Is it possible for students purchasing health insurance in their hometown to medical treatment at other places in Vietnam?

Is it possible for students purchasing health insurance in their hometown to medical treatment at other places in Vietnam?

Based on Article 22 of the Law on Health Insurance 2008 (amended by Clause 15, Article 1 of the Amended Law on Health Insurance 2014):

Health insurance benefits

1. Participants in health insurance, when going for medical examination and treatment as stipulated in Articles 26, 27, and 28 of this Law, will have the costs of examination and treatment covered by the health insurance fund within the prescribed scope and the following benefits:

a) 100% of the medical examination and treatment costs for individuals specified at points a, d, e, g, h, and i, Clause 3, Article 12 of this Law. The medical examination and treatment costs outside the health insurance scope for the individuals specified at point a, Clause 3, Article 12 of this Law will be paid from the health insurance funds allocated for these groups; if this fund is insufficient, it will be ensured by the state budget;

b) 100% of the medical examination and treatment costs for cases with a cost per examination and treatment below the threshold prescribed by the Government of Vietnam and for examinations and treatments at the communal level;

c) 100% of the medical examination and treatment costs for individuals with continuous health insurance participation of 5 years or more, and a co-payment exceeding 6 months statutory pay rate within a year, except when they voluntarily go to an incorrect healthcare level;

d) 95% of the medical examination and treatment costs for individuals specified at point a, Clause 2, point k, Clause 3, and point a, Clause 4, Article 12 of this Law;

dd) 80% of the medical examination and treatment costs for other individuals.

2. In case a person belongs to multiple groups participating in health insurance, the health insurance benefits will be according to the group with the highest benefits.

3. In case a person with a health insurance card voluntarily goes to an incorrect healthcare level, the health insurance fund will cover according to the benefits prescribed in Clause 1 of this Article at the following rates, except as stipulated in Clause 5 of this Article:

a) At the central hospital level, 40% of inpatient treatment costs;

b) At the provincial hospital level, 60% of inpatient treatment costs from the date this Law takes effect until December 31, 2020; 100% of inpatient treatment costs from January 1, 2021, nationwide;

c) At the district hospital level, 70% of medical examination and treatment costs from the date this Law takes effect until December 31, 2015; 100% of medical examination and treatment costs from January 1, 2016.

4. From January 1, 2016, participants in health insurance who register for initial medical examination and treatment at a communal health station or polyclinic or district hospital have the right to receive health insurance medical examination and treatment at communal health stations, polyclinics, or district hospitals within the same province at the prescribed benefit rate in Clause 1 of this Article.

5. Ethnic minorities and people from poor households participating in health insurance living in areas with difficult socio-economic conditions, extremely difficult socio-economic conditions; individuals participating in health insurance living in island communes or districts, when voluntarily going to an incorrect healthcare level, will have the health insurance fund cover the medical examination and treatment costs at district hospitals, inpatient treatment at provincial and central hospitals, at the prescribed benefit rate in Clause 1 of this Article.

6. From January 1, 2021, the health insurance fund will cover inpatient treatment costs at the prescribed benefit rate in Clause 1 of this Article for health insurance participants who voluntarily go to an incorrect healthcare level at provincial medical facilities nationwide.

7. The Government of Vietnam provides specific regulations on the benefit rates for health insurance medical examination and treatment in border areas; medical examination and treatment on demand and other cases not stipulated in Clause 1 of this Article.

According to the regulations, when students purchase health insurance in their hometown and go for medical treatment according to the correct healthcare level, the health insurance fund will cover inpatient treatment costs as per the prescribed benefit rate. Specifically, the health insurance benefit for students who follow the correct healthcare level is 80% within the health insurance scope.

Therefore, students who buy health insurance in their hometown are entirely eligible to receive medical treatment elsewhere with an in-scope benefit rate of 80%.

Is it possible for students purchasing health insurance in their hometown to medical treatment at other places in Vietnam?​ (Image from Internet)

Are students in Vietnam required to participate in health insurance?

Pursuant to Article 12 of the Law on Health Insurance 2008 (amended by Clause 6, Article 1 of the Amended Law on Health Insurance 2014):

Participants in health insurance

...

4. The group with state budget contributions, including:

a) Individuals from near-poor households;

b) Pupils, students.

5. The group participating in health insurance as households includes household members, except for those specified in Clauses 1, 2, 3, and 4 of this Article.

6. The Government of Vietnam sets out specific regulations concerning participants outside those specified in Clauses 3, 4, and 5 of this Article; the issuance of health insurance cards to individuals managed by the Ministry of National Defense, the Ministry of Public Security, and individuals specified in point 1, Clause 3 of this Article; implementation timeline for health insurance, scope of benefits, benefit level, medical examination, and treatment covered by health insurance, management, and use of funds for medical examination and treatment covered by health insurance, inspection of health insurance, payment, and settlement of health insurance for individuals specified at point a, Clause 3 of this Article.

Therefore, students are required to participate in health insurance and belong to the group with state budget contributions to health insurance premiums.

What benefits do students in Vietnam receive when participating in health insurance?

According to Article 21 of the Law on Health Insurance 2008 (as amended by Article 1 of the Amended Law on Health Insurance 2014), students participating in health insurance receive the following scope of benefits:

- Participants in health insurance are covered by the health insurance fund for the following costs:

+ Medical examination, treatment, rehabilitation, periodic pregnancy check-ups, childbirth;

+ Transport of patients from district level to higher levels for individuals specified at points a, d, e, g, h, and i, Clause 3, Article 12 of the Law on Health Insurance 2008 in emergency cases or while undergoing inpatient treatment requiring transfer for technical expertise.

- The Minister of Health presides over, in cooperation with related ministries and central authorities, the issuance of the list and percentage, conditions of payment for drugs, chemicals, medical supplies, and medical technical services within the scope covered by health insurance participants.