Vietnam: Will health insurance premiums of primary school students be covered by the State?

Will health insurance premiums of primary school students be covered by the State of Vietnam?

Under the provisions of Article 4 of Decree 146/2018/ND-CP as amended by Article 1 of Decree 75/2023/ND-CP, the regulations are as follows:

Group of health insurance policyholders whose premiums are supported by the state budget

1. Members in near-poor households, as defined according to the near-poor household criteria for the period 2022-2025 prescribed in Decree No. 07/2021/ND-CP and subsequent amendments or replacements thereto;

2. Members of multidimensional-poverty family households falling into the cases specified in point a, clause 9, Article 3 hereof.

3. Pupils and students.

4. Members in households working in agriculture, forestry, fishery, and salt production who have the average standard of living, as defined according to the average household criteria for the period 2022-2025 prescribed in Decree No. 07/2021/ND-CP and subsequent amendments or replacements thereto;

Thus, health insurance premiums of primary school students will be covered by the State of Vietnam.

Will health insurance premiums of primary school students be covered by the State of Vietnam? (Image from the Internet)

What is the health insurance premium for primary school students?

Under Article 7 of Decree 146/2018/ND-CP, the regulations are as follows:

Health insurance premium and health insurance premium payment responsibilities

1. Monthly health insurance premium shall be subject to the following regulations:

a) The premium shall be equal to 4.5% of the employee’s monthly pay with respect to those policyholders specified in clause 1, Article 1 of this Decree.

- Employees on sick leaves from at least 14 days per a month in accordance with laws on social insurance shall not be required to pay health insurance premiums and shall be entitled to health insurance benefits;

- With respect to employees that are detained, held in custody or suspended from work for investigations, consideration of judgement whether they have committed violations against laws, the monthly premium shall be defined as 4.5% of 50% of each employee's monthly pay. In case where a competent authority makes its judgement that none of violations has been committed, the employee shall be required to pay health insurance premiums in proportion to the accrued pay amount that he/she has received;

b) The premium shall be equal to 4.5% of the retirement pension and incapacity benefit with respect to those policyholders specified in clause 1, Article 2 of this Decree;

c) The premium shall be equal to 4.5% of the monthly pay that an employee receives before his/her pregnancy and parental leave with respect to those policyholders specified in clause 5, Article 2 of this Decree;

d) The premium shall be equal to 4.5% of the unemployment benefit with respect to those policyholders specified in clause 6, Article 2 of this Decree;

dd) The premium shall be equal to 4.5% of the statutory pay rate rate with respect to those policyholders other than the abovementioned;

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Under Article 8 of Decree 146/2018/ND-CP, the regulations are as follows:

State budget’s support rate

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c) The state budget’s support shall be paid for at least 30% of the health insurance premium with respect to those policyholders referred to in clause 3 and 4, Article 4 hereof.

2. In case where a policyholder falls into multiple beneficiaries of the state budget’s health insurance premium support as prescribed in clause 1 of this Article, the state budget’s support for the policyholder entitled to the highest support rate shall be applied.

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Therefore, the health insurance premium for primary school students is 4.5% of the statutory pay rate for other individuals.

Under Article 3 of Decree 73/2024/ND-CP, the statutory pay rate for teachers as public employees in public service providers is VND 2,340,000/month.

Additionally, primary school students are entitled to a minimum support rate of 30% of health insurance premiums.

Annual health insurance premium = 4.5% x 2,340,000 x 12 x up to 70%

Thus, the annual health insurance premium for primary school students (12 months) is a maximum of VND 884,520.

When are primary school students in Vietnam entitled to 100% health insurance benefits?

Under clause 1, Article 14 of Decree 146/2018/ND-CP as amended by point d, clause 1, Article 183 of Decree 131/2021/ND-CP, the health insurance benefit levels for cases specified in Article 22 of the Law on Health Insurance 2008 as amended by clause 15, Article 1 of the Law on Amendments to Law on Health Insurance 2014 is as follows:

Health insurance benefit levels for cases specified in clause 1 and clause 7, Article 22 of the Law on Health Insurance

1. Participants in health insurance when undergoing medical examination and treatment as stipulated in Articles 26, 27, and 28 of the Law on Health Insurance; clauses 4 and 5, Article 22 of the Law on Health Insurance shall have eligible expenses covered by the health insurance fund as follows:

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c) 100% of medical costs at the commune level;

d) 100% of medical costs if the cost per visit is less than 15% of the statutory pay rate;

dd) 100% of medical costs if the insured has participated in health insurance for 5 consecutive years or more and their co-payment costs in a year exceed 6 months of the statutory pay rate, except for cases of self-referred medical examination and treatment;

e) 95% of medical costs for individuals specified in clause 1, Article 2; clauses 12, 18, and 19, Article 3; and clauses 1, 2, and 5, Article 4 of this Decree;

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Thus, primary school students are entitled to 100% health insurance benefits when incurring medical costs at the commune level; per-visit medical costs below 15% of the statutory pay rate.

Additionally, medical costs are also covered at 100% if the insured has participated in health insurance for 5 consecutive years or more and their co-payment costs in a year exceed 6 months of the statutory pay rate, except for self-referred cases.