What are cases that are not eligible for health insurance benefits in Vietnam in 2024?
What are cases that are not eligible for health insurance benefits in Vietnam in 2024? - Ms. Trinh (Vinh Long)
What is the health insurance premium rate regarding members of the households in Vietnam?
Pursuant to Clause 3 Article 13 of the Law on Health Insurance in 2008 (amended by Clause 7 Article 1 of the Law on amendments to the Law on Health Insurance in 2014) stipulating health insurance premium rates as follows:
Health insurance premium rates
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3. All of the members of the households as prescribed in Clause 4 Article 12 of this Law must purchase health insurance. The premiums shall decrease from the second member of a household, in particular:
a) The premiums of the first ones must not exceed 6% of the base salary;
b) The premiums of the second, third, forth ones shall be equal to 70%, 60%, 50% of the premiums of the first ones respectively;
c) The premiums of fifth ones and the followings shall be equal to 40% of the premiums of the first ones;
4. The government regulates the specific insurance rates and financial support rates prescribed in this Article
As regulations above, the premiums shall decrease from the second member of a household, in particular:
- The premiums of the first ones must not exceed 6% of the base salary;
- The premiums of the second, third, forth ones shall be equal to 70%, 60%, 50% of the premiums of the first ones respectively;
- The premiums of fifth ones and the followings shall be equal to 40% of the premiums of the first ones.
What are cases that are not eligible for health insurance benefits in Vietnam in 2024? - image from internet
Who are eligible to participate in health insurance for households in Vietnam?
Pursuant to Clause 6 Article 17 of the Decision 595/QD-BHXH in 2017 (amended by Clause 20 Article 1 of the Decision 505/QD-BHXH in 2020, Clause 6 Article 2 of the Decision 490/QD-BHXH in 2023, Clause 1 Article 2 of the Decision 948/QD-BHXH in 2023) stipulating households participating in health insurance as follows:
Participants in health insurance prescribed in Article 12 of Law on health insurance and its instructional documents
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5. Households participating in health insurance shall include:
5.1. Individuals listed in the same registered permanent residence household, except for those specified in clauses 1, 2, 3, 4, and 8 of this Article, and individuals who have declared temporary absence.
5.2. Individuals listed in the same registered temporary residence household, except for those specified in clauses 1, 2, 3, 4, and 8 of this Article, and individuals who have already participated in health insurance according to the provisions in point 5.1 of this Article.
5.3. The following individuals are eligible to participate in health insurance for households:
a) Officials, positions, and religious practitioners;
b) Individuals living in social welfare facilities without state budget support for health insurance contributions
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Therefore, households participating in health insurance shall include:
- All individuals in the same registered permanent residence household, except for the following groups:
+ Groups covered by workers and their employers;
+ Groups covered by Social Insurance organization;
+ Groups covered by the state budget;
+ Groups supported by the state budget for contribution payments;
+ Groups covered by employers;
+ Individuals who have declared temporary absence.
- Individuals listed in the same registered temporary residence household, except for the following group:
+ Groups covered by workers and their employers;
+ Groups covered by Social Insurance organization;
+ Groups covered by the state budget;
+ Groups supported by the state budget for contribution payments;
+ Groups covered by employers;
+ Individuals who have already participated in health insurance for households at their registered permanent residence.
Note: In addition, the following individuals are eligible to participate in health insurance for households:
- Officials, positions, and religious practitioners;
- Individuals living in social welfare facilities without state budget support for health insurance contributions.
In the case where the company covers health insurance for an individual, does the individual still need to participate in health insurance for households in Vietnam?
According to Clause 7, Article 17 of Decision 595/QD-BHXH in 2017 (supplemented by Clause 21, Article 1 of Decision 505/QD-BHXH in 2020), the participants in health insurance are as follows:
Participants in health insurance prescribed in Article 12 of Law on health insurance and its instructional documents
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7. In the case where an individual belongs to multiple different categories of health insurance participants as regulated in this Article, they will contribute to health insurance based on the first category that they are determined to belong to, following the order of categories specified in this Article.
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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) specifies the subjects not eligible for health insurance for households as follows:
Health insurance participants include:
1. Groups covered by workers and employers, including:
a) Workers employed under indefinite-term labor contracts, fixed-term labor contracts lasting at least 3 months; workers who are enterprise managers receiving salaries; officials, civil servants, and employees (hereinafter referred to as workers).
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5. Groups participating in family health insurance include individuals belonging to a family, except for the categories specified in clauses 1, 2, 3, and 4 of this Article.
Therefore, if an employee is already covered by health insurance provided by their company, they do not need to participate in health insurance for households.
12 cases that are not eligible for health insurance benefits in Vietnam in 2024
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 of the Law on Health Insurance in 2008 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.
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