What are the benefit levels of health insurance for employees in Vietnam in 2023?
What are the benefit levels of health insurance for employees in Vietnam in 2023?
According to the provisions of Article 22 of the Law on Health Insurance 2008 as amended by Clause 15, Article 1 of the Law on amendments to the Law on Health insurance 2014, the benefit levels of health insurance are specified as follows:
Benefit levels of health insurance
1. The benefit levels of the insured receiving medical examination and treatment in accordance with the regulations in Articles 26, 27 and 28 of this Law whose medical examination and treatment expenditures are covered by the health insurance fund shall be:
a) Total medical examination and treatment expenditures with regard to the insured prescribed in points a, d, e, g, h and i Clause 3 Article 12 of this Law. The costs of the non-covered medical services of the insured prescribed in point a Clause 3 Article 12 of this Law shall be paid by the health insurance budget used for medical examination and treatment of these insured persons; if this budget is insufficient, the State budget shall be in charge.
b) Total medical examination and treatment expenditures with regard to any medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government.
c) Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals;
d) 95% of the medial examination and treatment expenditures with regard to the insured prescribed in point a Clause 2, point k Clause 3 and point a Clause 4 Article 12 of this Law;
dd) 80 % of the medial examination and treatment expenditures with regard to other insured persons;
2. In case an insured person belongs to different groups of the insured, (s)he shall be provided with the highest health insurance benefits.
3. In case any card holder goes to a hospital different from the registered hospital except for the insured prescribed in Clause 1 this Article, his or her costs shall be covered by the health insurance fund according to the benefit levels prescribed in Clause 1 this Article as follows:
a) 40% of the inpatient treatment expenditures at the central hospitals.
b) 60% of the inpatient treatment expenditures at the provincial hospitals from the effective date of this Law to December 31, 2020; total inpatient treatment costs from January 01, 2021 at all hospitals in Vietnam.
c) 70% of the medical examination and treatment expenditures at the district hospitals from the effective date of this Law to December 31, 2015; total medical examination and treatment expenditures from January 01, 2016.
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Thus, according to the above regulations, the benefit levels of the insured receiving medical examination and treatment whose medical examination and treatment expenditures are covered by the health insurance fund shall be:
- Total medical examination and treatment expenditures with regard to any medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government.
- Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals;
- 80 % of the medial examination and treatment expenditures with regard to other insured persons.
What are the benefit levels of health insurance for employees in Vietnam in 2023? (Image from the Internet)
Vietnam: Are employees entitled to health insurance benefits when the employers are late in paying health insurance?
In Article 49 of the Law on Health Insurance 2008, amended by Clause 28, Article 1 of the Law on amendments to the Law on Health insurance 2014, regulations on handling violations are as follows:
Handling of violations
1. Any person who violates the regulations of this Law or relevant law regulations on health insurance shall be disciplined, penalized for administrative violations or liable to criminal prosecution according to nature and severity of the violations. In case of any damage, compensation must be offered under the regulations of the law.
2. Any organization and association that violates the regulations of this Law or relevant law regulations on health insurance shall be penalized for administrative violations. In case of any damage, a compensation must be offered under the regulations of the law.
3. The employers in charge of paying health insurance that fail to discharge their duties shall be penalized as follows:
a) The employers must pay the unpaid premiums and the interest as twice as the inter-bank interest rate calculated according to the unpaid premiums and time; if they do not follow the regulations, the State Treasuries shall deduct the money from the deposit account of the employers to transfer the unpaid premiums and their interest to the account of the health insurance fund according to the request of other competent persons, banks or credit institutions.
b) The employers must pay all the expenditures for the employees within their scope of benefits, benefit levels that the employees pay during the time they are not provided with the health insurance cards
Thus, according to the above regulations, employees are not entitled to health insurance. However, the employers must pay all the expenditures for the employees within their scope of benefits, benefit levels that the employees pay during the time they are not provided with the health insurance cards.
What are the penalties for late payment of health insurance for employees in Vietnam?
Penalties for late payment of health insurance by employers are prescribed in Clause 2, Article 80 of Decree 117/2020/ND-CP as follows:
Violations against regulations on health insurance contributions
1. A warning or a fine ranging from VND 300.000 to VND 500.000 shall be imposed upon a compulsory health insurance policyholder for failing to make health insurance contributions.
2. The following fines shall be imposed upon an employer for failing to pay, insufficiently or lately paying health insurance contributions for his/her employees who are subjected to compulsory health insurance, or evading payment of health insurance contributions:
a) A fine ranging from VND 1.000.000 to VND 3.000.000 shall be imposed for the violation involving less than 10 employees;
b) A fine ranging from VND 3.000.000 to VND 5.000.000 shall be imposed for the violation involving from 10 to less than 50 employees;
c) A fine ranging from VND 5.000.000 to VND 10.000.000 shall be imposed for the violation involving from 50 to less than 100 employees;
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5. Remedial measures:
a) The violating entity is compelled to make compensations for any damage incurred by health insurance policyholders in case of commission of the violation in Clause 2, 3 or 4 of this Article. Any payments which cannot be made to payers shall be paid to state budget in accordance with regulations of law;
b) Any benefits illegally obtained from the violation in Clause 2, 3 or 4 of this Article shall be paid to account of the health insurance fund.
* Note: The above penalty level applies to individuals, the organizational penalty level is 2 times the penalty level for individuals.
Thus, according to the above regulations, the penalty level will depend on the number of employees for whom the enterprise is late in paying health insurance. In addition, the violating entity is compelled to make compensations for any damage incurred by health insurance policyholders in case of commission of the violation in Clauses 2, 3 and 4, Article 80 of Decree 117/2020/ND-CP.
Any payments which cannot be made to payers shall be paid to state budget in accordance with regulations of law.
Any benefits illegally obtained from the violation in Clause 2, 3 or 4 of Article 80 of Decree 117/2020/ND-CP shall be paid to account of the health insurance fund.
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