Medical Services: Are They Covered by Health Insurance?
Based on Official Dispatch 1608/BYT-KH-TC of 2019 regarding the implementation of payment for medical examination and treatment costs covered by health insurance when the patient uses services as required, the provisions are as follows:
...Therefore, the Ministry of Health requests Vietnam Social Security to implement the payment of health insurance medical examination and treatment costs in accordance with the law on health insurance when the patient uses services on request such as: medical examination, bed days, medical technical services, drugs, medical supplies, etc., as follows:
For services prescribed on professional requirements within the coverage scope of health insurance participants: The health insurance fund pays according to the coverage scope and benefits of health insurance participants. The difference between the requested medical examination and treatment costs and the payment level of the health insurance fund shall be paid by the patient to the medical examination and treatment facility.
For services not prescribed on professional requirements or not within the coverage scope of health insurance participants: The patient shall bear the entire cost of such services.
Thus, for your mother's case of using service-based medical examination and treatment, health insurance coverage depends on 02 scenarios as follows:
- If the service is not prescribed on professional requirements or not within the coverage scope of health insurance participants, the entire cost of such services must be borne by the patient.
- If the service is prescribed on professional requirements within the coverage scope of health insurance participants, health insurance will cover the cost according to the coverage scope and benefits of the health insurance beneficiary.
Sincerely!
