How to determine household-based health insurance contributions in Vietnam? What are regulations on health insurance benefits for households in 2024?

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How to determine household-based health insurance contributions for 2024 in Vietnam?

- Based on Point e, Clause 1, Article 7 of Decree 146/2018/ND-CP, the monthly household-based health insurance contribution for 2024 is as follows:

+ The first member of the household contributes 4.5% of the statutory pay rate; the second, third, and fourth members contribute 70%, 60%, and 50% of the first member's contribution, respectively; from the fifth member onward, the contribution is 40% of the first member's contribution.

+ The reduction in health insurance contributions as stipulated in this point is applied when household members join health insurance within the same financial year.

- Based on Clause 2, Article 3 of Decree 24/2023/ND-CP, the current statutory pay rate is VND 1,800,000/month.

Therefore, the household-based health insurance contributions for 2024 are as follows:

However, from July 1, 2024, when the wage reform is implemented, the statutory pay rate will be abolished. Thus, there may be new guidelines for household-based health insurance contributions from July 1, 2024.

How to determine household-based health insurance contributions in Vietnam? What are regulations on health insurance benefits for households in 2024? (Image from the internet)

Who is eligible to participate in household-based health insurance in Vietnam in 2024?

Based on Article 5 of Decree 146/2018/ND-CP amended by Article 2 of Decree 104/2022/ND-CP, the eligible participants for household-based health insurance in 2024 include:

- Individuals with their names registered in the same household registry, except those specified in Articles 1, 2, 3, 4, and 6 of Decree 146/2018/ND-CP:

+ Group contributed by employees and employers;

+ Group contributed by social insurance agencies;

+ Group financed by the state budget;

+ Group having partial state budget contribution support;

+ Group with contributions from employers.

- Individuals with their names registered in the same temporary residence, except those specified in Articles 1, 2, 3, 4, and 6 of Decree 146/2018/ND-CP and those participating in health insurance according to Clause 1, Article 5 of Decree 146/2018/ND-CP.

- The following individuals can participate in health insurance in the form of household insurance:

- Clergy and dignitaries;

- Individuals living in social protection establishments, except those specified in Articles 1, 2, 3, 4, and 6 of Decree 146/2018/ND-CP who are not supported by the state budget for health insurance contributions.

How are the health insurance benefits for households regulated in 2024?

Based on Article 14 of Decree 146/2018/ND-CP amended by Clause 1, Article 183 of Decree 131/2021/ND-CP, and Point a, Clause 5, Article 1 of Decree 75/2023/ND-CP, the health insurance benefits for households are as follows:

Health insurance benefit levels for cases specified in Clause 1 and Clause 7, Article 22 of the Health Insurance Law

1. Individuals participating in health insurance when seeking medical examination and treatment according to the provisions of Articles 26, 27, and 28 of the Health Insurance Law; Clauses 4 and 5, Article 22 of the Health Insurance Law, will have their medical examination and treatment expenses covered by the health insurance fund within the coverage limits with the following benefit levels:

a) 100% of medical examination and treatment costs for individuals specified in Clauses 3, 4, 5, 8, 9, 11, and 17 of Article 3 of this Decree;

b) 100% of medical examination and treatment costs without applying a ratio limit on the payment for drugs, chemicals, medical supplies, and technical services as stipulated by the Minister of Health for:

- Revolutionary activists before January 1, 1945;

- Revolutionary activists from January 1, 1945, to the August Revolution 1945;

- Heroic Vietnamese Mothers;

- War invalids, individuals receiving policies like war invalids, type B war invalids, disabled veterans with a labor reduction of 81% or more;

- War invalids, individuals receiving policies like war invalids, type B war invalids, disabled veterans receiving treatment for relapsing injuries or diseases;

- Resistance activists affected by chemical toxins with a labor reduction rate of 81% or more;

- Children under six years old.

c) 100% of medical examination and treatment costs at the commune level;

d) 100% of medical examination and treatment costs if the cost for one medical visit is less than 15% of the statutory pay rate;

dd) 100% of medical examination and treatment costs when patients have participated in health insurance for five consecutive years or more and have co-paid amounts for medical examination and treatment expenses within a year exceeding six months' statutory pay rate, except for cases of improper medical examination and treatment;

e) 95% of medical examination and treatment costs for groups specified in Clause 1, Article 2, Clause 12, Article 3, and Clauses 1 and 2, Article 4 of this Decree;

g) 80% of medical examination and treatment costs for other groups;

h) Patients diagnosed and treated at superior-level medical facilities and referred back to commune-level medical facilities for management, monitoring, and medication supply according to the regulations of the Minister of Health, will have their expenses covered within the permissible limits and rates specified in point a, b, dd, e, and g, Clause 1 of this Article.

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Thus, the health insurance benefits for households in 2024 will be as follows:

- For medical examination at the commune level, the benefit rate is 100%.

- For proper medical examinations and treatments with expenses less than 15% of the statutory pay rate, the benefit rate is 100%.

- The benefit rate is 100% for medical examination and treatment costs when patients have attended health insurance for five consecutive years or more and the co-paid amount exceeds six months' statutory pay rate within a year, except for improper medical examinations and treatments.

- The benefit rate is 80% if the medical examination and treatment costs are 15% of the statutory pay rate or more.

*Note: From July 1, 2024, when the wage reform is implemented, the statutory pay rate will be abolished. Therefore, there may be new guidelines regarding household-based health insurance benefits from July 1, 2024.