Which cases are allowed to temporarily cease health insurance contributions but are still considered to have participated in health insurance for 5 consecutive years in Vietnam?
What are cases where it is allowed to have interrupted health insurance contributions but still considered continuous participation for 5 years in Vietnam?
In Article 12 of Decree 146/2018/ND-CP, there are regulations on health insurance cards as follows:
Health Insurance Card
The health insurance card is issued by the social insurance agency and reflects the following information:
1. Personal information of the health insurance participant, including: Full name; gender; date of birth; address of residence or workplace.
2. Health insurance benefit level according to Article 14 of this Decree.
3. Effective date of the health insurance card.
4. Initial registration place for health insurance medical examination and treatment.
5. Participation duration in health insurance of 5 consecutive years or more for subjects who must co-pay medical examination and treatment costs. The continuous participation duration is the usage period recorded on the health insurance card following the previous one; in case of interruption, it should be a maximum of 3 months only.
Persons who are assigned by competent authorities to work, study, work overseas, or follow the policies for spouses or children under 18 years old accompanying their parents on delegation at Vietnamese agencies abroad, the time abroad is considered as participation in health insurance.
For workers going to work abroad, the time of participating in health insurance before going abroad is counted as time of participating if they join health insurance within 30 days from the date of entry back to the country.
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Hence, in case there is an interruption in health insurance participation, it is only allowed to have an interruption of a maximum of 3 months to be considered as continuous 5-year health insurance participation. Beyond this period, it will not be recognized as continuous 5-year health insurance participation.
What are cases where it is allowed to have interrupted health insurance contributions but still considered continuous participation for 5 years in Vietnam? (Image from the Internet)
What benefits will be enjoyed for continuous participation in insurance for 5 years in Vietnam?
According to Article 22 of Law on Health Insurance 2008, as amended by Clause 15 Article 1 of Amended Law on Health Insurance 2014, the health insurance benefit levels are regulated as follows:
Health Insurance Benefit Levels
1. Participants in health insurance when going for a medical examination and treatment according to Articles 26, 27, and 28 of this Law will have their medical examination and treatment costs covered by the health insurance fund within the scope of benefits with the following levels:
a) 100% of the medical examination and treatment costs for subjects specified at points a, d, e, g, h, and i of Clause 3, Article 12 of this Law. Medical examination and treatment costs outside the scope of health insurance benefits for subjects specified at point a, Clause 3, Article 12 of this Law are paid from the health insurance fund allocated to the medical examination and treatment of this group; if this fund is insufficient, the State budget will cover the shortfall;
b) 100% of the medical examination and treatment costs for cases where the cost for one time of medical examination and treatment is lower than the amount stipulated by the Government of Vietnam and for medical examinations and treatments at the commune level;
c) 100% of the medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more and have co-paid medical examination and treatment costs in the year exceeding 6 months of statutory pay rate, except for cases of unauthorized medical examinations and treatments;
d) 95% of the 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;
đ) 80% of the 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 in the year exceeding 6 months of the statutory pay rate will enjoy the following benefits:
- 100% of the medical examination and treatment costs when the patient goes for medical examination and treatment.
Note: In cases of unauthorized medical examinations and treatments, the benefits of continuous 5-year health insurance participation will not be enjoyed.
Vietnam: What information does an Health Insurance Card contain?
According to the provisions in Article 12 of Decree 146/2018/ND-CP, the Health Insurance Card issued by the social insurance agency reflects the following information:
- Personal information of the health insurance participant, including: Full name; gender; date of birth; address of residence or workplace.
- Health insurance benefit level
- Effective date of the health insurance card.
- Initial registration place for health insurance medical examination and treatment.
- Duration of health insurance participation
- Photo of the health insurance participant (except for children under 6 years old) in the case where the health insurance participant does not have a photo identification document issued by competent authorities, or a confirmation paper from the commune police or other document confirmed by the educational institution, vocational training institution managing the students, or other valid identification.
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