Changes in Health Insurance Contribution Rates and Medical Examination and Treatment Costs from July 1, 2024, with the Implementation of the 2024 Salary Reform in Vietnam
Changes in Health Insurance Contribution Rates and Medical Examination and Treatment Costs from July 1, 2024, with the Implementation of the 2024 Salary Reform in Vietnam
Currently, the health insurance contribution rates are stipulated in Article 7 of Decree 146/2018/ND-CP as follows:
Monthly Health Insurance Contribution Rates and Responsibilities
1. The monthly health insurance contribution rates for different subjects are as follows:
a) Equivalent to 4.5% of the employee's monthly salary for subjects prescribed in Clause 1, Article 1 of this Decree.
- Employees taking sick leave for 14 days or more in the month, as stipulated by social insurance law, are not required to contribute to health insurance but still enjoy health insurance benefits;
- Employees under temporary detention, temporary custody, or temporary suspension of work for investigation will contribute 4.5% of 50% of their monthly salary during such periods. If the competent authority concludes there is no violation of the law, employees must retroactively pay health insurance on the recovered wages;
b) Equivalent to 4.5% of the pension or loss of working capacity allowance for subjects prescribed in Clause 1, Article 2 of this Decree;
c) Equivalent to 4.5% of the employee's monthly salary before maternity leave for subjects prescribed in Clause 5, Article 2 of this Decree;
d) Equivalent to 4.5% of the unemployment benefit for subjects prescribed in Clause 6, Article 2 of this Decree;
dd) Equivalent to 4.5% of the statutory pay rate for other subjects;
e) Health insurance contribution rates for subjects prescribed in Article 5 of this Decree are as follows: The first person contributes 4.5% of the statutory pay rate; the second, third, and fourth persons contribute 70%, 60%, and 50%, respectively, of the first person's contribution; from the fifth person onwards, they contribute 40% of the first person's contribution.
The reduction in health insurance contributions per this point shall apply when household members join health insurance in the same fiscal year.
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According to the above regulations, health insurance contributions are based on the statutory pay rate. However, on November 10, the National Assembly passed a resolution on the state budget estimates for 2024. The resolution clearly states that from July 1, 2024, comprehensive wage policy reforms will be implemented as per Resolution 27-NQ/TW 2018 of the Seventh Conference, the 12th Party Central Committee.
Specifically, Clause 1, Article 3 of Resolution 104/2023/QH15 states that from July 1, 2024, officials, public employees, and armed forces will undergo comprehensive wage policy reforms. From this date, the statutory pay rate will be abolished and replaced by new basic salary scales with specific amounts.
Thus, with the Salary Reform from July 1, 2024, the health insurance contribution rates for 2024 will also change.
Currently, no official document specifically stipulates the health insurance contribution rates starting from July 1, 2024.
Changes in Health Insurance Contribution Rates and Medical Examination and Treatment Costs from July 1, 2024, with the Implementation of the 2024 Salary Reform in Vietnam? (Image from the Internet)
What Are Benefits of Continuous Health Insurance Contributions for 5 Years in Vietnam?
Article 22 of the Health Insurance Law 2008 amended by Clause 15, Article 1 of the Amended Health Insurance Law 2014 provides for health insurance benefits as follows:
Health Insurance Benefits
1. Participants in health insurance who undergo medical examinations and treatment as prescribed in Articles 26, 27, and 28 of this Law shall be covered by the health insurance fund for medical expenses within the coverage limits, with the following benefit levels:
a) 100% of medical examination and treatment costs for subjects specified at Points a, d, e, g, h, and i, Clause 3, Article 12 of this Law. Medical examination and treatment expenses outside the scope of health insurance for subjects specified at Point a, Clause 3, Article 12 of this Law shall be paid from the health insurance fund for the group of these subjects; if this fund is insufficient, the state budget will ensure the remaining amount;
b) 100% of medical examination and treatment costs if the expenses for one-time medical examination and treatment are lower than the amount stipulated by the Government of Vietnam and for medical examinations and treatments at the commune level;
c) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has co-paid for medical examination and treatment costs within the year exceeding 6 months' statutory pay rate, except for cases of self-referral;
d) 95% of medical examination and treatment costs for subjects specified at Point a, Clause 2; Point k, Clause 3; and Point a, Clause 4, Article 12 of this Law;
dd) 80% of medical examination and treatment costs for other subjects.
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Thus, patients who have participated in health insurance for 5 consecutive years or more and have co-paid medical examination and treatment costs within the year exceeding 6 months' statutory pay rate will enjoy the following benefits:
- 100% of medical examination and treatment costs when the patient visits for medical examinations and treatments.
Note: If patients self-refer for medical examinations and treatments not in accordance with the referral regulations, they will not enjoy 100% of medical expenses even after participating in health insurance for 5 consecutive years, except for treatments at district hospitals where 100% coverage is maintained as per regulations.
Who Will Participate in Health Insurance in Vietnam in 2024?
Article 12 of the Health Insurance Law 2008 (amended by Clause 6, Article 1 of the Amended Health Insurance Law 2014) stipulates the subjects participating in health insurance as follows:
Subjects Participating in Health Insurance
1. The group with contributions by workers and employers, including:
a) Employees with indefinite-term labor contracts or fixed-term labor contracts of 3 months or more; managers of enterprises receiving a salary; officials and public employees (hereinafter referred to as employees);
b) Non-specialized staff working in communes, wards, and commune-level towns as prescribed by law.
2. The group with contributions by social insurance organizations, including:
a) Recipients of pensions and monthly allowances for loss of working capacity;
b) Persons receiving monthly social insurance allowances due to labor accidents, occupational diseases, or illnesses requiring long-term treatment; persons aged 80 or above receiving monthly survivor benefits;
c) Former commune, ward, and commune-level town officials receiving monthly social insurance allowances;
d) Persons receiving unemployment benefits.
3. The group with contributions by the state budget, including:
a) Officers, professional soldiers, non-commissioned officers, conscripts serving in the military; officers, non-commissioned officers in professional and technical services serving in the public security forces, students in security academies, non-commissioned officers and conscripts serving fixed terms in the public security forces; persons undertaking cipher work receiving salaries equivalent to military personnel; students in cipher work academies enjoying policies equivalent to those in military academies;
b) Former commune, ward, and commune-level town officials receiving monthly allowances from the state budget;
c) Persons no longer receiving monthly allowance for loss of working capacity supported by the state budget;
d) Persons with meritorious services to the revolution, war veterans;
dd) Incumbent National Assembly and People's Council members;
e) Children under 6 years old;
g) Persons receiving monthly social protection allowances;
h) Persons belonging to poor households; ethnic minorities living in areas with difficult socio-economic conditions; persons living in areas with extremely difficult socio-economic conditions; persons living in island communes, island districts;
i) Relatives of persons with meritorious services to the revolution, including biological parents, spouses, and children of martyrs; persons responsible for raising martyrs;
k) Relatives of persons with meritorious services to the revolution, except those specified at Point i of this Clause;
l) Relatives of subjects specified at Point a, Clause 3 of this Article;
m) Persons who have donated human organs as prescribed by law;
n) Foreign students studying in Vietnam receiving scholarships from the Vietnamese state budget.
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Subjects participating in health insurance shall comply with the provisions of Article 12 of the Health Insurance Law 2008.
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