Which Individuals Are Entitled to 100% Health Insurance Medical Examination and Treatment Costs from October 19, 2023?
Who Is Entitled to 100% Health Insurance Coverage for Medical Examination and Treatment Costs from October 19, 2023?
At point a, clause 1, Article 14 of Decree 146/2018/ND-CP, as amended by clause 5, Article 1 of Decree 75/2023/ND-CP, it is stipulated the health insurance coverage level for the cases specified in clause 1 and clause 7, Article 22 of the Health Insurance Law 2008 as follows:
Health Insurance Coverage Level for the Cases Specified in Clause 1 and Clause 7, Article 22 of the Health Insurance Law
1. Participants in health insurance when they go for medical examinations and treatments in accordance with Articles 26, 27, and 28 of the Health Insurance Law; clauses 4 and 5, Article 22 of the Health Insurance Law, are entitled to have their medical examination and treatment costs covered by the health insurance fund to the extent of the coverage as follows:
a) 100% of medical examination and treatment costs for subjects as stipulated in clauses 3, 4, 5, 8, 9, 11, 17, and 20, Article 3 of this Decree.
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At Article 3 of Decree 75/2023/ND-CP, the enforcement is regulated as follows:
Enforcement
1. This Decree takes effect from December 3, 2023.
2. The provisions at clause 1, points a and b of clause 2, clauses 3, 4, 5, and 6 of Article 1 of this Decree shall apply from October 19, 2023.
3. The State budget shall support the subjects specified at point c, clause 2 of Article 1 of this Decree for a period of 36 (thirty-six) months from November 1, 2023.
4. The provisions at clause 8 of Article 1 and clause 3 of Article 2 of this Decree shall apply from January 1, 2019. The payment and settlement for health insurance medical examination and treatment costs from January 1, 2019, shall be implemented according to the provisions at Articles 30, 31, and clause 2 of Article 32 of the Health Insurance Law and the provisions at clause 8 of Article 1 of this Decree.
The 8 subjects entitled to 100% health insurance coverage for medical examination and treatment costs include:
- People with meritorious services to the revolution as regulated by the Ordinance on Preferential Treatment to People with Meritorious Services to the Revolution 2020.- Veterans.- People entitled to monthly social protection allowances as regulated by the laws on the elderly, the disabled, and social protection beneficiaries.- People belonging to poor households; ethnic minorities living in economically and socially deprived areas; people living in extremely difficult economic and social regions; people living in island communes and districts, among others.- Relatives of martyrs.- People aged 80 and above receiving monthly survivorship pensions.- People participating in the resistance and national defense as prescribed by law.- Residents of safe zone communes and revolutionary safe zone regions during the French and American wars currently residing in revolutionary safe zone communes recorded in the national database on population and residence databases.
Who is entitled to 100% health insurance coverage for medical examination and treatment costs from October 19, 2023? (Image from Internet)
What Are the Principles of Health Insurance as Regulated?
Based on the provisions at Article 3 of the Health Insurance Law 2008 (as amended by clause 2, Article 1 of the Amended Health Insurance Law 2014) as follows:
Principles of Health Insurance
1. Ensure risk-sharing among health insurance participants.
2. Health insurance premiums are determined based on a percentage of the salary serving as the basis for compulsory social insurance contributions as stipulated by the Social Insurance Law (generally referred to as monthly salary), pensions, allowances, or statutory pay rate.
3. The extent of health insurance benefits is based on the severity of illness, the category of subjects within the scope of benefits, and the duration of participation in health insurance.
4. Health insurance medical examination and treatment costs are shared by the health insurance fund and health insurance participants.
5. The health insurance fund is centrally managed, unified, transparent, ensuring balanced revenue and expenditure, and is protected by the State.
Thus, currently, health insurance is implemented according to the principles outlined above.
What Information Does the Health Insurance Card Contain?
Based on the provisions at Article 12 of Decree 146/2018/ND-CP, the health insurance card issued by the social insurance agency reflects the following information:
- Personal information of the health insurance participant, including: Full name; gender; date of birth; address of residence or workplace.- Health insurance benefit level.- The effective date of the health insurance card.- The initial registration location for health insurance medical examination and treatment.- Duration of participation in health insurance.- A photo of the health insurance participant (except for children under 6 years old) in cases where the health insurance participant does not have personal identity documents with a photo issued by a competent authority or a certification from the local police or other legal identity documents.
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