Are pregnancy check-ups covered by health insurance in Vietnam?

Are pregnancy check-ups covered by health insurance in Vietnam?

Pursuant to Article 21 of the 2008 Health Insurance Law as amended by Clause 14, Article 1 of the 2014 Revised Health Insurance Law, on the scope of benefits of health insurance participants, as follows:

1. The insured has the following costs covered by the health insurance fund:

a/ Costs of medical examination and treatment, function rehabilitation, regular pregnancy check-ups and birth giving;

b) Costs of the transfer of the patients from district hospitals to superior hospitals with regard to the insured prescribed in points a, d, e, g, h and i Clause 3 Article 12 of this Law in case of medical emergency or inpatients needing such transfer.

2. The Minister of Health shall take charge and cooperate with the relevant Ministries and regulatory authorities in providing the list, proportion and payment conditions for the medicines, chemicals, medical equipments and services within the scope of benefits of the insured.

According to Article 23 of the 2008 Health Insurance Law on cases not eligible for health insurance benefits:

1. Cases specified in Clause 1 of Article 21 in which costs have been paid by the state budget.

2. Convalescence at sanatoria or convalescence establishments.

3. Medical check-up.

4. Prenatal tests and diagnosis for non-treatment purposes.

5. Use of obstetric supportive techniques, family planning services or abortion services, except for cases of discontinuation of pregnancy due to fetal or maternal diseases.

6. Use of aesthetic services.

7. Treatment of squint, short-sightedness and refractive defects.

8. Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.

9. Medical examination, treatment and function rehabilitation in case of occupational diseases, labor accidents or disasters.

10. Medical examination and treatment in case of suicide or self-inflicted injuries.

11. Medical examination and treatment for addiction to drugs, alcohol or other habit-forming substances.

12. Medical examination and treatment of physical or mental injuries caused by the injured’s law-breaking acts.

13. Medical assessment, forensic examination, forensic mental examination.

14. Participation in clinical trials or scientific research.

Thus, only periodic prenatal examinations are covered by health insurance and are performed according to the hospital's standard appointment schedule and standard examination procedure and are not cases not covered by health insurance in Vietnam.

Are pregnancy check-ups covered by health insurance in Vietnam? (Image from the Internet)

Are pregnancy check-ups covered by maternity insurance in Vietnam?

Article 32 of the 2008 Health Insurance Law stipulates advancement, payment, settlement of costs of health insurance-covered medical care:

1. Health insurance institutions shall quarterly pay in advance to health insurance-covered medical care providers at least 80% of the costs of health insurance-covered medical care of the preceding quarter which have been settled. With regard to a health insurance-covered medical care provider which signs a health insurance-covered medical care contract for the first time, the first advance will at least equal 80% of the medical care cost of one quarter under the signed contract.

2. An health insurance-covered medical care provider and a health insurance institution shall make payment and settlement on a quarterly basis as follows:

a/ In the first month of every quarter, the health insurance-covered medical care provider shall send a report on settlement of costs of health insurance-covered medical care in the previous quarter to the health insurance institution;

b/ Within 30 days after receiving the settlement report from the health insurance-covered medical care provider, the health insurance institution shall consider and notify the latter of the results of settlement. Within 15 days after notifying the settlement results, the health insurance institution shall complete the settlement with the health insurance-covered medical care provider.

3. Within 40 days after receiving a complete dossier of request for payment of medical care costs from an insured under Points a and b, Clause 2, Article 31 of this Law or 60 days, for cases defined at Points c and d. Clause 2, Article 31 of this Law, the health insurance institution shall pay the medical care costs to that insured.

In addition, Point 2.2.1 Clause 2 Article 4 Decision 166/BHXH 2019 stipulates as follows:

2.2.1. Female workers take leave for antenatal care, miscarriage, abortion, stillbirth or therapeutic abortion, or follow methods of contraception:

a) For inpatient treatment: The copy of discharge note. If a patient moves to a higher-level hospital during his/her inpatient treatment, the copy of the medical referral certificate or hospital transfer certificate must be submitted.

b) For outpatient treatment: The confirmation of eligibility to receive social insurance benefits or the copy of discharge note including the physician or medical assistant’s indication to take rest after the inpatient treatment.

According to this Article, when you go for a prenatal check-up and are eligible to enjoy the prenatal check-up regime (participating in social insurance) and get a Certificate of leave to enjoy social insurance benefits, you will be entitled to the maternity benefit when going for a prenatal check-up in Vietnam.

Best regards!