Is it eligible for 5-year-old children to enjoy health insurance benefits when treating short-sightedness in Vietnam?

Is it eligible for 5-year-old children to enjoy health insurance benefits when treating short-sightedness 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 the Law on Health Insurance in 2014) stipulating cases not eligible for health insurance benefits as follows:

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.

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

11. Medical assessment, forensic examination, forensic mental examination.

12. Participation in clinical trials or scientific research.

As regulations above, it is eligible for your son to enjoy health insurance benefits when treating short-sightedness in Vietnam.

Who shall pay health insurance for 5-year-old children in Vietnam?

Pursuant to Article 12 of the Law on Health Insurance in 2008 (amended by Clause 6 Article 1 of the Law on amendments to the Law on Health Insurance in 2014) stipulating persons eligible for health insurance as follows:

3. The group of the insured whose insurance is paid by the State budget, including:

a) Commissioned officers, professional soldiers, non-commissioned soldiers on active duty; commissioned police officers and non-commissioned police officers; police students, non-commissioned police officers or soldiers on fixed term contracts; ciphers whose salaries are the same as the salaries as the servicemen; cipher students whose benefits are the same as the benefits of students in military or police academies.

c) Officers in communes, wards and towns who have left employment and been receiving monthly pensions funded by the State budget.

c) Persons no longer receiving compensation for loss of capacity for work and being receiving monthly pensions funded by the State budget;

d) Persons performing meritorious services in the wars, war veterans;

dd) Incumbent deputies of the National Assembly or the People’s Councils at all levels;

e) Children under the age of 6;

g) Persons receiving monthly social protection pensions;

h) Poor household members, ethnics living in regions facing socio-economic difficulties, persons living in regions facing extreme socio-economic difficulties; persons living in island communes or districts.

i) Relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

k) Relatives of persons performing meritorious services in the wars, except for the insured prescribed at point i this Clause;

k) Relatives of the insured prescribed in point a clause 3 this Article;

m) Persons who have donated body parts under the regulations of the law;

n) Foreigners studying in Vietnam that are granted scholarships funded by the Vietnam State budget.

As regulations above, health insurance for 5-year-old children in Vietnam shall be paid by the Vietnam State budget.

What are regulations on levels of health insurance benefits in Vietnam?

Pursuant to Article 22 of the Law on Health Insurance in 2008 (amended by Clause 15 Article 1 of the Law on amendments to the Law on Health Insurance in 2014) stipulating persons eligible for health insurance as follows:

1. The benefit levels of the insured receiving medical examination and treatment in accordance with the regulations in Articles 26, 27 and 28 of this Law whose medical examination and treatment expenditures are covered by the health insurance fund shall be:

a) Total medical examination and treatment expenditures with regard to the insured prescribed in points a, d, e, g, h and i Clause 3 Article 12 of this Law. The costs of the non-covered medical services of the insured prescribed in point a Clause 3 Article 12 of this Law shall be paid by the health insurance budget used for medical examination and treatment of these insured persons; if this budget is insufficient, the State budget shall be in charge.

b) Total medical examination and treatment expenditures with regard to any medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government.

c) Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals;

d) 95% of the medial examination and treatment expenditures with regard to the insured prescribed in point a Clause 2, point k Clause 3 and point a Clause 4 Article 12 of this Law;

dd) 80 % of the medial examination and treatment expenditures with regard to other insured persons;

2. In case an insured person belongs to different groups of the insured, (s)he shall be provided with the highest health insurance benefits.

3. In case any card holder goes to a hospital different from the registered hospital except for the insured prescribed in Clause 1 this Article, his or her costs shall be covered by the health insurance fund according to the benefit levels prescribed in Clause 1 this Article as follows:

a) 40% of the inpatient treatment expenditures at the central hospitals.

b) 60% of the inpatient treatment expenditures at the provincial hospitals from the effective date of this Law to December 31, 2020; total inpatient treatment costs from January 01, 2021 at all hospitals in Vietnam.

c) 70% of the medical examination and treatment expenditures at the district hospitals from the effective date of this Law to December 31, 2015; total medical examination and treatment expenditures from January 01, 2016.

4. The insured applying for medical examination and treatment at commune medical facilities, clinics or district hospitals can receive medical examination and treatment at any commune medial facility, clinic or district hospital in the same province according to the benefit levels prescribed in Clause 1 this Article from January 01, 2016.

5. The insured who are poor household members or ethnics living in regions facing socio-economic difficulties, regions facing extreme socio-economic difficulties; the insured living in island communes or islands districts who go to the hospitals different from the registered hospital shall be paid for their medical examination and treatment expenditures at the commune hospitals, their inpatient treatment costs at the provincial and central hospital by the health insurance fund according to the benefit levels prescribed in Clause 1 this Article.

6. The inpatient treatment expenditures of the insured who go to any provincial hospital in Vietnam different from their registered hospitals shall be paid by the health insurance fund from January 01, 2021.

7. The Government shall prescribe the specific benefit levels of the medical examination and treatment at bordering areas; medical services and other kinds of medical examination and treatment which is not prescribed in Clause 1 this Article.

Above are regulations on levels of health insurance benefits in Vietnam.

Best regards!