What are methods of payment of healthcare costs covered by the health insurance fund in Vietnam from July 16, 2024? What are the healthcare costs covered by the health insurance fund in Vietnam from July 1, 2024?
Procedures for payment of healthcare costs covered by the health insurance fund Effective from July 16, 2024
On July 16, 2024, Vietnam Social Security issued Decision 1003/QD-BHXH 2024 announcing the amended administrative procedures in the field of implementing the health insurance policy under the authority of Vietnam Social Security.
The procedures for the payment of healthcare costs covered by the health insurance fund with healthcare facilities are implemented as follows:
Step 1. Prepare and submit the dossier:
- Within 7 working days (from the end date of the medical examination and treatment for the patient), the health insurance medical examination and treatment facility must send the electronic data requesting payment of health insurance examination and treatment costs to the Data Reception Portal of the Health Insurance Assessment Information System of Vietnam Social Security (hereinafter referred to as the Health Insurance Assessment Portal), data arising in the last days of the month or quarter or year to the Health Insurance Assessment Portal before the 5th day of the following month.
- During the first 15 days of each month, the health insurance medical examination and treatment facility prepares a consolidated list of healthcare costs of health insurance participants (Form C79-HD) for the previous month and submits it to the Social Insurance Agency.
- Within the first 15 days of each quarter, the health insurance medical examination and treatment facility submits the quarterly report on the settlement of healthcare costs covered by the health insurance fund for the previous quarter to the Social Insurance Agency.
Step 2. The Social Insurance Agency receives the dossier and processes it as regulated.
Regarding the method of implementation:
- The health insurance medical examination and treatment facility submits the dossier online or directly at the Social Insurance Agency or through public postal services (simultaneously sending the data requesting payment to the Health Insurance Assessment Portal as regulated in Circular 48/2017/TT-BYT).
- Implement signing the cost settlement record of health insurance medical examination and treatment at the headquarters of the Social Insurance Agency or at the medical examination and treatment facility.
Regarding the dossier components: Consolidated cost list of medical examination and treatment of health insurance participants (according to Form No. C79-HD issued with Circular 102/2018/TT-BTC). Includes 01 set along with electronic data.
Regarding the processing time: No later than 40 days from the date the Social Insurance Agency receives the complete and valid dossier.
What are methods of payment of healthcare costs covered by the health insurance fund in Vietnam from July 16, 2024?' (Internet image)
What are the healthcare costs covered by the health insurance fund in Vietnam from July 1, 2024?
Article 30 of Decree 146/2018/ND-CP stipulates the direct payment levels for healthcare costs covered by the health insurance fund as follows:
Direct Payment Levels
1. If the patient goes to a medical examination and treatment facility at the district level and equivalent without a health insurance medical examination and treatment contract (except in case of emergency), the payment is as follows:
a) For outpatient medical examination and treatment, payment is made according to the actual incurred costs within the benefit scope and benefit level of health insurance as regulated but not exceeding 0.15 times the statutory pay rate at the time of medical examination and treatment;
b) For inpatient medical examination and treatment, payment is made according to the actual incurred costs within the benefit scope and benefit level of health insurance as regulated but not exceeding 0.5 times the statutory pay rate at the time of discharge.
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The direct payment level for health insurance medical examination and treatment from July 1, 2024, when the statutory pay rate increases to 2.34 million VND (Decree 73/2024/ND-CP) changes as follows:
| Instance | Before July 1 | After July 1 |
| Outpatient (no more than 0.15 times statutory pay rate) | 270,000 VND | 351,000 VND |
| Inpatient (no more than 0.5 times statutory pay rate) | 900,000 VND | 1,170,000 VND |
| Inpatient treatment at provincial level and equivalent without health insurance medical examination and treatment contract (no more than one month statutory pay rate) | 1.8 million VND | 2.34 million VND |
| Inpatient treatment at central level and equivalent without health insurance medical examination and treatment contract (no more than 2.5 times statutory pay rate) | 4.5 million VND | 5.85 million VND |
On July 1, 2024, the Ministry of Health issued Official Dispatch 3687/BYT-BH 2024 applying the statutory pay rate according to the regulations of Decree 73/2024/ND-CP in the payment of healthcare costs covered by the health insurance fund.
In Section 2 of Official Dispatch 3687/BYT-BH 2024, the Ministry of Health guides the direct payment levels for healthcare costs covered by the health insurance fund from July 1, 2024, when the statutory pay rate increases to 2.34 million VND as follows:
(2) Regarding direct payment levels as stipulated in Article 30 of Decree 146/2018/ND-CP from July 1, 2024, or if the patient was admitted to the hospital or started treatment before July 1, 2024, but discharged or ended treatment from July 1, 2024:
- At Point a, Clause 1, the maximum amount not exceeding 0.15 times the statutory pay rate: equivalent to a maximum of 351,000 VND (Three hundred and fifty-one thousand VND).
- At Point b, Clause 1, the maximum amount not exceeding 0.5 times the statutory pay rate: equivalent to a maximum of 1,170,000 VND (One million one hundred seventy thousand VND).
- At Clause 2, the maximum amount not exceeding 1.0 times the statutory pay rate: equivalent to a maximum of 2,340,000 VND (Two million three hundred forty thousand VND).
- At Clause 3, the maximum amount not exceeding 2.5 times the statutory pay rate: equivalent to a maximum of 5,850,000 VND (Five million eight hundred fifty thousand VND).
If the patient was admitted to the hospital or started treatment before July 1, 2024, but was discharged or ended treatment from July 1, 2024, the direct payment levels for healthcare costs covered by the health insurance fund are calculated as above.
What are the cases eligible for direct payment of healthcare costs covered by the health insurance fund in Vietnam?
In Clause 2, Article 31 of Health Insurance Law 2008 (amended by Clause 20, Article 1 of the Amended Health Insurance Law 2014) and Clause 1, Article 4 of Circular 09/2019/TT-BYT, it is stipulated that persons holding health insurance cards are entitled to direct payment of healthcare costs in the following cases:
- At a medical examination and treatment facility without a health insurance medical examination and treatment contract;
- Medical examination and treatment not conforming to health insurance medical examination and treatment procedures;
- The insured person has participated in health insurance for 5 consecutive years or more and has co-paid the healthcare costs in the year exceeding 6 months’ statutory pay rate (except for cases of self-referral to a non-compliant medical facility) but has not yet received the reimbursement for the amount exceeding 6 months’ statutory pay rate;
- The data of the health insurance card is not provided or provided inaccurately regarding the information on the health insurance card;
- The insured person cannot present the health insurance card before discharge, transfer on the same day due to emergency, loss of consciousness, or death, or lost the card but has not been reissued.
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