If I go to the hospital different from the registered hospital on my health insurance card, will the insurance cover expenditures in Vietnam?

If I go to the hospital different from the registered hospital on my health insurance card, will the insurance cover expenditures in Vietnam?

The hospital listed on my mother's health insurance card is Phu Nhuan district hospital. However, yesterday my mother had a stomachache so I took her to the emergency room at Binh Dan Hospital. So, can you advise me if I go for medical examination or treatment other than the hospital listed on my health insurance card, will the insurance cover the costs? Sincerely thank!

Answer: According to the provisions of Article 22 of the 2008 Health Insurance Law, amended and supplemented by Clause 15, Article 1 of the 2014 Revised Health Insurance Law, benefit levels of health insurance is 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.

==> Thus, it is not necessary to have medical examination and treatment at the hospital listed on the health insurance card to be covered by insurance. Visiting a hospital different from the registered hospital on your health insurance card is still covered by insurance but at a lower rate.

According to the provisions of Clause 3, Article 14 of Decree 146/2018/ND-CP:

 In case where a health insurance card holder visits an inappropriate-level healthcare establishment at his/her discretion, and then is referred to another healthcare establishment by the receiving healthcare establishment, he/she shall be paid the health insurance fund’s coverage at the coverage rate specified in clause 3 of Article 22 in the Law on Health Insurance, except the following cases: he/she is given emergency treatment services; he/she is given inpatient treatment services while being diagnosed with any other disease of which treatment is out of professional capabilities of the referring healthcare establishment; his/her pathological conditions have changed to the extent that they are out of competencies of the referring healthcare establishment.

==> The initial place of registration for medical treatment on your mother's health insurance card is Phu Nhuan district hospital. Your mother has a stomach ache, so you take her to the emergency room at Binh Dan hospital. In this case, it is not considered outside medical examination and treatment because it is an emergency. Therefore, health insurance will still pay 80% of your mother's medical examination and treatment costs at Binh Dan hospital in Vietnam.

According to the provisions of Article 15 of Decree 146/2018/ND-CP, you must present your mother's health insurance card before leaving the hospital to carry out procedures to enjoy health insurance benefits.

We hope that our advice will help answer your questions.

If I participate in household health insurance when I give birth, will I be covered by insurance in Vietnam?

I'm a housewife, I don't work at a company, so I participate in family health insurance. I have participated in household health insurance for 3 years. In 2 months I will give birth. I've always wondered if a household health insurance card covers the cost of giving birth or does it only pay for medical examinations? Therefore, please help me answer the above problem as soon as possible. By the time I gave birth, my health insurance card was still valid for a very long time.

Answer: According to the provisions of Point a, Clause 1, Article 21 of the Health Insurance Law 2008, costs of medical examination and treatment, function rehabilitation, regular pregnancy check-ups and birth giving;

Health insurance benefits when giving birth are specified in Article 22 of the 2008 Health Insurance Law, amended and supplemented by Clause 15, Article 1 of the 2014 Revised Health Insurance Law as follows:

- 80% of the cost for giving birth within the district or outside the district hospital

- 48% of costs for births at a provincial hospital

- 32% of costs for births at a central hospital

==> If you participate in health insurance as a household, when you give birth, your health insurance will still cover the costs. Depending on whether you give birth on the right or different from the registered hospital, the level of health insurance benefits will be different. Therefore, you can rest assured that health insurance will cover part of the costs when giving birth.

We hope that our advice will help answer your questions.

Is short-sightedness surgery covered by health insurance in Vietnam?

I have full health insurance. My eyes are currently 5 degrees nearsighted, so I want to have eye surgery to facilitate my work. Can I ask if my nearsighted eye surgery is covered by health insurance?

Answer: According to the provisions of Article 23 of the 2008 Health Insurance Law, amended and supplemented by Clause 15, Article 1 of the 2014 Revised Health Insurance Law, the cases not covered by 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.

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.

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

13. Medical assessment, forensic examination, forensic mental examination.

14. Participation in clinical trials or scientific research.

==>Thus, if you have eye surgery, you will not be entitled to health insurance according to the regulations cited above in Vietnam.

Best regards!