What are the cases not eligible for health insurance benefits in Vietnam? What are the regulations on family health insurance rates?
What are the cases not eligible for health insurance benefits in Vietnam?
Pursuant to Article 23 of the 2008 Law on Health Insurance of Vietnam, a number of regulations are amended and annulled by Clause 16, Article 1 of the 2014 Law Amendments to the Law on Health Insurance, stipulating the cases not eligible for health insurance benefits in Vietnam as follows:
- Cases specified in Clause 1 of Article 21 in which costs have been paid by the state budget.
- Convalescence at sanatoria or convalescence establishments.
- Medical check-up.
- Prenatal tests and diagnosis for non-treatment purposes.
- Use of obstetric supportive techniques, family planning services or abortion services, except for cases of discontinuation of pregnancy due to fetal or maternal diseases.
- Use of aesthetic services.
- Treatment of squint, myopia and eye refraction defect except for the children under age 6.
- Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.
- Medical examination, treatment and functional rehabilitation in case of disasters.
- Medical examination and treatment for addiction to drugs, alcohol or other habit-forming substances.
- Medical assessment, forensic examination, forensic mental examination.
- Participation in clinical trials or scientific research.
What are the cases not eligible for health insurance benefits in Vietnam? What are the regulations on family health insurance rates in Vietnam?
What are the regulations on family health insurance rates in Vietnam?
Pursuant to Article 13 of the 2008 Law on Health Insurance of Vietnam (amended by Clause 7, Article 1 of the 2014 Law Amendments to the Law on Health Insurance) stipulating family health insurance rates as follows:
Health insurance rates and responsibilities to pay health insurance premiums
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3. All of the members of the households as prescribed in Clause 4 Article 12 of this Law must purchase health insurance. The premiums shall decrease from the second member of a household, in particular:
a) The premiums of the first ones must not exceed 6% of the statutory pay rate;
b) The premiums of the second, third, forth ones shall be equal to 70%, 60%, 50% of the premiums of the first ones respectively;
c) The premiums of fifth ones and the followings shall be equal to 40% of the premiums of the first ones.
Thus, according to the above regulations, it is possible to know how to calculate the purchase of health insurance for the family.
Currently, the statutory pay rate is VND 1,490,000, so the first member has to pay VND 67,050 per month (VND 804,600/year).
How much are the benefit levels of health insurance for medical examination and treatment?
According to the provisions in Clauses 1 and 3, Article 22 of the 2008 Law on Health Insurance of Vietnam (amended by Clause 15, Article 1 of the 2014 Law Amendments to the Law on Health Insurance) on the benefit levels of health insurance 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;
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.
According to each specific case, the benefit levels of health insurance during medical examination and treatment shall comply with the above provisions.
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