Participants in Household Health Insurance in 2023: Who Are They? What Are the Contribution Rates?
Who is covered under the family-based health insurance in 2023?
Based on Clause 5, Article 17 of the Procedure issued with Decision 595/QD-BHXH of 2017, supplemented by Clause 20, Article 1 of Decision 505/QD-BHXH of 2020, and Article 2 of Decision 490/QD-BHXH of 2023, the group participating in family-based health insurance is stipulated as follows:
Entities participating in health insurance as regulated in Article 12 of the Health Insurance Law and guiding documents. Specifically:
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5. Group participating in family-based health insurance, includes:
5.1. All individuals listed in the household registration book, except for those stipulated in Clauses 1, 2, 3, and 4 of this Article and those who have declared temporary absence;
5.2. All individuals listed in the temporary residence book, except for those stipulated in Clauses 1, 2, 3, and 4 of this Article;
5.3. The following individuals can participate in health insurance under the family mode:
a) Religious dignitaries, officers, and monks;
b) Persons living in social protection establishments who are not sponsored by the state budget to pay health insurance.
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Thus, according to the above regulations, the entities participating in family-based health insurance include:
- All individuals listed in the household registration book, except for:
+ Groups where contributions are made by the employee and the employer;
+ Groups where contributions are made by social insurance organizations;
+ Groups where contributions are made by the state budget;
+ Groups receiving support from the state budget for contributions;
+ Those who have declared temporary absence;
- All individuals listed in the temporary residence book, except for:
+ Groups where contributions are made by the employee and the employer;
+ Groups where contributions are made by social insurance organizations;
+ Groups where contributions are made by the state budget;
+ Groups receiving support from the state budget for contributions;
- The following individuals who can participate in family-based health insurance:
+ Religious dignitaries, officers, monks;
+ Persons living in social protection establishments who are not sponsored by the state budget to pay health insurance.
Who are covered under the family-based health insurance in 2023, and what are the premiums? (Image from Internet)
What are the current family-based health insurance premiums?
Based on Decree 146/2018/ND-CP guiding the Health Insurance Law:
At point e, Clause 1, Article 7 of Decree 146/2018/ND-CP stipulates:
Insurance premiums and responsibilities for paying health insurance
1. The monthly health insurance premium for various entities is stipulated as follows:
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e) Health insurance premiums for the entities specified in Article 5 of this Decree are as follows: The first person pays 4.5% of the statutory pay rate; the second, third, and fourth persons pay 70%, 60%, and 50% respectively of the first person's premium; from the fifth person onwards, they pay 40% of the first person's premium.
2. For entities receiving support from the state budget for insurance premiums, the reduction as stipulated in point e, Clause 1 of this Article does not apply.
3. In cases where the entities specified in Clause 1, Article 1 of this Decree have additional one or more indefinite-term labor contracts or fixed-term labor contracts of at least 3 months, they shall pay health insurance premiums based on the highest salary stipulated in the labor contracts.
4. In cases where the entities participating in health insurance according to Article 6 of this Decree simultaneously belong to multiple different health insurance participation categories as stipulated in Articles 1, 2, 3, and 4 of this Decree, the health insurance premium shall be paid in the following order: Paid by the employee and employer; paid by the social insurance agency; paid by the state budget; paid by the employer.
5. The Ministry of Health shall take the lead, in cooperation with the Ministry of Finance, in submitting to the Government of Vietnam to adjust health insurance premiums to ensure the balance of the health insurance fund, in line with the capabilities of the state budget and contributions of entities responsible for paying health insurance premiums as stipulated in the Health Insurance Law.
The health insurance premiums for family-based health insurance are determined as follows:
- The first person: 4.5% of the statutory pay rate;
- The second person: 70% of the first person's premium (3.15% of the statutory pay rate);
- The third person: 60% of the first person's premium (2.7% of the statutory pay rate);
- The fourth person: 50% of the first person's premium (2.25% of the statutory pay rate);
- The fifth person onwards: 40% of the first person's premium (1.8% of the statutory pay rate).
What is the statutory pay rate used for family-based health insurance premiums?
Based on Article 3 of Decree 24/2023/ND-CP, it is stipulated as follows:
Statutory Pay Rate
1. The statutory pay rate is used as the basis for:
a) Calculating the salary levels in the salary tables, allowances, and implementing other policies as prescribed by law for the entities specified in Article 2 of this Decree;
b) Calculating operational and living expenses according to the law;
c) Calculating deductions and policies enjoyed based on the statutory pay rate.
2. From July 1, 2023, the statutory pay rate is 1,800,000 VND/month.
The statutory pay rate used for family-based health insurance premiums is currently 1,800,000 VND.
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