Vietnam: Who will have their rates of entitlement to health insurance coverage increased from 80% to 100% from October 19, 2023?
Vietnam: Who will have their rates of entitlement to health insurance coverage increased from 80% to 100% from October 19, 2023?
Pursuant to Point a, Clause 1, Article 14 of Decree 146/2018/ND-CP, amended in Clause 5, Article 1, Decree 75/2023/ND-CP as follows:
Rates of entitlement to health insurance coverage with respect to cases prescribed in clause 1 and clause 7 of Article 22 in Law on Health Insurance
1. When receiving medical examination and treatment services in accordance with Article 26, 27 and 28 in the Law on Health Insurance; clause 4 and 5 of Article 22 in the Law on Health Insurance, health insurance policyholders shall be entitled to the health insurance fund’s coverage of permissible medical costs at the following rates:
a) 100% of medical costs paid by the policyholders prescribed in Clauses 3, 4, 5, 8, 9, 11, 17 and 20 Article 3 herein;
Thus, the regulation on rates of entitlement to health insurance coverage mentioned above has added 02 additional subjects in Clause 5, Clause 20, Article 3 of Decree 146/2018/ND-CP.
In particular, the subjects in Clause 20, Article 3 of Decree 146/2018/ND-CP are a new group of subjects just added in Decree 75/2023/ND-CP.
Regarding the subjects in Clause 5, Decree 146/2018/ND-CP, according to the old regulations, this group of subjects belongs to the group of "other subjects" entitled to 80% of medical costs. Therefore, when the new regulations are applied, the rates of entitlement to health insurance coverage for this group of subjects will be increased to 100%.
Specifically, this group are people participating in the resistance war and defending the Fatherland, including:
No | Sujects |
1 | Persons fighting the war against the US for protection of the Motherland who have been granted benefits under one of the following documents: |
2 | Persons who have already been entitled to benefits under the Decision No. 62/2011/QD-TTg but are not veterans as stipulated in clause 4 of this Article 3 Decree 146/2018/ND-CP; |
3 | Officers and soldiers of the People's Police participating in the anti-US resistance war for national salvation who have less than 20 years working in the People's Police, who have resigned or returned from the People's Police to their localities and have been entitled to benefits under the Prime Minister's Decision No. 53/2010/QD-TTg |
4 | Young volunteers who have been provided with benefits according to the Prime Minister's Decision No. 170/2008/QD-TTg, Decision No. 40/2011/QD-TTg, Decree No. 112/2017/ND-CP |
5 | Frontline non-combat soldiers participating in the resistance war against France, against the US or the Fatherland protection war and sent on international missions who have been entitled to benefits under the Prime Minister's Decision No. 49/2015/QD-TTg |
Vietnam: Who will have their rates of entitlement to health insurance coverage increased from 80% to 100% from October 19, 2023? (Image from the Internet)
Who are the subjects whose 100% of medical costs are covered by health insurance fund in Vietnam?
Pursuant to the provisions of Article 14 of Decree 146/2018/ND-CP amended and supplemented by Clause 5, Article 1 of Decree 75/2023/ND-CP and Point d, Clause 1, Article 183 of Decree 131/2021/ND-CP, subjects entitled to 100% of health insurance medical costs include:
No. | Suject | Note |
Group 01 | 100% of medical costs | |
1 | Persons rendering meritorious revolutionary services under the provisions of the Ordinance on preference treatment for persons rendering meritorious revolutionary services | |
2 | War veterans | |
3 | Persons engaged in the resistance war and protecting the Fatherland | |
4 | Persons aged 80 years or older who are entitled to monthly benefits for elderly people under laws on social insurance | |
5 | People in safe zone communes and revolutionary safe zones during the resistance war against the French and Americans and currently residing in safe zone communes during the resistance wars against the French and the Americans, who have been updated with information in the National Population Database, Residence Database that are not policyholders specified in Clauses 1, 2 and 3, Article 12 of the Law on Health Insurance | |
6 | Persons currently entitled to monthly social insurance benefits | |
7 | Members of poor households; ethnic minority people living in areas with difficult socio-economic conditions; people living in areas with extremely difficult socio-economic conditions; persons living in island communes or districts and some other subjects | |
8 | Relatives of martyrs include: biological father; biological mother; spouses and children of martyrs; the person who has the merit of raising martyrs | |
Group 2 | 100% of medical costs, and any restrictions on the rate of payment of medical costs such as medicines, chemicals, medical supplies and medical technology services | |
9 | Revolutionaries performing their activities before January 1, 1945; | |
10 | Revolutionaries performing their activities from January 1, 1945 to the date of the uprising event taking place in August, 1945 | |
11 | Vietnamese heroic mothers | |
12 | War invalids, beneficiaries of the same compensation policies as war invalids, class-B war invalids whose labor capacity is reduced by at least 81%; | |
13 | Sick soldiers whose labor capacity is reduced by at least 81% | |
14 | Partisans suffering diseases due to exposure to toxic chemicals whose labor capacity is reduced by at least 81%; | |
15 | War invalids, beneficiaries of compensation policies as war invalids, class-B war invalids and sick soldiers whose injuries are cured or whose diseases relapse; | |
16 | Children under 6 years of age. | |
Group 03 | Except self-referrals to inappropriate-level healthcare establishments | |
17 | Patient participates in the health insurance for a consecutive period of at least 5 years and has made the co-payment of medical costs in a year which is greater than total base pay amount received during 6 months |
Thus, according to regulations, there are 17 subjects whose 100% of medical costs are covered by health insurance fund.
In addition, there are also cases in which 100% of other medical costs are eligible according to Points c and d, Clause 1, Clause 4, Article 14 of Decree 146/2018/ND-CP.
What are the current health insurance principles in Vietnam?
Pursuant to the provisions of Article 3 of the Law on Health Insurance 2008 amended by Clause 2, Article 1 of the Law on amendments to the Law on Health insurance 2014 as follows:
Health insurance principles
1. Ensuring the sharing of risks among the insured.
2. Health insurance rates shall be determined according to the percentage of the wages as the basis for paying for the compulsory health insurance in accordance with the Law on Health insurance (hereinafter referred to as monthly salaries), retirement pensions, allowances or base salaries.”
3. Benefit levels depend on the seriousness of sickness, groups of the insured within the scope of the benefits and the period of time that the insured pay health insurance.
4. Costs of health insurance-covered medical care shall be jointly paid by the health insurance fund and the insured.
5. The health insurance fund shall be managed in a centralized, unified, public and transparent manner, ensuring the balance between revenue and expenditure, and be protected by the State.
Thus, currently health insurance is implemented according to the above principles.
Decree 75/2023/ND-CP will take effect from December 3, 2023. However, Clause 5, Article 1 of Decree 75/2023/ND-CP will take effect from October 19, 2023.
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