If I lose my identity card, am I covered by the health insurance in Vietnam?
If I lose my identity card, am I covered by the health insurance in Vietnam? Are medical check-ups covered by health insurance in Vietnam? What are 06 prohibited acts in implementation of health insurance in Vietnam?
If I lose my identity card, am I covered by the health insurance in Vietnam?
Please let me know: I am currently working for a company in Ho Chi Minh City and am participating and issued a health insurance card by the company. But if I lose my ID card, will I be eligible for health insurance when I go to the hospital?
Reply:
According to the provisions of Article 21 of the 2008 Health Insurance Law as amended by Article 1 of the 2014 Amended Health Insurance Law, the insured has the following costs covered by the health insurance fund:
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.
Therefore: In case a health insurance participant has documents related to the payment of the above expenses during medical examination and treatment, he/she is entitled to health insurance in accordance with law in Vietnam.
On the other hand, according to the provisions of Decree 146/2018/ND-CP, the law stipulates that health insurance participants when coming for medical examination and treatment must:
- Photo health insurance cards;
- In case of absence of the photo, they shall be required to present one of their photo identity documents issued by competent bodies or authorities, or certificates endorsed by commune-level police authorities or others endorsed by educational institutions in charge of management of pupils or students;
- Other legitimate personal identification documents.
Thus: Based on the above-cited regulations in Vietnam, the law does not require health insurance participants when visiting medical examination and treatment facilities at medical examination and treatment establishments to present their identity cards.
In case a health insurance participant has a health insurance card but does not have a photo, when going for medical examination and treatment at a medical examination and treatment facility, he or she can present one of the papers with a photo such as a photo ID card, driver's license, ... together with health insurance to be entitled to receive health insurance according to regulations in Vietnam.
Therefore: For the case that you are currently working for a company in Ho Chi Minh City and are participating and issued a health insurance card by the company. Then you can use your health insurance card to get medical treatment at medical facilities and be treated to the health insurance regime in accordance with the law.
In case you provide medical examination and treatment at medical facilities that do not have a health insurance contract with a social insurance agency, after paying medical examination and treatment expenses, you can bring the following medical conditions: from payment of medical examination and treatment costs to the social insurance agency to pay back the health insurance costs that you are entitled to in accordance with the law in Vietnam.
Are medical check-ups covered by health insurance in Vietnam?
Please ask: This morning, I went to the hospital for the first time to have a medical examination to make an application, but when I brought my health insurance to get a discount, my case was not entitled to health insurance. I was very curious, I thought I should go to the doctor as long as I am entitled to health insurance. Can you explain to me if they're right or do I think they're right?
Reply:
According to the law, health insurance is a form of compulsory insurance that is applied in the health care sector for non-profit purposes, organized by the State and joined by responsible persons under this Law.
Health insurance fund means a financial facility set up from health insurance premium payments and other lawful collections, which is used to cover costs of medical care for the insured, managerial costs of health insurance institutions and other lawful costs related to health insurance.
According to the law, 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.
However, the law also stipulates that in certain cases, health insurance participants are not covered by the health insurance fund as prescribed in Vietnam.
According to the provisions of Article 23 of the Law on Health Insurance 2008 and Clause 16, Article 1 of the 2014 Amended Health Insurance Law, the following cases are not entitled to health insurance:
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, myopia and eye refraction defect except for the children under age 6
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 functional rehabilitation in case of disasters.
11. Medical examination and treatment for addiction to drugs, alcohol or other habit-forming substances.
13. Medical assessment, forensic examination, forensic mental examination.
14. Participation in clinical trials or scientific research.
Thus, based on the above regulations as well as the analysis above in Vietnam, it is possible to determine the medical examination case that is not covered by the health insurance fund.
Therefore, if an individual goes for a medical check-up, he or she is not entitled to health insurance in Vietnam.
What are 06 prohibited acts in implementation of health insurance in Vietnam?
I have a few questions and would like to ask. Specifically, let me ask: What behaviors are prohibited in the implementation of health insurance? Hope to get a response soon. Thank you!
Reply:
In Article 11 of the Law on Health Insurance 2008, there are regulations on prohibited acts in the implementation of health insurance as follows:
1. Failing to pay or fully pay health insurance premiums under this Law.
2. Committing fraud related to or forging health insurance files or cards.
3. Using collected health insurance premiums or the health insurance fund for improper purposes.
4. Obstructing, troubling or causing harms to the insured and parties involved in health insurance in the exercise of their lawful rights and enjoyment of their benefits.
5. Deliberately making false reports or providing false information and data on health insurance.
6. Abusing one’s position, power or professional operations to act in contravention of the health insurance law.
The above content answers about what acts are prohibited in the implementation of health insurance in Vietnam.
Best regards!
