Health Insurance Coverage for Hospital Visits During Lunar New Year 2024: Who Qualifies for State-Supported Health Insurance Premium Contributions?
Is health insurance covered for hospitalized patients during Lunar New Year 2024?
Based on Point a Clause 10 Article 27 of Decree 146/2018/ND-CP regulating the payment of medical examination and treatment costs in certain cases as follows:
Payment of medical examination and treatment costs in certain cases
1. Payment of medical examination and treatment costs for children under 6 years old in cases where they do not have health insurance cards: Medical examination and treatment establishments aggregate the list of children under 6 years old and health insurance medical examination and treatment costs according to the entitled range and payment levels and send it to the social insurance agency for payment as regulated.
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10. Payment of medical examination and treatment costs for medical establishments that provide health insurance medical examination and treatment on holidays and public holidays:
a) Persons with health insurance cards receiving medical examination and treatment are entitled to payment by the health insurance fund within the entitled range and payment levels of health insurance;
b) Medical establishments are responsible for ensuring personnel, professional conditions, and publicizing the costs that patients must pay beyond the entitled range and payment levels of health insurance, and must notify patients in advance; notify the social insurance agency in writing to supplement the medical examination and treatment contract before conducting medical examination and treatment on holidays and public holidays as a basis for payment.
Thus, patients with health insurance cards receiving medical examination and treatment during the Lunar New Year are still covered by the health insurance fund within the entitled range and payment levels as usual, as long as the health insurance medical examination and treatment procedures are ensured.
Is health insurance covered for hospitalized patients during Lunar New Year 2024? Who is supported by the state to pay health insurance premiums? (Image from the Internet)
Who is supported by the state to pay health insurance premiums in 2024?
In Article 4 of Decree 146/2018/ND-CP amended and supplemented by Clause 2 Article 1 of Decree 75/2023/ND-CP five groups are specified to be supported by the state to pay health insurance premiums as follows:
(1) People belonging to near-poor households according to the near-poor household standard phase 2022-2025 regulated in Decree 07/2021/ND-CP and other documents by competent authorities amending, supplementing, or replacing the near-poor household standards applied for each phase.
(2) People belonging to multidimensional poor households not falling under the case regulated at Point a Clause 9 Article 3 of Decree 146/2018/ND-CP.
(3) Students.
(4) People belonging to households engaged in agriculture, forestry, fishery, and salt production with an average living standard according to the average living standard household standard phase 2022-2025 regulated in Decree 07/2021/ND-CP and other documents by competent authorities amending, supplementing, or replacing the average living standard household standards applied for each phase.
(5) Ethnic minorities living in areas of level 2, level 3 communes, particularly difficult villages within ethnic minorities and mountainous regions for the phase 2016-2020 and these communes are no longer on the list of level 2, level 3 communes, particularly difficult villages within ethnic minorities and mountainous regions for the phase 2021-2025 as determined by the Prime Minister's decision.
Note: For group 5, the state budget supports the health insurance premium payment for 36 months from November 01, 2023 (according to the provisions of Article 3 of Decree 75/2023/ND-CP).
In which cases are individuals not entitled to health insurance benefits?
According to Clause 7 Article 23 of the Law on Health Insurance 2008 amended by Clause 16 Article 1 of the Law on Health Insurance Amendments 2014, individuals are not entitled to health insurance benefits when falling under one of the following cases:
- Costs in the cases stipulated in Clause 1 Article 21 of the Law on Health Insurance 2008 have been covered by the state budget.
- Convalescence and rehabilitation at convalescence and rehabilitation establishments.
- General health check-ups.
- Pregnancy tests and diagnosis not for treatment purposes.
- Using assisted reproductive techniques, family planning services, abortion, except for cases where the pregnancy must be terminated due to pathological reasons of the fetus or the pregnant woman.
- Cosmetic services.
- Treatment of strabismus, myopia, and refractive errors of the eyes, except for children under 6 years old.
- Using medical supplies replacements including prosthetic limbs, artificial eyes, dentures, glasses, hearing aids, and mobility aids in medical examination, treatment, and functional rehabilitation.
- Medical examination, treatment, and rehabilitation in disaster cases.
- Medical examination and treatment for drug addiction, alcoholism, or other addictive substances.
- Medical examination for judicial expertise, forensic expertise, and forensic psychiatric expertise.
- Participation in clinical trials and scientific research.
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