If a person goes to a hospital different from the registered hospital in Vietnam, what percentage of health insurance will he/she be entitled to?
If a person goes to a hospital different from the registered hospital in Vietnam, what percentage of health insurance will he/she be entitled to? - Mr. Phat (An Giang)
Will health insurance cover medical examinations on Saturdays and Sundays in Vietnam?
Pursuant to Clause 10.a Article 27 of the Decree 146/2018/ND-CP stipulating payment of health insurance in certain cases:
Payment of medical costs in certain cases
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10. Payment of medical costs with respect to a healthcare establishment providing health insurance-covered medical services on weekly rest days and holidays:
a) When receiving medical services at the healthcare establishment, health insurance card holders shall be entitled to the health insurance fund’s coverage for medical services in the list of health insurance-covered medical services with respective coverage rates;
b) The healthcare establishment shall be responsible for satisfying personnel and professional requirements, publicly disclosing costs that are paid at the patient's expense and are not in the list of health insurance-covered medical costs with respective coverage rates, and informing the patient of this in advance; sending a written notification to the social insurance agency so that they supplement the health insurance-covered medical service contract with terms and conditions of provision of medical services on weekly rest days and holidays as a basis for later payments before the official provision of such medical services.
As regulations above, health insurance card holders shall be entitled to the health insurance fund’s coverage for medical services in the list of health insurance-covered medical services with respective coverage rates.
If a person goes to a hospital different from the registered hospital in Vietnam, what percentage of health insurance will he/she be entitled to? - image from internet
What is the current rate of health insurance coverage for medical examinations and treatment in Vietnam?
Pursuant to Article 14 of the Decree 146/2018/ND-CP (amended by Clause 1 Article 183 of the Decree 131/2021/ND-CP), when receiving medical examination and treatment services in accordance with Article 26, 27 and 28 in the Law on Health Insurance in 2008; clause 4 and 5 of Article 22 in the Law on Health Insurance in 2008, health insurance policyholders shall be entitled to the health insurance fund’s coverage of permissible medical costs at the following rates:
(1) 100% of medical costs paid by the policyholders prescribed in clause 3, 4, 8, 9, 11 and 17 of Article 3 of the Decree 146/2018/ND-CP;
(2) 100% of the medical costs are covered, and there are no limits on the reimbursement rates for medications, chemicals, medical supplies, and technical services as regulated by the Minister of Health for the following individuals:
- Revolutionaries before January 1, 1945;
- Revolutionaries from January 1, 1945, to August Revolution in 1945;
- Vietnamese heroic mothers;
- War invalids, including Type B war invalids recognized before December 31, 1993, and those who have a disability rate of 81% or higher;
- Disabled soldiers with a disability rate of 81% or higher;
- Resistance fighters exposed to chemical toxins with a disability rate of 81% or higher;
- War invalids, including Type B war invalids recognized before December 31, 1993, and war invalids receiving policies similar to war invalids when treating wounds or recurrent illnesses;
- Children under 6 years old.
(3) 100% of healthcare service costs at the commune level;
(4) 100% of medical service costs if the cost of each medical examination or treatment accounts for less than 15% of the base pay rate;
(5) 100% of medical costs if a patient participates in the health insurance for a consecutive period of at least 5 years and has made the co-payment of medical costs in a year which is greater than total base pay amount received during 6 months, except self-referrals to inappropriate-level healthcare establishments;
(6) 95% of medical costs paid by the policyholders prescribed as follows:
- Persons eligible to be entitled to retirement pensions and incapacity benefits
- Relatives of persons rendering meritorious revolutionary services, except those defined in clause 11, Article 3 of the Decree 146/2018/ND-CP
- Members of near-poor family households defined according to the near-poor criteria under regulations of the Government and the Prime Minister.
- Members of multidimensional-poverty family households falling into the cases specified in point a, clause 9, Article 3 hereof.
(7) 80% of medical costs paid by others;
With respect to patients who are diagnosed, given therapeutic indications and referred to commune-level healthcare establishments for their management, monitoring and dispensing of medicines by higher-level healthcare establishments under regulations of the Minister of Health, their medical costs shall be paid by the health insurance fund within their scope of insurance benefit entitlement and contribution rates as prescribed in items (1),(2), (5), (6) and (7).
If a person goes to a hospital different from the registered hospital in Vietnam, what percentage of health insurance will he/she be entitled to?
Pursuant to Clause 3 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 levels of health insurance benefits by the health insurance fund:
Levels of health insurance benefits
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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.
As regulations above, if a person goes to a hospital different from the registered hospital in Vietnam, he/she will be entitled to health insurance according to following rates:
- 40% of the inpatient treatment expenditures at the central hospitals.
- 60% of the inpatient treatment expenditures at the provincial hospitals
- 70% of the medical examination and treatment expenditures at the district hospitals
Note: The above-mentioned coverage does not apply to ethnic minorities and individuals from poor households participating in health insurance and living in economically and socially difficult areas or areas with particularly difficult economic and social conditions.
For health insurance participants residing in island communes and island districts, if they go to a hospital different from the registered hospital in Vietnam, the health insurance fund will cover the costs of medical examinations and treatment at district-level hospitals and inpatient treatment at provincial, central-level hospitals, with applicable reimbursement rates.
Best regards!
