What cases will participants in Health Insurance be entitled to 100% coverage? This is a question that Thu Ky Luat has recently received quite frequently from our Customers and Members. The editorial team at Thu Ky Luat will address this issue in the article below.
Article table of contents
Which cases are eligible for 100% Health Insurance Coverage? (Illustrative Photo)
According to the provisions in Decree 146/2018/ND-CP, participants of health insurance (HI) when going for medical check-ups and treatment as stipulated in Articles 26, 27, 28 and Clauses 4 and 5, Article 22 of the Amended Health Insurance Law 2014 will be covered 100% by the HI fund in the following cases:
- Subjects specified in Clauses 3, 4, 8, 9, 11, and 17, Article 3 of Decree 146/2018/ND-CP;
- 100% medical expenses without applying the payment limit ratios for drugs, chemicals, medical supplies, and technical services as regulated by the Minister of Health for:
- Revolutionaries before January 01, 1945;- Revolutionaries from January 01, 1945, to the August 1945 uprising;- Vietnamese Heroic Mothers;- War invalids, policy beneficiaries like war invalids, type B war invalids, and persons with work capacity impairment of 81% or more;- War invalids, policy beneficiaries like war invalids, type B war invalids, and sick soldiers when treated for recurring injuries or illnesses;- Resistance activists contaminated with toxic chemicals with labor capacity impairment of 81% or more;- Children under 6 years old.
- Medical check-ups and treatment at the commune level;
- For cases where the cost of one-time medical check-up or treatment is less than 15% of the statutory pay rate;
- When the patient has participated in health insurance for 5 consecutive years or more and the co-payment costs exceed 6 months' statutory pay rate in a year, except for cases of self-referred medical check-ups or treatment not following the approved route.
Thus, in the above-mentioned cases, HI participants are entitled to 100% medical expenses coverage. For other cases, participants will still be entitled to coverage but at a lower rate, with different levels of support depending on the specific situation. HI participants should take note when seeking medical check-ups and treatment to maximize the support for medical expenses.
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