Are prenatal care workers covered by health insurance in Vietnam? Is general health check for employees covered by health insurance in Vietnam?
Are prenatal care workers covered by health insurance in Vietnam? Is general health check for employees covered by health insurance in Vietnam? What is level of health insurance benefits when employees give birth in Vietnam?
Are prenatal care workers covered by health insurance in Vietnam?
Hello, the other day my wife had a leave of absence from her job to take a pregnancy test and do some related tests. But the hospital replied that the cost of antenatal care is not covered by health insurance. May I ask if is this case correct? Please advise me.
Reply:
According to the provisions of Article 21 of the Law on Health Insurance 2008, scope of health insurance benefits is as follows:
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 medical examination for screening and early diagnosis of some diseases;
c/ Costs of transferal from district hospitals to higher-level hospitals, for persons defined in Clauses 9, 13. 14, 17 and 20, Article 12 of this Law in case of emergency or for inpatients who need technical transferal.
2. The Minister of Health shall specify Point b, Clause 1 of this Article: and assume the prime responsibility for. and coordinate with relevant agencies in. promulgating lists of medicines, chemicals, medical supplies and equipment as well as technical services which the insured is entitled to.
In Article 23 of the Law on Health Insurance 2008, the cases not entitled to health insurance are 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.
For your case, we would like to advise in 2 cases as follows:
In the first case, your wife goes for regular prenatal check-ups: In case your wife goes for regular prenatal check-ups, your wife will be covered by the health insurance fund in Vietnam.
The second case, your wife does not have to go for regular prenatal check-ups: If your wife goes to the antenatal clinic for non-therapeutic purposes, your wife will not be covered by the health insurance fund, but your wife will have to pay for it herself, so then the hospital's answer is correct as prescribed by law in Vietnam.
Is general health check for employees covered by health insurance in Vietnam?
My company organizes periodic health check-ups for employees every year. We have purchased health insurance for all employees, ask: Is the general health check-up for employees covered by health insurance?
Reply:
Article 23 of the Law on Health Insurance 2008, amended in 2014 stipulates:
Cases not eligible for health insurance benefits
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.
...
Scope of health insurance benefits under Article 21 of the Law on Health Insurance 2008 includes:
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 medical examination for screening and early diagnosis of some diseases;
c/ Costs of transferal from district hospitals to higher-level hospitals, for persons defined in Clauses 9, 13. 14, 17 and 20, Article 12 of this Law in case of emergency or for inpatients who need technical transferal.
2. The Minister of Health shall specify Point b, Clause 1 of this Article: and assume the prime responsibility for. and coordinate with relevant agencies in. promulgating lists of medicines, chemicals, medical supplies and equipment as well as technical services which the insured is entitled to.
Thus, when employees go to medical examination and treatment, the health insurance fund will pay the costs according to regulations in Vietnam. However, a periodic health check-up is one of the cases that are not covered by health insurance. Therefore, your company's organization of periodic health check-ups for employees will not be covered by health insurance in Vietnam.
What is level of health insurance benefits when employees give birth in Vietnam?
May I ask this case: My wife buys health insurance in Cam Tay ward, Cam Pha city, where she initially registered for medical examination and treatment at Cam Pha city general hospital. My wife went to her mother's hometown and gave child birth on 11/01/2016 at Van Yen district hospital. On Van Yen district hospital, they wrote an invoice to pay 100% of the hospital amount and told my wife to return to Cam Pha to pay. Another case is: My baby was just born in Van Yen district hospital when he was 5 days old, he had jaundice, so he had to be treated with incubator heating and Van Yen district hospital also suspected the receipt of 100% of the hospital fee and recorded bill for him. I would like to ask Minh Khue Law Firm in the above two cases to pay for the health insurance in Cam Pha City, what documents do my wife and children need, what are procedures and what percentage are they entitled to? Looking forward to the advice of you. Sincere thanks!
Reply:
Article 11 of the Law on Health Insurance 2008 stipulates the cases that are determined to be the correct medical examination and treatment routes covered by health insurance:
1. Health insurance card holders who register for initial medical examination and treatment at commune medical examination and treatment establishments or general clinics or district hospitals are entitled to medical examination and treatment covered by health insurance at the commune level health stations or general clinics, or district hospitals in the same province.
2. Health insurance card holders who register for initial medical examination and treatment at commune-level medical examination and treatment establishments will be referred to district hospitals, including district hospitals that have been ranked I or II and the provincial traditional medicine hospital (in case the district hospital does not have a traditional medicine department).
Clause 3, Article 22 of the Law on Health Insurance 2008 stipulates: The Government shall specify levels of medical care costs paid for the cases of transferal to higher-level hospitals, medical examination and treatment at upon request, and use of hi-tech and expensive services and other cases not specified in Clause 1 of this Article.
a) At a central hospital, 40% of inpatient treatment costs;
b) At the provincial hospital, 60% of inpatient treatment costs from the effective date of this Law to December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide;
c) At district hospitals, 70% of medical examination and treatment costs from the effective date of this Law to December 31, 2015; 100% of medical examination and treatment expenses from January 1, 2016.
Thus, the case of your wife and your child is entitled to 100% of medical examination costs. You send your application to the agency where you apply for health insurance to request payment for health insurance in Vietnam.
Above is the advice of you on the level of health insurance benefits when employees give birth. You should refer to the Health Insurance Law 2008 for details on this provision in Vietnam.
Best regards!
