08:07 | 17/06/2023

What is health insurance for 5 consecutive years in Vietnam? What is the procedure for receiving health insurance for 5 consecutive years?

What is health insurance for 5 consecutive years in Vietnam? What is the procedure for receiving health insurance for 5 consecutive years? Question of Ms. Yen in Ha Nam.

What is health insurance for 5 consecutive years in Vietnam?

Currently, the law has not specifically defined health insurance for 5 consecutive years, but in fact, health insurance for 5 consecutive years is understood as when the insured has a period of 5 consecutive years of payment.

During such a period of 5 consecutive years of payment, a maximum of 3 months of interruption is allowed.

The time when a person participates in health insurance for 5 consecutive years will be recorded directly on his/her health insurance card.

Pursuant to Decision No. 1666/QD-BHXH in 2020 on the form of health insurance card issued by the Vietnam Social Insurance, the recording period of 5 consecutive years is prescribed as follows:

- Persons who have had full health insurance for 5 consecutive years participation up to January 1, 2015 shall print from January 1, 2015.

- From January 1, 2015 onward, if the insured person has not had enough health insurance or has started full 05 consecutive years, it shall be printed from the first day of the sixth year.

What is 5 consecutive years of health insurance in Vietnam? What is the procedure for receiving 5 consecutive years of health insurance?

What is health insurance for 5 consecutive years in Vietnam? What is the procedure for receiving health insurance for 5 consecutive years?

What is the procedure for receiving health insurance for 5 consecutive years in Vietnam?

According to the provisions of Clause 3, Article 27 of Decree No. 146/2018/ND-CP, in order to enjoy maximum benefits when participating in health insurance for 5 consecutive years, patients need to do the following:

Payment of medical costs in certain cases
3. With respect to payment of medical costs of a patient participating 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 in accordance with point dd of clause 1 of Article 14 hereof:
a) If a patient makes co-payment for each visit or multiple visits for medical care at the same healthcare establishment which is greater than the base pay amount received during 6 months, that healthcare establishment shall not be allowed to collect the patient’s co-payment which is greater than the base pay amount that he/she has received during 6 months. The healthcare establishment shall be responsible for providing an invoice for the co-payment amount equal to the base pay amount during 6 months so that the patient can use it as a basis for requesting the health insurance agency to give its certification of exemption from making any co-payment in that year;
b) In case where the patient's accrued amount of co-payments in a financial year at different healthcare establishments or at the same healthcare establishment is greater than 6 months’ base pay amount, that patient may present evidencing documents to the social insurance agency issuing his/her health insurance card to pay the amount of co-payment greater than 6 months’ total base pay amount and receive the certification of exemption from co-payment in that year;
c) In case where the patient's co-payment amount is greater than the 6 months’ total base pay amount as from January 1, the health insurance fund shall cover 100% of costs incurred from healthcare services falling within the scope of a patient’s interests from the anniversary date of 5 consecutive years of health insurance participation to the end of December 31 in that year.

Thus, the procedures for enjoying health insurance for 5 consecutive years are carried out as follows:

(1) For cases where the co-payment amount at one time or many times of medical examination and treatment at the same medical examination and treatment establishment is greater than 6 months' statutory pay rate.

As long as you follow the correct medical examination and treatment procedures, you will not have to pay the co-payment amount greater than 6 months' statutory pay rate.

(2) For cases where the accumulated co-payment amount in the fiscal year at different medical examination and treatment establishments or at the same facility is greater than 6 months' statutory pay rate.

- Go to the social insurance agency where the health insurance card is issued to request payment of the co-payment amount that is greater than 6 months' base salary.

- It is necessary to prepare and bring the following specific documents:

+ Health insurance card.

+ Copy of ID document with photo.

+ Original hospital bill.

What are benefits of participants of health insurance for 5 consecutive years?

Pursuant to Point c, Clause 1, Article 22 of the 2008 Law on Health Insurance in Vietnam as amended by Clause 15, Article 1 of the 2014 Law on Amendments to the Law on Health Insurance in Vietnam, stipulating:

Patients are paid total medical examination and treatment expenditures by the health insurance fund within the scope of entitlement if they meet the conditions for enjoying health insurance.

Specifically, in Decree No. 146/2018/ND-CP guiding the payment of medical costs of a patient participating in the health insurance for a consecutive period of at least 5 years as follows:

- If a patient makes co-payment for each visit or multiple visits for medical care at the same healthcare establishment which is greater than the base pay amount received during 6 months, that healthcare establishment shall not be allowed to collect the patient’s co-payment which is greater than the base pay amount that he/she has received during 6 months.

The healthcare establishment shall be responsible for providing an invoice for the co-payment amount equal to the base pay amount during 6 months so that the patient can use it as a basis for requesting the health insurance agency to give its certification of exemption from making any co-payment in that year;

- In case where the patient's accrued amount of co-payments in a financial year at different healthcare establishments or at the same healthcare establishment is greater than 6 months’ base pay amount, that patient may present evidencing documents to the social insurance agency issuing his/her health insurance card to pay the amount of co-payment greater than 6 months’ total base pay amount and receive the certification of exemption from co-payment in that year;

- In case where the patient's co-payment amount is greater than the 6 months’ total base pay amount as from January 1, the health insurance fund shall cover 100% of costs incurred from healthcare services falling within the scope of a patient’s interests from the anniversary date of 5 consecutive years of health insurance participation to the end of December 31 in that year.

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