of this Article, the insurance fund is covered by the insurance fund. The health care provider shall pay according to the benefit rate specified in Clause 1 of this Article as follows:
- At central level medical examination and treatment establishments, 40% of medical examination and treatment costs are covered by inpatient health insurance; No payment for outpatient medical examination and treatment
- At provincial-level medical examination and treatment establishments, 100% of medical examination and treatment expenses are covered by inpatient health insurance. No payment for outpatient medical examination and treatment;
- At district medical examination and treatment establishments, 100% of medical examination and treatment costs are covered by health insurance;
- At commune medical examination and treatment establishments, 100% of medical examination and treatment costs are covered by health insurance.
In case the provincial or district medical examination and treatment establishments are assigned the task of taking care of people's health in the locality
4. The following subjects participating in health insurance are covered by the health insurance fund 100% of medical examination and treatment expenses covered by inpatient health insurance at medical examination and treatment establishments of level III care. , including:
- Ethnic minorities and people from poor households are living in areas with difficult socio-economic conditions, areas with extremely difficult socio-economic conditions;
- People living in island communes or island districts.
Above is the information we provide to you about health insurance benefits. Best regards!
See details of the Draft Health Insurance Law dated February 15, 2022 here.
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