Instructions on how to convert health insurance benefit codes according to Decree 75/2023/NĐ-CP in Ho Chi Minh City

Instructions on how to convert health insurance benefit codes according to Decree 75/2023/NĐ-CP in Ho Chi Minh City

On November 6, 2023, the Social Insurance Agency of Ho Chi Minh City issued Official Dispatch 6394/NHXH-TST in 2023 to implement Decree 75/2023/NĐ-CP amending some detailed regulations on health insurance.

For the case of converting the health insurance benefit code according to the provisions of Clause 5, Article 1 of Decree 75/2023/NĐ-CP: the Social Insurance Agency has automatically updated the health insurance benefit data but does not issue a new health insurance card for the participants.

Participants use the VSSID application to check the health insurance benefits they are entitled to under the above regulations and use their old health insurance card or citizen identity card with chip to go to the hospital, specifically:

- Change the health insurance benefit code from 80% to 100% for people who participated in the resistance and defense of the country (with object code KC).

- Change the health insurance benefit code from 80% to 95% for people who serve people with revolutionary merits living at home.

In addition, for the case of adding the object code and health insurance benefit code on the health insurance card for new participants as stipulated in Decree 75/2023/NĐ-CP and Decree 131/2021/NĐ-CP:

The management agency of the object urgently coordinates with the Social Insurance Agency to check, review, and compile a list of proposals for issuing health insurance cards for the objects added in Decree 75/2023/NĐ-CP, specifically:

- Wife or husband of a martyr who remarried or remarried and is currently receiving a monthly allowance: object code is TG and benefit code is 3.

- People from safe zones, revolutionary safe zones in the resistance against France and the United States are currently residing in the safe zones of the revolutionary resistance against France and the United States that have been updated in the national database of population, residence database: object code is AK and benefit code is 2.

- Ethnic minorities living in the areas of communes in areas 2, 3, and special difficult villages in the lowlands of ethnic minorities and mountainous areas in the period 2016-2020, but these communes are no longer in the list of areas 2, 3, and special difficult villages in the mountainous areas of ethnic minorities and mountainous areas in the period 2021-2025 according to the decision of the Prime Minister: object code is DS and benefit code is 3.

For participants who are currently participating in compulsory health insurance in the group covered by the Social Insurance Agency and the group covered by employees and employers but belong to the above 2 groups, the employer, the management agency of the object guides the participants to submit the full set of documents according to the 613 form to be able to the Social Insurance Agency adjusts the health insurance benefit code in accordance with regulations.

Instructions on how to convert health insurance benefit codes according to Decree 75/2023/NĐ-CP in Ho Chi Minh City - Source: Internet

How much does an employee in Vietnam have to pay for health insurance each month?

Pursuant to Clause 1 Article 13 of the Law on Health Insurance in 2008 (amended by Clause 7 Article 1 of the Law on amendments to some articles of the Law on Health insurance in 2014) stipulating health insurance premium rates and responsibilities to pay health insurance premiums as follows:

Health insurance rates and responsibilities to pay health insurance premiums

1. Health insurance rates and responsibilities to pay health insurance are prescribed as follows:

a) The monthly premiums of the insured prescribed in point a Clause 1 Article 12 of this Law must not exceed 6% of the monthly salaries, two thirds of which is paid by the employers and the remaining one third is paid by the employees. During the time the employees are entitled to maternity leave due to maternity benefits under the regulations of law on health insurance, the maximum premiums equal to 6% of their monthly salaries before the maternity leave shall be paid by the health insurance organizations.

...

Pursuant to Clause 1 Article 7 of the Decree 146/2018/NĐ-CP stipulating as follows:

Health insurance contribution rates and health insurance contribution responsibilities

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

a) The contribution rate 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.

...

Therefore, the monthly contribution to health insurance for employees is currently 4.5% of the monthly salary.

In which:

- The employee contributes 1/3, equivalent to 1.5% of the monthly salary.

- The employer contributes 2/3, equivalent to 3% of the monthly salary.

What are cases of not eligible for health insurance benefits in Vietnam?

Pursuant to Article 23 of the Law on Health Insurance in 2008 (amended by Clause 16 Article 1 of the Law on amendments to some articles of the Law on Health insurance in 2014) stipulating cases not eligible for health insurance benefits as follows:

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

- Convalescence at sanatoria or convalescence establishments.

- Medical check-up.

- Prenatal tests and diagnosis for non-treatment purposes.

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

- Use of aesthetic services.

- Treatment of squint, myopia and eye refraction defect except for the children under age 6.

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

- Medical examination, treatment and functional rehabilitation in case of disasters.

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

- Medical assessment, forensic examination, forensic mental examination.

- Participation in clinical trials or scientific research.

Best regards!